Medical Billers and Coders

  As physicians, doctors, healthcare units, ASCs, and  medical billing and coding companies  observe this year’s passage of the newly laid  MACRA/MIPS  reporting rule, there are a lot of dilemmas about its positives and avoidance for the year 2018. However, it will be important to notice whether the final rule continues to trend toward value-based care. Also, given the intricacy and sweeping nature of QPP, it is yet to be seen whether or not positives and avoidances will alleviate administrative burden. Understanding the MACRA/MIPS Proposed Rule Experts, including those working in the government, who are keenly observing the scenario, have some important takeaways from the proposed rule: Around 34%-36% of physicians will be eligible for MIPS after all exclusions, although they make up 55%-58% of Medicare Part B charges. MACRA/QPP is an enormous piece of legislation. At its business end, it will eliminate the sustainable growth rate formula and replace it with a 0.5% annual rate

  Managing legacy accounts receivable can be a challenge for hospitals. These outstanding balances can be difficult to collect and may have been on the books for years. They can negatively impact a hospital’s cash flow, financial performance, and overall stability. However, with effective management strategies and best practices, hospitals can tackle the puzzle of legacy accounts receivable and boost their revenue. The Hidden Costs of Unpaid Medical Bills Image Source The financial burden of unpaid medical bills is a significant issue for hospitals. When patients do not pay their outstanding balances, hospitals are left with uncompensated care costs that can impact their bottom line. Uncompensated care costs include both bad debt, which is when a hospital cannot collect payment from a patient or insurance company, and charity care, which is when a hospital provides care for free or at a reduced cost to patients who are unable to pay. In addition to the direct financial impact of

  The behavioral health industry has historically lagged behind physical healthcare in adopting value-based and outcomes-based care models. Value-based care is also known as accountable care. A value-based care system is focused on getting value from quality services. Value-based healthcare is a payment system that rewards healthcare providers in accordance with the quality of care provided to their patients. Payments are based on better health for populations and other things, such as cost reduction, which can lead to a focus on preventative care. The benefit of value-based care is a patient in a value-based healthcare model will have fewer doctor’s visits, medical tests, and medical procedures. Additionally, they pay less for medication as their health gradually improves. BlueCross BlueShield came into the value-based reimbursement arrangement with Value Network. The provider group has 100+ providers in behavioral health care in Western New York. “This is another step we’re takin

  The US healthcare is evolving. To improve pharmacy Revenue the pharmacies need to be equipped with a better billing system. Here are some challenges faced by pharmacies that cause billing errors and affect customer relations, revenues, and reimbursements: Access to the patient’s eligibility at the time of service may be unavailable. The staff may not be updated with information about various drugs, allergies, maximum dosage, billing system, rules, codes, and insurance clauses. Claim denials due to unspecified codes put pharmacies at risk. An increase in turn-around time, duplication of work, workforce shortage, and inefficient time and energy utilization of staff members in case of critical cases, could lead to billing errors. Medical billing cannot process vaccine claims covered by pharmacy or medical benefits. The  pharmacy billing  system is not scalable or flexible. Incorrect CDM could result in underpayment, claims denials, and fines. Incorrect payments could affect r

  Ambulatory billing refers to the process of generating and submitting accurate claims for services rendered at ambulatory surgery centers. In the rapidly evolving landscape of healthcare, ambulatory surgery centers (ASCs) have gained significant prominence as a cost-effective and efficient alternative to traditional hospital-based care. As the demand for ASCs continues to grow, it becomes crucial for ambulatory owners to optimize their revenue cycle management processes, particularly ambulatory surgical center billing. This blog aims to shed light on the importance of  Ambulatory Surgical Center Billing  and the benefits of outsourcing these services to a reliable medical billing company like  Medical Billers and Coders (MBC) . Understanding Ambulatory Billing  It involves coding procedures, documenting medical necessity, verifying insurance coverage, and ensuring compliance with regulatory guidelines. A well-executed ambulatory billing process is essential for ASCs to maintain

  Basics of Telehealth Physical Therapy Medicare covers three types of telehealth physical therapy services i.e., telehealth services, e-visits, and virtual check-ins. But physical therapist still needs to follow a few basic practices for getting paid for telehealth physical therapy, let’s discuss them. During the c, the federal government has broadened access to telehealth services including physical therapy. With revised billing guidelines, all beneficiaries can now connect with their healthcare providers online, and providers will get the same reimbursement for these services as they would for in-person sessions. Verification of Identity Given that in the telehealth clinical setting, the beneficiary and therapist are not in the same location and may not have established a prior in-person relationship, it is critical, at least initially, that the identities of the physical therapy providers and beneficiaries be verified. Photo identification is recommended for both the beneficia

  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