Medical Billers and Coders

Medical billing on its own can be a complex process, requiring specific expertise. However, substance abuse billing comes with unique challenges even for certified billing and coding experts. Substance abuse billing is one of the major areas with which drug and alcohol addiction treatment centers struggle resulting in lost revenue and delayed payments. Many drug rehabilitation centers and behavioral health organizations are closing their doors due to rapidly changing industry laws, regulations, and payer reimbursement policies. Substance abuse services are provided by: Physicians (medical doctors or doctors of osteopathy); Clinical psychologists; Clinical social workers; Nurse practitioners; Clinical nurse specialists; Physician assistants; and, Certified nurse-midwives. These substance abuse treatment providers are finding it increasingly difficult to get reimbursements from payers. To get more information about Substance Abuse Billing and its challenges click here: https://bit.ly/3Wh

  Challenges of Ambulatory Surgical Centre (ASC) Billing Ambulatory Surgical Centre (ASC) billing and coding are completely different from the rest of medical specialties or the usual physician billing or even facility billing as they majorly are a combination of hospital and physician medical billing. Plus Ambulatory Surgical Centre (ASC) billing involves specialties like  orthopedics ,  pain management , bariatric surgery,  podiatry,   ophthalmology , obstetrics, gynecology, endoscopy, and dental. CMS and Medicare allow only certain surgical procedures can be done in ASC, which makes the billing and reimbursement from Insurance difficult with restrictions on out-of-network coverage. Frequent release of upgrades in coding guidelines and billing regulations can add up to the complexities involved in billing and coding for ASC. Sourcing and retaining highly experienced ASC billers and coders can be a pain point and outsourcing  Ambulatory Surgical Centre  (ASC) billing could be the only

Increased administrative hassles and reduced potential for income are two main reasons behind the shortage of PCP in the US. Primary Care Billing and revenue-related challenges have been causing great dissatisfaction among primary care doctors. This has also led to a steady decline in the number of medical students willing to pursue a career in primary care. Around 52,000 more PCPS will be required in the United States by 2025 The total number of office visits to primary care doctors will increase to 565 million in 2025 By 2025, the population in the USA will increase by an estimated 15.2%. There will be a 60% increase in the older-than-65 age group Challenges Faced by Primary Care Doctors PCPs are paid less than surgeons and other specialists. Care provided by them is not appropriately recognized by payment policies and this affects their compensation Due to low income, physicians have no option but to keep the costs down They are forced to attend to a large number of patients on a da

It has been observed that for emergency room and urgent care providers, the collection of payment is becoming more complex owing to the increasing number of payers. As a result which scope of the capacity of payable charges appears to be diminishing.   Emergency medicine   is widely different from other specialties of healthcare, specifically when there are factors like reimbursement, payer mix, and others that are responsible to strengthen the business model. Emergency Room (ER) services are blessings for medical conditions, which need quick action like sudden illness or injury. Treating patients is a primary objective of Emergency Departments (ED), however, many of them fail to understand the challenges in emergency room   medical billing . Let us understand Emergency room medical billing and its challenges: What is Emergency Room Medical Billing? Emergency room medical billing is considered one of the critical challenges for healthcare organizations and physicians. It encompasses th

On 4 th  April 2022, CMS published a rule on “suspension of prior authorization requirements for orthoses prescribed and furnished urgently or under special circumstances”. Prior authorization helps Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers ensure that applicable Medicare coverage, payment, and coding rules are met before DMEPOS items are delivered. The prior authorization program helps to protect the Medicare Trust Fund from improper payments while ensuring that beneficiaries can receive the DMEPOS items they need in a timely manner. CMS maintains a master list of DMEPOS items that requires either a face-to-face encounter and written order or prior authorization requirements. You will find the updated list  here . Due to the need for certain patients to receive an orthoses item that may otherwise be subject to prior authorization when the two-day expedited review would delay care and risk the health or life of the beneficiary, CMS suspended pri

  Exponential Growth of Pathology Services during COVID-19  COVID-19 is caused by severe acute respiratory syndrome corona virus-2 (SARS CoV-2), a highly contagious single-stranded RNA virus genetically related to SARS CoV. The lungs are the main organs affected leading to pneumonia and respiratory failure in severe cases that may need mechanical ventilation. Pathologically, the lungs show either mild congestion and alveolar exudation or acute respiratory distress syndrome (ARDS) with hyaline membrane or histopathology of acute fibrinous organizing pneumonia (AFOP) that parallels disease severity. The treatment for COVID-19 was principally symptomatic and prevention by proper use of personal protective equipment and other measures is crucial to limit the spread. Digital pathology was also introduced and the COVID-19 pandemic accelerated its adoption as there is the need to deal with higher (as much as 250 percent increase) case volume. During the COVID-19 pandemic, pathology billing wi

The beginning of the   Patient Protection and Affordable Care Act  resulted in millions of Americans becoming insured on plans with out-of-network benefits. Also, this act has narrowed insurance networks which left many providers completely out-of-network. Therefore, the out-of-network strategy for   ASC   is only revenue enhancing strategy for some ASCs. There are some key opportunities available with out-of-network offerings and you will get the details of opportunities in the following briefs: The rise in overall reimbursement The changing and sometimes volatile world of insurance can be stressful for practitioners who desire a more predictable income stream. Fortunately, there are some ways that exist to improve your reimbursements and it starts with developing a good out-of-network strategy combined with the right expertise. You can avail the best pay-off by creating a hybrid strategy that includes an out-of-network and in-network strategy. Moreover, you can enhance revenues by ma