Medical Billers and Coders

  The changing political trends have affected the way physicians are implementing changes in their functioning at work, be it at clinics or hospitals. Keeping up with the times is the need of the hour and hence never knowing which way the winds will blow, physicians should initiate certain goals that can help them ride the rough weather when it comes and sail through the smooth times. Here we shared information on Top Goals for Physicians to Implement In Their Facility So What Goals Can Physicians Implement? Based on a recent online research Toluna’s healthcare panel of 500 physicians revealed that nearly 9 in 10 respondents ranked “achieving work-life balance” as their most or second most-important resolution for 2017. This was followed by 69 percent who ranked “staying up-to-date with technology,” and 58 percent ranked “taking advantage of more leadership and training opportunities”. The latter two goals can help achieve the former and topmost goal of achieving a work-life b...

  Let’s always keep in mind that patients come with some problems that they hope will be solved quickly and without any hassles. So, how does one keep the patients happy? While keeping a smiling face makes good sense, giving the patients a great experience is an art in itself. Here are a few valuable tips that can help you do just that.  Outsourcing your medical billing can seem scary. The more empowered you are, the easier will be to make the right decision for your practice´s medical billing needs. In our webinar  “Five reasons to outsource your medical billing” , Health Prime´s Strategic Account Manager, Caroline Balestra, reviewed the main reasons to outsource your billing and some benefits for your medical practice. 5 Things About Better Medical Billing and Happier Patients Give them the right to have a better choice Being transparent is probably the first step in giving healthcare to patients in distress. Allowing them to make the right choice, or rather giving...

  Importance of A/R Follow-up Medical billing is a complicated process that requires special skills in medical billing, coding, denial, and AR management from experienced and well-trained staff. The financial health and success of any medical practice are dependent on maintaining positive cash flow. In order to provide patient care and cover expenses, it’s important that payments are not delayed, lost, or denied. With the understanding of billing guidelines and a highly trained staff in place, you’ll start to reap the benefits of high first-pass acceptance rates and shorter billing cycles. But even when everything goes right, some claims will still be rejected or denied. The accounts receivable (A/R) follow-up team in a healthcare organization is responsible for looking after such denied claims and reopening them to receive rightful reimbursement from the insurance carriers. Even though these claims could be held up by simple mistakes, you will be surprised to know that over hal...

  For you to improve the accounts receivable  (AR)  of your practice there are many different factors that come into consideration. Your quality of patient care is one such important factor that will contribute to attracting more patients. To improve the patient care for your practice things need to be systemized; we have to sync the work of an admin along with other patient-care factors. Healthcare providers lose millions of dollars each year due to inefficiencies in their accounts receivable (AR). Learn how to improve your AR days here. One of the easiest ways to achieve the complex goal setting of practice is to have a defined target and nothing can be better than an Account Receivable (AR) of a practice. A physician might say that yes I am seeing many patients but still my AR is low; one thing we ignore is the need for constant cash flow and collecting timely AR. Physicians often come out on a short end especially when they are dealing with bigger insurance compan...

You were putting up your own medical practice! This means you have probably done your research on the pros and cons, and are aware of the benefits and risks factors. The crucial question now is how to deal with the one and only daunting task –  Medical Billing . To be able to maintain that balancing act of funding your practice and continuing to provide quality patient care, an effective practice management cycle is essential. For a successful  Revenue Cycle  Optimization, given that each component is interdependent right from eligibility checking, charge coding, and claims reimbursement, to accounts receivable and denial management, the state-of-the-art approach is required. Here are 5 essential billing tips that can help you get started to avoid the pitfalls in your new venture: Basic Billing Tips for New Medical Practice Start-ups 1. Be informed:  Your clinical and administrative staff should be trained to collect all insurance details from the patient before the ...

  Provider-Based Physician Services Providers may retain physicians on a full-time or part-time basis in, for example, the fields of pathology, psychiatry, anesthesiology, and radiology, and in many instances (especially in teaching hospitals) in other fields of medical specialization as well. Any one of these physicians may be engaged in a variety of activities including teaching, research, administration, supervision of professional or technical personnel, service on hospital committees, and other hospital-wide activities, as well as direct medical services to individual patients. The provider’s arrangement may be with a single physician or a group of physicians who assume joint responsibility for discharging agreed-upon duties. Provider-based physicians may include those on a salary, or a percentage arrangement, lessors of departments, etc. (whether or not they bill patients directly). The services to the patient are known as the professional component. The services to the pr...

  Increasing Claim Denials Recently Kaiser Family Foundation published an analysis of claim denials for various marketplace payers for the year 2020. Under the Affordable Care Act, marketplace payers need to report claims denial data and this analysis used the same data to understand claim denial status. The analysis found that, overall, nearly one out of every five claims submitted for in-network services in 2020 was denied by marketplace payers. However, depending on the payer, average claim denial rates ranged from just 1 percent to 80 percent. Claim denial rates also varied significantly by location, the average claim denial rates were highest in states such as Indiana (29 percent) and Mississippi (29 percent), while rates were just 6 percent in South Dakota and 7 percent in Oregon. This analysis just confirmed ever-increasing claim denials for healthcare providers. Claim Denial Reason Payers denied claims for multiple reasons, among denials for in-network services, about ...

  Understanding False Claims Act As a healthcare practice, you can typically submit claims to Medicare or Medicaid. Your claims are bills for goods you provide and services you conduct for patients. These federal health insurance programs cover the costs associated with your services. The False Claim Act is a federal law that makes it a crime for any person or organization to knowingly make a false record or file a false claim regarding any federal health care program, which includes any plan or program that provides health benefits, whether directly, through insurance or otherwise, which is funded directly, in whole or in part, by the United States Government or any state healthcare system. In other words, healthcare practices must not bill the government for things they did not do. Examples of false claims include billing for services not provided, billing for the same service more than once, or making false statements to obtain payment for services. Penalties under the False ...

  Revised Role of Prior Authorization So far insurance carriers have been using prior authorization as a tool to control spending and promote cost-effective care. But in changing billing scenarios role of prior authorizations has changed drastically. There is little information about how often prior authorization is used and for what treatments, how often authorization is denied, or how reviews affect patient care and costs. As per the 2021 American Medical Association survey, almost 88 percent of providers characterized administrative burdens from this process as high or extremely high. Doctors also indicated that prior authorization often delays the care patients receive and results in negative clinical outcomes.  Another independent 2019 study concluded that research to date has not provided enough evidence to make any conclusions about the health impacts nor the net economic impact of prior authorization generally. This blog will explore the Revised Billing Updates for ...

As a healthcare provider, during your residency, you probably are not focused on who pays for your patients’ care. Once you start practicing, it is important to understand who the payers are. The U.S. healthcare system relies heavily on third-party payers, and, therefore, your patients often are not the ones who pay most of their medical bills. Third-party payers include commercial insurers and the Federal and State governments. When the Federal Government covers items or services rendered to Medicare and Medicaid beneficiaries, the Federal fraud and abuse laws apply. Many States also have adopted similar laws that apply to your provision of care under State-financed programs and to private-pay patients. Consequently, you should recognize that the issues discussed here may apply to your care of all insured patients. The topics discussed in this article will help you in avoiding fraudulent billing as you have just started your new medical practice.  Accurate Coding and Billing G...

Receiving accurate insurance reimbursement for delivered services is always been a challenge for healthcare providers. Practice owners spend most of their time and energy on doing administrative tasks of medical billing to receive sufficient insurance reimbursements to cover overhead expenses and provide quality care. But often they make this task even harder by doing sloppy coding and billing which leads to delayed or incorrect reimbursements from insurance carriers. Providers can follow some practice management guidelines to improve coding and billing accuracy. It will help reduce denials and rejections, ultimately helping to enhance practice collections. These guidelines will help receive timely and accurate reimbursements and avoid the chances of external payer coding or billing audits.  Practice Management Guidelines to Improve Practice Collections Front Office Issues Leading to Claim Denials  Most practices only focus on submitting claims quickly but no one pays att...