All posts by Stephen Brighton

Urology Billing

Urology Billing & Codes

It’s very important that the proper codes are used in Urology billing, so that denials by insurance carriers can be minimized, and so that payments can be received promptly. Improper coding can cause significant delays in reimbursement, and can lead to claims being denied altogether, and that will have a serious impact on cash flow for your medical organization.

An experienced coding specialist can help in this regard, but to really ensure that your claims are being submitted with proper coding, it’s always a good idea to avail yourself of the services provided by medical billing companies, such as Medical Healthcare Solutions. Here is some background on the coding procedures which top-notch billing companies make use of daily, and which must be correctly used in order to ensure prompt reimbursement for medical services provided to patients.

CPT Codes

There are actually two different types of Current Procedural Terminology (CPT) codes which can be used, one which is used for Evaluation and Management (E&M), and the other being used for Procedures and Services rendered. Medicare recognizes these codes, along with a number of extensions or modifiers, which are added to the codes for the purpose of providing greater detail and clarifying the medical operation being performed. All E&M codes are included in the range of numbers between 99201 and 99499, and are used to describe patient visits such as visits to the office, consultations, or even hospital visits.

Procedures and Services are included in the range of codes from 50010 through 55899, which are used to identify urological procedures, and any of these codes which describe procedures can be billed to the insurance carrier. As with the E&M codes, there are also a number of modifier codes which further define the specific procedure which was performed, so that it clarifies exactly what was done. Insurance carriers are particularly on the lookout for these, since they tend to pinpoint the exact type of procedure which was carried out.

ICD-10-CM Coding System

This is the International Classification of Diseases, and it’s the 10th Revision in the series, with Clinical Modifications. This system of coding covers everything related to the diagnosis, conditions, symptoms, complaints, problems, or other reasons associated with the procedure which is being undertaken. These codes actually serve to justify the E&M codes and the Procedures and Services codes which are being used. It is allowable to use as many as four of these ICD codes on a Medicare claim form, with the first one which is listed considered to be the primary cause for the procedure.

When entering any of these codes, it is necessary to enter only one diagnosis on a line of detail for the claim you are making, and any additional diagnoses can be used to describe conditions which are co-existing at the time. It will also be necessary to enter the main reason for the procedure as well as any co-existing conditions into the medical record, so as to justify the claim. If any of the co-existing conditions require their own procedures or tests, these must also be entered on the claim form and in the medical record.

Makeup of ICD-10 Codes

All ICD-10 medical billing codes are composed of between three and seven characters, both numeric and alpha, and they classify groups of injuries or diseases according to the bodily organs they affect, and according to their etiology. Three digit codes may use four or five digit codes as sub-codes, but the billable codes will always be the ones which are at the highest level of specificity, so any code which lists a sub-code will be considered a category, rather than an actual billable code.

How Medical Healthcare Solutions can help

If your medical facility lacks the coding expertise to get medical claims processed quickly and efficiently, it will definitely be to your advantage to have all that handled for you, so that your practice can have a steady flow of incoming revenue. Medical Healthcare Solutions employs highly skilled and knowledgeable specialists who have all been thoroughly trained in the proper use of billing codes which insurance carriers expect to see on claim forms. With far less mistakes and much quicker handling of your medical billing codes, delays and denials will become a thing of the past for your company.

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4 Factors of Surgical Billing Success

Whenever medical facilities are reimbursed for any kind of surgical procedure, it falls under the concept of what is known as the Global Surgical Package. This includes all services which are deemed medically necessary with regard to the surgical procedure, and it is observed by Medicare, Medicaid, and all third-party insurers.

QUICK LINK: Global Surgery Booklet PDF Download

Whether the services are considered to be incidental to the actual surgery, or whether they are considered integral to the process, they are covered under this Global Surgical Package concept. Thus, the evaluation, management, and all physical interventions associated with the surgery are included and will be reimbursed under the GSP package. The most important factors for coding these procedures correctly and achieving surgical billing success are described below.

Identifying the surgical Period

There is a global period defined for every Healthcare Common Procedural Coding System (HCPCS) code, and this period can be anywhere from zero to 10 days following what is considered to be a minor surgical procedure, and up to 90 days when major surgery is involved. Any procedure performed during this Global Surgical Period is considered to be integral to the process, and can successfully be claimed on billing forms.

The amounts which are approved for these claims will depend on all the elements which were necessary in order to complete the service. This will include all visits to the surgeon after an initial decision was made to operate. In effect, the Global Surgical Period begins on the day that surgery is performed for minor surgeries and the day before surgery for major operations.

Listing intra-operative services

All services performed by the surgeon are considered by the GSP to be important processes and can be billed for surgery. Even evaluation of the patient is billable, but – none of the processes related to surgery should be billed separately. Everything which happens while the surgery is being performed is considered to be included in the billing for surgery.

Also, any complications which arise as a result of surgery are considered to be part of the surgical process, and likewise do not require any separate billing codes. Thus, any complications which arise during the 90 days of a Global Surgical Period for a major operation are treated as part of the surgery, and any complications which arise within the 10 days of the GSP for minor surgery are considered part of that surgery billing.

Including necessary supplies

Any surgical supplies used by the surgeon to perform the procedure are billable also and should be coded up using the appropriate HCPCS code. Examples of such supplies would include catheters, dressings, suture materials, casts, drains, and anesthesia materials, assuming that a separate anesthesiologist was not used. Any follow-up procedures are done after surgery, e.g. removal of catheters, would not be coded separately on a billing claim since they would be considered part of the procedure itself.

Excluding non-GSP factors

There are some elements related to surgery which are not included in the Global Surgical Package, and for this reason, they must not be coded on to billing forms, or there is a good possibility that the claim will be denied. Right at the very beginning of the process is one good example. The very first consultation, at which it is decided that surgery will be needed, is not included in the GSP, although every consultation afterward would be included. Once it has been determined that surgery will be necessary, all further consultations are included in the GSP.

It is also possible for a patient to exhibit symptoms while within the Global Surgical Period, which are unrelated to the surgery itself or the condition which is necessitating surgery – these cannot be claimed on a billing form. They may indeed be claim-able as standalone procedures, but they cannot be claimed under the Global Surgical Package, and they would not be honored if listed. There are also no kinds of diagnostic tests or procedures which can be included in the GSP, nor can peripheral surgical procedures be claimed, which are not part of the main procedure.

If you follow the guidelines identified above, you should have no trouble with billing your surgical procedures and having them honored by insurance carriers. With a little attention to detail and some knowledge of what is allowed and what is not, you should have smooth billing operations for all your surgical procedures.

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Substance Abuse Billing Codes vs. Standard Billing Codes

It’s no secret that billing procedure codes are pretty much the lifeblood of medical billing, and if you have any doubt of that, you should consider the fact that there’s an entire profession which has been built up around medical coding. The reason medical coding and billing is so important is that it helps insurance companies to understand exactly what has transpired between doctor and patient. It also helps to eliminate or reduce the potential for insurance fraud.

There is a different set of codes and protocols for filing claims against a patient’s insurance for virtually every kind of medical situation. Substance abuse billing is no exception, and without the proper use of substance abuse billing codes, any kind of medical billing would be rendered useless and ineffective. On the other hand, when substance abuse billing codes are used correctly, it can provide much better communication between the insurance carrier, the treatment center, and the billing company, because of the customized paperwork and code system being used.

Standard billing codes

Most countries throughout the world have already adopted the latest version of medical billing codes, known as ICD-10, with the United States being one of the last major nations of the world to embrace ICD-10. The difference between the two most recent billing code systems is that ICD-9 allows for only 17,000 different codes, while ICD-10 contains over 155,000 specific medical billing codes, obviously allowing for greater precision in identifying specific treatments being used for patients. The U.S. finally adopted the new standard in 2015, deciding that the costs of maintaining the less precise billing codes of ICD-9 simply did not justify its continued usage.

While there has been more intense scrutiny of claims for medical treatment by insurance companies, the majority of standard billing codes for treatment are still being approved by insurance companies, simply because there are no real grounds for denying them. When there are denials, it is often possible to correct any mistakes made on the billing codes and re-submit a claim to the insurance company. Even though the payment is thus delayed, the payment will at least be forthcoming, even if it makes the Aging Report on a treatment center billing process.

Substance abuse billing codes

Using the proper substance abuse billing codes has never been more important than it is at present, with claim denials becoming more and more common among insurance carriers. It has been estimated that substance abuse treatment costs the U.S. something like $600 billion annually, which is a staggering amount of money, and that makes it almost understandable why insurance companies would be extremely selective in granting approval on claims for treatment of substance abuse.

A great many drug rehabilitation centers in the U.S. are now beginning to struggle as claim denials become very commonplace, and revenues undergo serious reductions, thereby causing serious cash flow issues that have already caused many to close their doors. This being the case, it has caused many still-operational centers to take a hard look at their internal processes, closely scrutinizing such factors as clean claim rates, billing lag times, denial tracking, and of course billing code procedures. Even the slightest mistake made on billing codes can either delay payments from insurance companies, or have them declined altogether.

One of the biggest differences between standard billing codes and substance abuse billing codes in the modern medical industry stems from the fact that substance abuse as a discrete section of medical practice has burgeoned into such an enormous part of medicine. Because the number of claims has steadily risen over the past several decades, the amount of claims paid out by insurance companies has been forced to rise right along with it, and that fact has made insurance companies very gun-shy about handling substance abuse claims.

Medical billing in the future

Maintaining cash flow has become so critical to hospitals and treatment centers that many of these organizations now have established dedicated teams which handle medical billing and particularly, substance abuse billing codes. This reduces the likelihood that claims will be denied by insurance companies, and it increases the potential for being reimbursed promptly for services rendered by the institution.

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5 Tips to Maximize Surgery Center Billing

Maintaining a healthcare center can be quite costly. For those in charge of revenue management for medical practices, it can be a task to make sure all cylinders are functioning and a healthy flow of revenue is constant. This can be an obstacle for general health practitioners, but for surgery centers, revenue cycle management becomes even more complex. With special coding regulations in place specifically for surgical services and increased interaction with outside parties, the surgery center billing process creates a unique set of circumstances that only a surgery center can appreciate. Although there are many ways to cut costs in order to ensure the financial health of your surgery center, there are also things you can do within the medical billing process to contribute to the overall health and wellness of your practice. Here are 5 tips to maximize surgery center billing.

Manage Billing Turnaround Time

One of the general guidelines we advise is to send claims the same day charges are entered. If there is any time difference between when charges are entered and claims are sent, it can point to a larger problem that should be resolved within your billing department or significant delays in receiving payment for your services. As a general rule of thumb charges should be entered two to five days after a service has been rendered.

Identify Coding Issues Before it Becomes a Problem

We also advise surgery centers to conduct routine audits using an outside coding company. Audits can help you identify your weakest link so that you can resolve the problem before it causes anymore damage. Audits also provide accountability to your billing department in such a way that creates incentive to prioritize accuracy. This is another reason we recommend using an outside coding company to conduct the audit in order to avoid conflicts of interest. Your audits should return results above 90 percent accuracy. Some of the most common discrepancies found during audits are differences between what was performed during a procedure and what was dictated. Routine audits can ensure the quality of your coding to maximize speedy payments for the procedures you perform.

Assemble Detailed Patient Charts

It is very important to master comprehensive patient charts for all patients to ensure accurate coding and billing. Every patient chart should include patient identification, insurance identification, insurance verification, insurance authorization, all medical records, and any payment agreements that have been made. This information should be readily accessible to the staff in charge of coding. Coders often need to reference this information in order to dictate accurate codes for billing procedures.

Don’t Forget To Post Payments

Payment posting should be performed in a timely manner. This is an area in which you can experience unnecessarily long delays if not attended to properly. We strongly advise making daily payment posting a priority. Billing professionals should always review explanation of benefits for each patient and procedure in order to identify any potential problems early on in the process. It’s also equally important that the payment process is always in motion whether it needs to be posted to the insurance or to the patient.

Communication With Patients

Communication is key! It’s important to keep the lines of communication open with your patients from the moment they first enter your business until the very last payment has been made relating to their procedure. Arming your patients with knowledge every step of the way will help keep them in the loop in terms of their own health and as it relates to what they see on their bills. It’s not easy to decipher a medical bill and patients are quick to contest something they don’t understand. Therefore, ensuring that your staff is available to explain what’s on a bill and making sure they stay in contact with the patients until a bill is paid, will contribute positively to the overall revenue cycle.
These are just a few of our tips to maximize your surgery center billing. To find out more about how we can help your surgery center save money and manage the health of your revenue cycle, contact us. We provide free demonstrations and would be happy to help get your revenue cycle functioning at a high quality level.

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The Advantages of Using Surgical Billing and Coding Services

Surgical Billing and Coding Services are a must have for healthcare providers. It is advantageous to utilize a surgical billing and coding provider for many reasons. Primarily a good provider will offer first-hand knowledge of the latest industry requirements for medical coding and billing. Additionally, they will be equipped with advanced software technology that can provide efficient means to handle all facets of surgery coding and billing procedures.

The process of medical billing itself is a complex system that can serve as the backbone of running a medical practice. The purpose of medical billing and coding is to process various forms of patient data including treatment records and corresponding insurance information, as well as reaching out to insurance representatives, coding patient’s diagnosis as well as requesting payments from necessary parties. The final result of this process ensures that healthcare providers are paid properly and efficiently for the services they perform. In regards to surgery, your surgical billing and coding team should have expert knowledge on what is special and unique about billing for general surgery. They should be able to keep surgeons bonus-able and help surgeons to avoid expensive billing and coding mistakes in order to maximize your profits.

If you’re a surgeon trying to handle these complex systems in the house, we’ll outline what the advantages are for using a surgical billing and coding service instead.

Uniformity and Compliance

The main aim of surgical billing and coding is to ensure uniformity. Having a service provider handle your billing and coding needs ensures that all of your billing and coding procedures are uniform across the board. Having a provider also ensures that your billing and coding procedures comply with the latest coding and billing requirements outlined for your particular industry. Additionally, a provider is more likely to acquire any needed credentialing and education necessary to maintain industry standards.

Accurate and Timely Billing

When you work with a surgical billing and coding provider, we make it our job to ensure that every facet of your revenue cycle management is working properly and that includes accurately billing insurance providers as well as patients. The nature of a professional third-party medical billing and coding service naturally lends itself to offering a network of medical billing and coding professionals to address any additional needs that might come up as it relates to your revenue cycle management. In particular, at MHS, we make it our mission to help you avoid costly mistakes such as incorrect billing codes or untimely billing practices. We work with all parties involved to ensure that your billing is accurate and that you get paid in a timely fashion.

Enhance Revenue Cash Flow

And finally, hiring a surgical billing and coding can boost revenue and cash flow. Although at first glance it may seem that hiring an outside professional or company to handle billing and coding can be more costly, it’s actually quite the opposite. Outsourcing these services can actually save you money in the long run. Additional costs such as employee taxes, vacation and time-off, educational expenses to ensure your employees stay up to date, and other expenses can be avoided when you outsource.  Medical coding and billing services are specially designed to handle complex patient billing tasks with efficiency. MHS offers quick and error-free surgery coding and billing procedures that not only eliminate paperwork but also minimize claim denials and thereby enhancing revenue and cash flow.
If you’re interested in finding out how MHS can help your practice save money and manage revenue cycle management more efficiently, give us a call. Outsourcing surgery coding to Medical Healthcare Solutions is the right professional solution for billing and coding needs that can help you to save substantially.

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