Medical Billers and Coders

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

  In the Final Medicare Physician Fee Schedule (MPFS) for 2022 issued on November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) added five new CPT codes in the categories of Chronic Care Management (CCM) and Principal Care Management (PCM) and increased reimbursement for already existing codes in the same categories. These codes are like chronic care management services in that the work involves the establishment, implementation, revision, and monitoring of a care plan for a patient. However, principal care management focuses on a single condition (rather than two or more). In the year 2022, Medicare will accept CPT codes 99424, 99425, 99426, and 99427, and discontinue HCPCS codes G2064 and G2065. 2022 Revised Codes for Principal Care Management CPT 99424: Principal care management services, for a single high-risk disease, with the following, required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at  signi

  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

  Account Receivable (AR)  is one step that divides the reimbursement and claims; the older the claim gets the harder it becomes for claims to get reimbursed. For practice when AR slips below a certain level you either have a pretty large backlog to be sorted out, or you can see that it becomes impossible to tackle the day’s run-out without any futile results.   The major challenge is that in recent years the financial responsibility and medical care for patients have compounded but on the other hand, we see that the widespread reach of more and more products through new healthcare insurance exchanges has prompted higher deductibles or coinsurance for physicians. As physicians cope with unfamiliar issues with different insurance companies, the AR suffers dearly. Here are three factors you can look into to solve your AR pile-up mess. 3 Unknown Myths about AR Pile-Up Step up the insurance verification process The starting point of addressing AR issues is the first step of  Reven

  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

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

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

  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

  “Although, in-house medical billing, owing to its proximity to the physician’s supervision, can work relate itself better than the outsourced solutions, yet, it is beset with inherent adequacies” Outsourcing medical billing services are composed of experts who have the time to carefully process your billing accurately. Although physician’s practices have equally been divided between in-house medical billing and outsourced solutions, there has been considerable migration to the latter in the last 5 years or so. The pattern, amidst an interesting debate over which is better – in-house or outsourced – assumes greater significance. Whereas the trend may enable us in concluding outsourced medical billing is financially more viable, coming to a hasty conclusion without making a relative study of the two might prove to be premature. Therefore, amidst the prevailing scenario, there should be an impartial comparison of the relative merits and demerits of the two available recourses. Outsou

  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

For the last couple of years, cardiology practices have encountered increasing administrative and overhead costs which have prompted a substantial decrease in payment reimbursements for cardiologists. As of late, cardiology practices have increased in size because of the advancing nature of this stream and the emergence of various ailments and their remedies. This has caused apprehension amongst practicing physicians as to how to evaluate and address the changes that are taking place or are being proposed. Henceforth, they rather pay attention to cardiovascular medicine than administrative or structural aspects of their practice.  Industry Fact File  The essential nature of the Cardiology industry has maintained demand and supported the industry expansion in the last five years. The increasing overhead expenses and lack of interest in administrative activities have prompted decreasing profit margins. The industry is fixed at $34 billion and annually it is slated to develop at the rate

You may be as of now mindful of how behavioral health billing is unique in relation to medical billing, you'll help thinking about what falls under billing for behavioral health services concerning the services we offer at Medical Billers and Coders the sorts of behavioral health billing we will help with include:  Behavioral Health Billing  To effectively charge for behavioral health, you might want a decent understanding of the shifted codes that behavioral health medicines fall into. Billing errors can lessen your assortment just as lead to dismissals and cause delays in installment. We'll guarantee your behavioral health billing claims are submitted effectively and on-schedule.  Psychologist/Psychotherapy Billing  In the event that you use billing software that doesn't appropriately consider brain research makes difficulties in billing which can prompt a misfortune in the assortment. Finding the right codes and monitoring reimbursed claims are regularly troublesome. In

Conventionally, pharmacist compensation has been majorly concentrated on collecting payment for the items' provision, for example, prescription medications. Nowadays, pharmacists possess an extended practice opportunity and the pharmacy profession has integrated different clinical avenues into regular patient care, for example, medication therapy management, chronic disease management, and care transitions interventions. A prescription has multiple stages of compensation while traveling from pharmacy to patients' hands, for pharmacy just as patients.  Knowing the progression of prescription from entry to arbitration can be complex, however, it is fundamental to know the functionality of the pharmacy billing process. To support these services, pharmacists have to be able to get reimbursed for the time and resources involved to enhance outcomes and patient care. Our payment resources are structured to support you to realize current and future opportunities to be reimbursed for of