Medical Billers and Coders

Changes in healthcare regulations can significantly impact medical billing procedures in the United States. These regulations can come from federal, state, or local government entities and may affect various aspects of healthcare delivery, insurance coverage, and reimbursement. Here are some ways in which changes in healthcare regulations can impact Medical Billing procedures: Coding and Documentation Requirements: New regulations may introduce changes in the coding and documentation requirements for medical procedures and services. This can impact the way healthcare providers document patient encounters and submit claims. Billing and Reimbursement Rates: Healthcare regulations often influence reimbursement rates for medical services. Changes in regulations can lead to adjustments in the amounts that healthcare providers are reimbursed for specific procedures or services. This, in turn, affects the amounts billed to patients or insurance companies. Compliance and Reporting Requirement

Let's be honest, medical bills can tangle anyone's brain, even those working inside hospitals and clinics! Folks like doctors' office assistants and hospital staff handle internal billing daily, but even they can stumble into common mistakes that leave patients grumpy and paperwork piled high. Let's shine a light on these hiccups and equip you with some simple tips to navigate the world of bills with ease, making everyone's day a little brighter! 1.        Blind Trust in Automation: Automating billing processes streamlines workflow, but relying solely on technology can be a trap. Errors can slip through the cracks, leading to inaccurate bills and unhappy patients. 2.        Misunderstanding Insurance Lingo: Medical jargon and insurance codes can feel like a foreign language. In-house staff who aren't familiar with the nuances can interpret coverage incorrectly, leading to mismatched bills and frustrated patients. 3.        Lack of Communication: Op

  EDI in medical billing helps doctor’s offices, hospitals, labs, pharmacies, and other healthcare facilities to communicate with each other. In today’s world of electronic claim submission, electronic data interchange (EDI) has become an essential component of medical billing processes. EDI enables healthcare providers and insurance companies to exchange crucial billing information efficiently and securely. This article will explore the details of EDI in medical billing, exploring its significance, working mechanism, and benefits in medical billing. What Does EDI Stand for in Medical Billing? EDI stands for electronic data interchange. In the context of medical billing, EDI refers to the electronic exchange of standardized healthcare transactions between healthcare providers and insurance companies. It involves the transmission of data in a structured format, allowing for seamless communication and streamlining of billing processes. Electronic Billing and EDI Transactions Electr

  Vagus Nerve Stimulation (VNS) is a pulse generator, similar to a pacemaker, that is surgically implanted under the skin of the left chest and an electrical lead (wire) is connected from the generator to the left vagus nerve. Electrical signals are sent from the battery-powered generator to the vagus nerve via the lead. These signals are in turn sent to the brain. VNS provides indirect modulation of brain activity through the stimulation of the vagus nerve. The vagus nerve, the tenth cranial nerve, has parasympathetic outflow that regulates the autonomic (involuntary) functions of heart rate and gastric acid secretion and also includes the primary functions of sensation from the pharynx, muscles of the vocal cords, and swallowing. It is a nerve that carries both sensory and motor information to/from the brain.  Medicare coverage  for many tests, items, and services depends on where you live.  Nationally Covered Indications  VNS treatment is reasonable and necessary for patients wi

  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 balan

  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 them the righ

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 patient–physician e

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 Gover

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 attention to

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 costs, non-availability of a cert

  Billing Manager's performance  goals and objectives to elevate job satisfaction and productivity. Billing Manager SMART goals to achieve success! Conducting performance analysis has been an age-old practice by many businesses worldwide. However, we come across many such physicians, solo and group practices, who do not feel the need to have any assessment and review done for their  billing  or accounts manager’s job. This can give rise to many of the following problems that are experienced: A billing manager does not have his/her clear statement of criteria for performance. In such situations, the billing manager puts forth criteria that seem good enough for the entire billing team. The problem is, there may be some area that needs the physician’s attention, which is many a time neglected. This results in a lack of oversight regarding billing and collection activities- which is the main lifeline of the practice. Secondly, a physician does not have any clear idea of the manage

  Healthcare Revenue Cycle Management Healthcare Revenue Cycle Management professionals use information technology to keep track of claims through their entire lifecycle. This is necessary to ensure payments are collected and denied claims are addressed. However, some hospitals struggle to put information technology and billing infrastructure in place in a way that successfully manages claims as well as large outpatient networks. In today’s healthcare environment, effective health information technology is essential. Unfortunately, not all hospitals and clinics have the capital or infrastructure to invest in new technologies or even required technologies, such as  EHRs . If you have ever come across or worked in a healthcare organization, you must be aware of the importance of medical claims and how they can put financial constraints on your revenue cycle when rejected. The administrative work of a healthcare facility is different from other industries as clinical treatment is not a

Durable medical equipment billing is that the process by which insurance companies are charged for the services provided to their clients. And in order to achieve the complete reimbursement dollars billing codes that represent different aspects of the DME process are implemented. The characters, the biller enters relate to different aspects of a diagnosis or procedure and permit the information to be uploaded for billing without having to physically define either diagnosis or procedure. This allows the method to be implemented faster without having to explain everything intimately. When we mention specialization consideration in DME suppliers' one specialty that always crosses the supplier's way is Orthopedics. Orthopedic facilities often provide patients with supplies, such as casting and canes, which are integral to patients' treatment plans. What DME supplies are often used for orthopedic treatment and the way to charge for them? The Current Terminology Codes (CPT) publ