Medical Billers and Coders

  Medical billing can be challenging for all types of medical practices; however, for internal medicine physicians/internists, it can be even trickier as the billing procedure for them is quite unique.  Internal Medicine Practices  is a medical practice providing healthcare services for adult patients Why is Billing Unique for Internists? For the majority of medical conditions, patients first go to internal medicine practitioners for diagnosis and basic treatment. From there they are referred to specialists for further medical care if required. Due to this, internists become dependent on other practices or practitioners for payment and the billing process gets complicated Internal medicine practitioners offer diverse services. They see approximately 30-40 patients on a daily basis. Besides hospitals and nursing homes, they also visit patients at offices and homes. Due to a high number of patients, they need to handle a large volume of claims which creates a greater possibility

  Physicians who are part of DME services now face an important operational decision: whether to persist with in-house billing staff or entrust to external sources. The long-held belief that in-house billing staff would manage DME-related billing complexities seems to have failed them recently – most of the in-house-staff-managed DME billing are reported to have high incidence denial, delay, or under the realization of DME bills from Medicare, Medicaid, and private DME health plans.  And, now that physicians strongly feel the reason to replace in-house DME billing, should they be embracing outsourced DME billing straight away? Yes, but not before they debated the pros and cons of DME billing outsourcing. Arguments in favor of DME Billing Outsourcing The primary argument in favor of outsourcing DME billing is that it will bring a fresh perspective to hitherto stereotyped practices – outsourced DME billing providers, with their specialization, could iron out deficiencies, and i

  The lack of primary care providers in the country is a topic that has been hotly debated among many circles and written about vehemently. Not many medical students are ready to enter primary care due to a lack of great financial prospects for the future. This is resulting in even more shortage of physicians and problems when it comes to the reputation of this line of medicine. The remuneration problems along with other difficulties faced by Primary Care Physicians (PCPs) are affecting the revenue of PCPs and bringing a disparity between other physicians who practice other specialties of medicine. Here are numerous reasons for the reimbursement disparities for PCPs and some possible solutions for countering this problem. One of the reasons for the lesser amount of remuneration for PCPs is that specialists who perform routine procedures such as some specific types of surgeries take a lesser amount of time to complete their task compared to a PCP whose case can be of any nature. Anot

  There is a distinctive difference between billing for Durable Medical Equipment (DME) services and other clinical procedures – durable medical equipment services are ancillary to the primary clinical purpose, and their admissibility is subject to certain conditions. One of the best ways to overcome the DME billing challenges is outsourcing the DME billing services and RCM system.  Physicians since long have found these conditions tricky and challenging to understand, and often either been denied or underpaid for DME services, which may either have been Deemed medical unnecessary, Uncertified by Medicare/Medicaid/private health insurers, Beyond the permissible reimbursement level Lack of solid grounding in the Healthcare Common Procedure Coding System (HCPCS), which governs level II codes designated for DME equipment and supplies While physicians have the right to recommend DMEs as part of clinical treatment, they will have to back their recommendation with sufficient proof

  Medical Billing Challenges in Family Practice Family Medicine forms a crucial point of entry in the health care system, and the need as well as the shortage of family physicians in the United States is becoming a growing concern. Other specialties such as radiology, neurosurgery, and dermatology are more attractive due to the higher amount of compensation provided to physicians in these areas. Moreover, the looming Medicare cuts that have been postponed for a long time and are now extended to January 1, 2012, present another problem for family practitioners in avoiding losses in income. Family medicine and family physicians play a vital role in the healthcare system of a country. Another important factor is the health reforms coupled with an increasing number of aging baby boomers in the coming years which would keep family physicians busier than before and hard-pressed for time and money. Chronic Hurdles Medicare is facing problems because of Federal fiscal troubles and Medicar

A Patient-Centered Medical Home (PCMH) is not a particular type of hospital or building but an alternative approach to delivering health care that provides coordinated, continuous patient-centric medical care, managed by a team of individuals led by a physician. PCMHs employ the latest technology available to make optimum use of time and funds in order to deliver the best possible healthcare to patients. Although the concept is not new it has gained recognition and popularity among patients and physicians alike due to the recent health reforms. There are numerous pilots being carried out in various parts of the country and the results are positive and fruitful for healthcare providers and patients. Coordinating Patient Care Primarily, a PCMH integrates care across the healthcare spectrum including specialists, hospitals, therapists, laboratories, druggists, and home health to avoid duplicate care and curtail errors. It aims to assist physicians in keeping up-to-date with the patien

  The necessity of Durable Medical Equipments (DMEs) had never been so high – in the U.S. 30% to 54% of those over 65 years have some form of disability; around 75% to 90% of such disabled require some form of DME to keep them mobile or enabled.  It is also estimated that around 1.5 million people are currently in need of wheelchairs and braces. And, when you add the population that is likely to be in need of other forms of durable medical equipment – prosthetics, orthotics, and supplies (DMEPOS) – it will be some opportunity for people involved in Durable Medical Equipment Practice Services: physicians, pharmacies, and manufacturers/suppliers. But, because DME services are physician-recommended, we are more interested in how physicians themselves can recommend, source, and administer DMEs. While physicians can benefit immensely from an integrated DME management, there are challenges on the way – being equipped with a Medicare-enrolled and recognized pharmacy, sourcing supplies from