Medical Billers and Coders

Understanding External Payer Audits An external payer audit is an examination of a healthcare practice’s finances or processes conducted at the will of payers. These payers are either the government or a commercial insurance company looking to ensure correct payments were provided to the practices for past cases. Government audits can be broken down even further into Medicare, Recovery Audits, and Medicaid audits. Whenever the payer has concerns about medical coding and medical billing, they may initiate an external audit process. In this blog, we discussed basic guidelines to avoid external payer audits. Reasons for Initiating Payer Audits There are a number of reasons why any payer might initiate an external audit, the most common reason is a medical necessity. The providers may feel that his or her treatment recommendations are medically necessary. But if they are not documented properly, it’s an issue. The provider may explain all the reasons why the treatment was medically ne...

  Outsourcing your revenue cycle operations to a medical billing company is the right move toward securing the financial stability of your practice. However, choosing any medical billing company could cause more headaches than benefits.  Medical Billers and Coders  is a leading medical billing company providing complete medical billing and coding services. While interacting with our potential clients, we found difficulties that are faced by healthcare practices while choosing the desired medical billing company. Evaluate Your Practice’s Pain Points As you are seeking external help in  Medical Billing and Coding  for your practice, there are some pain points that are badly affecting your  practice’s revenue . List down all those pain points and try to evaluate if that medical billing company can provide solutions to those pain points. Major pain points for any healthcare practice include hiring and retaining skilled (and experienced) staff, training cost...

  Podiatry is specific to the procedures for toe, ankle, or foot treatments, so  medical billing and coding  is a specialized process with detailed and specific codes. It also carries very precise guidelines and policies for the procedure to be billed. Your Podiatry practice cannot ignore the rapid changes and updates in the codes or will suffer from incomplete claims, decreased revenues, and possible audits. It requires the transition to ICD-10 coding as well as the varied codes for a wide range of medical and surgical procedures. A compliant billing and coding Podiatry Practice must keep in mind – Compliant Billing and Coding for your Podiatry Practice Relevant CPT codes –  Current Procedural Technology (CPT) ensures that your practice is following the latest and most up-to-date coding for your patients. The codes and policies of CPT facilitate accurate coding of claims for the services provided and regular revenue generation. Payer Specific Coding –  ...

  Care delivered by Ambulatory Surgical Centers (ASC) is more cost-effective compared to Hospital Outpatient Departments (HOPD) as it saves $2.6 billion a year for Medicare. However, the reimbursement rates for ASCs have been shrinking over the last decade, posing survival challenges for providers. On average, they are reimbursed 58% less compared to a hospital for a similar procedure. It has become important for the ASCs to identify and measure their revenue cycle key performance indicators ( KPI ) for ensuring financial success considering the shrinking reimbursement rate. According to industry experts, it is necessary to make sure that ASCs thrive financially because they play an essential role in providing high-quality, affordable care to patients. Have you Measured the KPIs yet? Is your revenue cycle being managed efficiently? Have you identified the KPIs of your revenue cycle such as net collection ratio and the AR aged above 90 days? If the answer is no, you need to sta...

  As a practice owner, you might have a team of professional physicians who possess the right qualification and licenses but without properly credentialed providers you invite the risk of losing payments. To enhance the performance of your practice you must complete the entire credentialing process including collecting provider documentation & validation; identifying top payers; applying for top payers; follow-up on the application; obtaining enrollment, and periodic updates of payer documents for credentialing. If you lack the know-how to navigate the  physician credentialing process , you need to outsource provider credentialing and enrollment services to professionals like us. Our Provider Credentialing Services  Our credentialing experts deeply understand payer enrollment guidelines and credentialing policies. Based on your geographical area of practice and patient mix, we identify top payers who need to get credentialed. Whether you own a group practice or ar...

  Healthcare reforms and services are driving the change in the way the medical industry, including hospitals, healthcare centers, ambulatory surgical centers, and medical coding and billing services   work. As medicinal reforms cause variance in repayment rates, doctors and physicians more or less are shifting towards in-house hospital jobs to provide quality, financially affordable care, which most of the ASCs do offer but with some hindrances. In this blog, Here our medical billing and coding experts shared 4 outpatient surgery center coding and billing tips. Here are 4 Outpatient Surgery Center Coding and Billing Tips. 1. Conduct Sporadic Coding Reviews. It is critical to direct and conduct periodic coding reviews by an outside coding organization, whether your center outsources its coding benefits or utilizes an ensured coder. That way you can wipe out the conflicting situation a customary coding institute might have in discovering coding mistakes in the belief of in...

  Same-day surgery now constitutes more than half the surgeries performed across America. Any surgical methodology performed without a healthcare office inpatient affirmation and an overnight stay is considered an outpatient surgery framework, whether they happen in a specialist facility, a physician’s clinic, or an outpatient surgery center. There are various obstinacies behind this development in the surgical zone. Outpatient surgeries are less immoderate than those performed on an inpatient premise and innovative advances have made outpatient surgeries more secure. Outpatient procedures, once compelled to astoundingly minor surgeries, for instance, cataract removals, now consolidate methodology as varied as facelifts, tonsillectomies, colonoscopies also pacemaker inserts. Alongside this  Ambulatory Surgical center billing and coding  maintenance has enhanced the utilization of ASCs, more than conventional social healthcare establishments. Here are the top 3 Ambulator...

  It is difficult to sustain a constantly altering healthcare industry and avoid losses. With the ever-changing healthcare industry and a rapidly growing relationship between physicians and pharmacists that is creating an influx of patients for both professionals, pharmacists are becoming busier by the day; as more and more patients are taking help from pharmacists in not only asking prescription-related queries but also inquiring and interacting with them on diet/lifestyle changes. Hence, pharmacists today need to focus on the foremost and toughest things which are accounting and bookkeeping. Here are some tips that can ensure success in pharmacy billing: 1. NCPDP sign up:  Pharmacists must sign up with the database service of the National Council for Prescription Drug Programs (NCPDP) which permits a pharmacy to bill. A six-digit number is provided to all pharmacies, known as the BIN, which is used for identification. 2. Insurance billing:  Pharmacists must keep a ...

  Ambulatory Surgical Centers (ASCs) cater to patients who need medically essential surgeries but do not require an overnight stay at a hospital. The following are certain frequently asked ASC Billing Questions arena: 7 Frequently Asked ASC Billing Questions 1. Which is the top information systems management for ASCs? A couple of models used for ASCs are Electronic billing and a strong reporting package, the ASP model for supporting business competence, data analysis using Excel, immediate insurance verification, scanning of reports into patients’ charts, software compatibility, facility billing, and the ASP model for business competency. Types of A/R reports that ASC software programs can generate are insurance provider, financial class, date, patient, and procedure. 2. What is the standard for A/R days outstanding? A/R is the money owed by a patient to ASC for services provided (short-term asset). Due to a difference in the case of each patient along with different insuran...