Medical Billers and Coders

  Financial stability and profitability are becoming a rising concern for all medical practitioners with the ongoing changes that the healthcare industry is experiencing. Increased patient walk-ins, reduced Medicare reimbursements, declining collections and coding complexities are making bottom lines diminish for many medical practices. In such a bleak industry atmosphere, internists are facing the toughest of all times due to the diverse services offered by them. Internal medicine practitioners offer the first and foremost diagnosis for most medical conditions and in addition to providing basic treatments, they refer the majority of their patients to specialists for further medical care. This increases the dependence of an internist on other practitioners and thereby complicates the billing procedures tremendously. However, efficient billing and coding practices can not only improve profitability but also enhance patient care provided by internal medicine practices. To ascertain pr

  Podiatric medicine, as we all know, is one of the most sought branches of medical science dedicated to the diagnosis, prevention, and treatment of various foot disorders resulting from diseases or injuries. A Podiatric physician is to the foot what an ophthalmologist is to the eye and a dentist to the mouth -a specialist who has undergone lengthy, thorough study to become qualified to treat a specific part of the body. A Doctor of Podiatric Medicine makes independent decisions and performs all necessary diagnostic tests. Also, administer medications, performs surgery, and prescribes therapy regimens. Podiatric physicians educated in state-of-the-art techniques involving surgery, orthopedics, dermatology, physical medicine, and rehabilitation hence; require constant up-gradation to be the best in their field. As A Practicing Podiatric Physician…. Due to the sudden increase in the quality and quantity of Podiatric medicine-related research in the past decade, the physicians prac

  Family practices across the US have been facing difficulties in revenue collection due to challenges related to medical billing and coding. Modifier omission, untimely claim submission, underscoring and inaccurate documentation may seem like minor errors; but they eventually have a major impact on the revenue cycle of practices. Our  Family Practice billing  has enhanced cash flow, reimbursements, and insurance eligibility verification  services . Demographics & Charge Entry  Services . Family practice physicians shouldn’t ignore the importance of expertise and experience in  handling billing and coding tasks ; especially as they lose 10-20% of their revenue every year; due to coding errors. Considering the rates at which family physicians are being paid by Medicare, approximately $8,396 a year will be lost if coders underscore just one level for 4 visits a day. Medicare payment cuts have tightened the financial condition for family physicians and with the payment rates expect

  Ambulatory Surgical Centers or ASCs as it is commonly called were first established in Phoenix, Arizona in 1970 by two physicians who wanted to provide comfortable care to the people in their community so that they could avoid more impersonal venues like hospitals. Slowly over the years with Medicare approving payments to ASCs they have gained prominence and in some cases are scoring over the normal hospitals for certain procedures. The fact that ASCs provide a high-quality yet cost-effective alternative to the inpatient care provided at hospitals has seen a surge in outpatient centers. Hospitals grappling with scheduling delays, slow operating room turnover, and budget cuts which have impacted the purchase of new medical equipment, coupled with other operational issues that have prompted patients to visit ASCs to receive care. Industry Snippet The revenue of the ASC is slated at $28 billion with an expected growth rate of over 5 percent between the years 2010– 015. ASCs are sai

  The state of California is facing an increased shortage of primary care physicians especially – with a rise in the number of the elderly population in the State leading to an increase in health coverage under Federal Health care reforms. Additionally, 30% of primary care physicians in the state are nearing retirement being above 60 or older- the highest percentage in any state. However, compared to the shortage, the State has not significantly increased the number of primary care physicians trained. HHS’s Council on Graduate Medical Education recommends 60 to 80 primary care physicians per 100,000 people to adequately serve a population. Statistics show in fast-growing regions of California such as the Inland Empire there are only 40, whereas in low-income rural communities where care for 25% of patients is paid by Med-Cal, there are only 45 primary care physicians. Even though medical school applications have been high in California, with a high proportion of U.S. medical school

  Did you know that since October 2013 physicians need to conduct a face-to-face interview with the proposed beneficiaries before ordering durable medical equipment? This is one of the rules specified by Medicare, which further clarifies the need to document the data in the patient’s records. A copy of this medical record needs to be sent to the supplier of the ordered DME. Documentation-  During such a face-to-face meeting there needs to be enough documentation in the relevant parts of the patient’s medical records justifying the beneficiary’s eligibility for the particular piece of durable medical equipment ordered on behalf of the patient. The physician also needs to be familiar with the Medicare policy requirements for the same. The particular policy clearly explains the specific conditions that qualify a patient for that particular DME. The relevant documentation of the medical record needs to be furnished with the suppliers of the DME   who will need it before they can submit

  CY 2023 Medicare Physician Fee Schedule Proposed Rule On 7th July 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. This calendar year (CY) 2023 PFS proposed a rule that made lots of provisions including expanding Medicare telehealth use even after the end of a public health emergency (PHE). Expanding Medicare Telehealth Use after PHE For the calendar year 2023, CMS is proposing a number of policies related to Medicare telehealth services including making several services that are temporarily available as telehealth services for the PHE available through CY 2023 on a Category III basis, which will allow more time for collection of data that could support their eventual inclusion as permanent additions to the Medicare telehealth services list. C

  Billing Part B Outpatient Therapy Services Outpatient rehabilitation therapy includes Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP) services. Medicare covers outpatient PT, OT, and SLP services when: A physician or Non-Physician Practitioner (NPP) certifies the “treatment plan,” called the Plan of Care (POC), ensuring: A patient needs therapy services  POC is:  Established by a physician, NPP, our qualified therapist provides services  Reviewed periodically by a physician or NPP  A patient gets services under physician care  POC certifying the provider’s name and NPI is on the claim  Providers meet medical necessity, documentation, and coding requirements where,  CERT: Comprehensive Error Rate Testing A physician is a Doctor of Medicine, osteopathy, podiatric medicine, and optometry (only for low vision rehabilitation).  NPP includes a Physician Assistant (PA), Clinical Nurse Specialist (CNS), or Nurse Practitioner (NP). 

  Determining Medicare Drug Coverage While  billing for Skilled Nursing Facilities (SNF)  or for  hospital billing , billers always make the mistake of considering the wrong Medicare drug coverage. For example, Medicare Part A and Part B generally do not cover outpatient prescription drugs, most of which are covered under Part D. In this article, we shared an excerpt from a CMS document, which will act as a basic tool to assist you in understanding Medicare drug coverage determinations under Part A, Part B and Part D of Medicare, and to clarify coverage for specific Part D products/drugs/categories.  We also shared billing scenarios, which will help you to determine which part of Medicare covers a drug in a particular situation, assuming all other requirements are met, e.g., a drug must still be medically necessary to be covered. This information is applicable to people in the Original Medicare Plan. People who have a Medicare Advantage HMO or PPO Plan with prescription drug covera

  Improper Payment Reasons Durable Medical Equipment (DME) suppliers of surgical dressings and physicians submit claims for surgical dressings and CMS covers it under the surgical dressings benefit i.e., SSA Section 1861[s][5]. CMS recently published Medicare Fee-for-Service (FFS) improper Medicare payments rate for surgical dressings for the 2020 reporting period. For this reporting period, the improper payment rate for surgical dressings was 67.3 percent, with a projected improper payment amount of over $194.9 million. For the 2020 reporting period, insufficient documentation accounted for 82.4 percent of improper Medicare payments for surgical dressings. Additional types of errors for surgical dressings in the 2020 reporting period were no documentation (1.9 percent), medical necessity (1.7 percent), incorrect coding (1.9 percent), and other (12.2 percent).  Avoiding Improper Medicare Payments All claims billed to Medicare require a written order or prescription from the treati

  Revenue Cycle Management duties for Pharmacy Hospital Management and Pharmacy billing may altogether be of different proportions as far as work undertakings are concerned, but the evolving healthcare scenario has pushed for stringent medical billing and coding practices. If your pharmacy is still undermined and not knowledgeable about the latest best practices, managing the Revenue Cycle Management for the pharmacy can become an uphill task. Revenue Cycle Management solutions from established and certified medical billers and coders reflect many years of experience in helping clients cut expenses and increase productivity. Whether you require a hearty revenue management solution for your venture or an adaptable billing framework to help you deal with your practice, outsourced billing, and  coding  agency definitely has an offering to bolster your necessities. Healthcare drug specialists have enough on their plates with clinical issues. However, with changing business requirement

  As a neurologist, you understand the importance of accurate and timely medical billing for your practice. However, managing complex billing and coding procedures can be time-consuming and often lead to errors that can have a significant impact on your revenue. This is where outsourcing your neurology medical billing can help streamline your billing process, reduce errors, and improve your bottom line. Neurology Medical Billing: Understanding the Challenges Image Source Neurology medical billing is a highly specialized area of medical billing that requires expertise in the unique coding and billing requirements specific to neurology. This includes the correct coding of procedures, treatments, and tests, as well as understanding the complexities of insurance policies and regulations. Any mistakes made in coding or billing can result in denied claims, delayed reimbursements, and lost revenue. Moreover,  neurology medical billing and coding  are not only complex but also require co

  Ever since their inception, Ambulatory surgery centers (ASCs), have been providing improved quality and customer service to the healthcare industry.  ASCs offer patients the opportunity to have selected surgical and procedural services performed outside the hospital setting.  ASC Centers  perform more than 7 million procedures for Medicare beneficiaries needing same-day surgical, diagnostic, and preventive procedures. Multisite practices operate nearly 26 percent of ASCs and the remaining 74 percent are stated to be independently owned. Because ASCs perform specific services and do so more efficiently, Medicare reimburses ASCs as a percentage of the amount paid to HOPDs, and pays ASC centers 53 percent of HOPD rates. A review of commercial medical claims data found that U.S. healthcare costs are reduced by more than $38 billion per year due to the availability of ASCs as an alternative, high-quality setting for outpatient procedures. The Basic Requirements Healthcare facilities

  The acute shortage of general surgeons is evident in the Occupational Outlook Handbook of the Bureau of Labor Statistics which states that only 5% of physicians were general surgeons in the year 2007, and the situation has not improved since. In fact, the shortage of general surgeons is getting worse and is projected to worsen in the future. The role of a general surgeon cannot be underestimated in a country where the population is increasing and millions more are receiving health insurance due to the reforms. The population of the country is estimated to grow by more than 30 million by the year 2020 and the country’s baby boomer population and the population of old people would be very high. This would certainly put humungous pressure on general surgeons and have manifold consequences for general surgeons as well as for the health industry. A hospital revenue bond is a type of municipal bond that finances the construction of new facilities or upgrades for existing hospitals. The

  The CPT 2015 will have approximately 550 new, revised, or deleted codes. It will also include revised guidelines and terminologies. These changes will affect family medicine physicians, cardiologists, radiologists, and internal medicine practitioners too. Similar to other medical specialties, family medicine will have to gear up for dozens of new and revised vaccine codes in 2015. It will include additions of 90630 and 90654 codes for flu immunizations. Our  Family Practice billing  services team can provide you with high-quality and error-free patient demographic and Family Practice charge entry services. The 2015 coding changes will alter the way family medicine practices report vaccinations, chronic care management services, and arthrocentesis (joint aspiration). Some descriptor changes to old codes will also affect this medical specialty. Coding Changes for Family Practice Medicine Practitioners Family medicine providers need to take CPT coding changes into serious considera

  Durable medical equipment billing is the process by which insurance companies are charged for the services provided to their clients. And to achieve complete reimbursement dollars billing codes that represent different aspects of the DME process are implemented. In this blog, here our experts shared information on specialization Considerations for DME Suppliers in Medical Billing. The characters the biller enters relate to different aspects of a diagnosis or procedure and allow the information to be uploaded for billing without having to manually define either diagnosis or procedure. This allows the process to be implemented faster without having to describe everything in detail. When we talk about specialization consideration in DME suppliers’ one specialty that often crosses the supplier’s path is Orthopedics. Orthopedic facilities often provide patients with supplies, such as casts and canes, which are integral to patients’ treatment plans. What DME supplies can be used for O

  Physicians consider it unprofessional when their patients do not show up at the appointed time. No-shows tell upon the revenue, wasting not just the physician’s time but also that of the supporting staff. In order to overcome this issue physicians adopt methods like overbooking patient appointments, treating alternative patients, contacting the patient who did not show up, etc. However, it is important to understand why some patients do not turn up so that revenue and time are not lost. Our  Family Practice billing  services team can provide you with high-quality and error-free patient demographic and Family Practice charge entry services. Why don’t patients show up in Family Practice? In order to fix no-shows, we need to first understand why some patients do not show up. There are several practices that are blissfully unaware of the no-show rate, nor do they spend some time analyzing patient visit statistics to arrive at a pattern. It would do well for practices to understand ho

  In  DME medical billing , your DME coders require correct HCPCS codes and correct modifiers for providing more details about the equipment. If your medical coders cannot use modifiers or not correctly use them, then the insurance company may deny the claims. Some common DME modifiers include RR- rental, UE- purchase of used equipment, and NU- purchase of new equipment. Know your DME HCPCS Codes When a laboratory demand, request for DME is being filled, medical coders will be needed for  ICD-10  codes for a patient’s diagnosis. To use an appropriate HCPCS code for the DME item, many  HCPCS  codes need a modifier. Modifiers are used to provide more details about the DME item. e.g. The modifier might indicate to HMSA that an item is new, rented on a capped basis, or rented. For capped rentals, modifiers differentiate which month’s rental is being billed. If your billers misuse these modifiers then the claim will be rejected. To speed up this process of your claims, show the first-m

  The crisis is indeed real. New York is facing a statewide shortage of primary care physicians, and it is nowhere near getting resolved as of now. The Healthcare Association of New York State reports that there are over a thousand unfilled physician positions across New York, of which nearly one-third of the shortage pertains to primary care. A doctor or other licensed medical professional who manages a person’s health care over time. Primary care providers diagnose and treat a wide range of common medical conditions. In 2013, a report published by Robert Graham Center estimated that the state of New York will fall short of at least an additional 1200+ physicians by 2030. According to the American Association of Medical Colleges ( AAMC ), there is a nationwide shortage of physicians, the number of which is estimated to rise up to 90,000 by the year 2020. Growing concerns over this issue have encouraged a team of industry experts at medicalbillersandcoders.com to sum up the fundame