How to Handle Reimbursement Issues

Medical coding and billing is by its nature a very precise business, because accurate codes must be used to indicate specific medical procedures provided by a caregiver. If any mistakes are discovered in the coding and billing process, the claim will be denied by an insurance company, and the caregiver will be obliged to resubmit the claim. This of course, can be very time-consuming, and it can result in reduced revenue for a medical facility, especially when several claims are denied at the same time.

The best way to reduce errors made in coding and billing is to train the staff very well so that such mistakes are minimized. However, at least a few errors in coding and billing will always crop up, and when they do, these need to be handled promptly and efficiently, so that minimum delay is encountered for reimbursement. Here are some ways that medical coding and billing errors can be handled in the most efficient manner.

Inadequate training

Even if there are minor issues involved in a claim to an insurance company, it will probably be rejected, and must then be resubmitted. All information included on any claim must have current and relevant information on it, and must be presented with the proper billing codes. The best solution for this situation is to conduct regular training sessions for your medical billing staff, so they are aware of proper standards such as ICD and HIPAA. This will undoubtedly increase the number of approved claims for reimbursement.

Poor documentation

Another frequent cause for rejection by insurance companies is that inadequate documentation is provided with the claim, so that it’s unclear about which processes were used in providing service. This happens most frequently on medical claims for patients who are insured by Medicare. Some of the important information required on these claims is often submitted in a confused state, or is not included at all.

There are also some diagnostic procedures which are hard to represent on a medical claim, and a good amount of confusion can arise from these. To avoid situations like these, guidelines for allowable medical billing services should be consulted, especially those issued by the Centers for Medicare and Medicaid Services. When necessary, information provided on claims should be verified by a second party, when it seems likely that there might be confusion surrounding a particular claim.

Data redundancy

It often happens that a duplication of data is included on medical claims, and this will often result in having a claim denied or receiving only partial reimbursement. This kind of issue most often appears when claims are handled manually, rather than through some kind of electronic process. Whenever there is any kind of confusion or unclear billing claims, an insurer is very likely to simply reject the claim, and require the caregiver to resubmit something which is more clear.

Data redundancy occurs most often on those claims associated with Medicare and Medicaid, and these are carefully scrutinized by insurance companies. One of the newest trends in the medical billing industry is to use software included in Electronic Healthcare Records, which at least partially removes the human element from medical claims. This can cut down on the number of human errors involved, and can virtually eliminate data redundancy on claims. It’s always worth having a second person check a medical claim whenever there’s any thing on the claim which is not crystal clear.

Conclusion

Healthcare in this country is becoming more competitive with the passage of every year, and that means maintaining regular income of revenue is critical. One of the best ways of ensuring that your medical facility has a steady stream of income is to minimize any mistakes made on claims sent to insurance companies. By following some of the recommendations referenced above, you should be able to cut down on any errors made, and improve your revenue flow significantly.

Professional handling of reimbursement issues 

All medical facilities encounter at least some issues with reimbursement. However, an experienced and efficient organization such as Medical Healthcare Solutions of Andover, MA can keep these issues to a minimum, and has the expertise to get them resolved promptly when they do occur. For worry-free medical coding and billing, contact Medical Healthcare Solutions, and receive prompt compensation for your provided services.

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How To Start a Career in Medical Billing

Careers in medical billing and coding are in great demand these days, as are many careers within the overall medical profession. For those people who are detail-oriented and are not prone to making mistakes, this could be a wonderful field to get into. All the important steps which you should address in order to get your start in the profession are identified below. Once you’ve completed these steps, you should be well prepared for a rewarding career in a fascinating field.

Find out what it’s all about

Specialists in the medical billing and coding field assist healthcare providers to be more efficient in conducting their practice. They do this by helping to ensure that all claims are coded correctly and are handled promptly, so that the facility can be reimbursed for services. There are two basic components to the position, the first of which is to figure out the appropriate code to use for all healthcare diagnoses and treatments. The second step is of course, to bill the insurance companies, patients, and other individuals responsible for payments for medical services which have been provided.

Research education options

If the job description appeals to you, your next step should be to research how you will acquire the necessary training. There are plenty of options available, so you’ll want to make sure you find a good program which has a track record of employing high numbers of graduates. There may be some good programs nearby, or there may be some online courses that appeal to you.

For many people starting out in the field, online education works best because it allows for a smooth integration of family life and academic life. However, there are some other practical considerations you should be aware of. Firstly, you need to make sure that the school you choose has been accredited, so that your diploma will be recognized by potential employers. You should also find out about the availability of financial aid, and you should be sure that the school program prepares you appropriately for certification in the industry.

Take the CPC certification exam

Once you’ve completed coursework at the school of your choice, you should be fully prepared to take the Certified Professional Coder (CPC) examination, which is offered by the AAPC. It’s not always necessary to obtain the certification in order to find work as a specialist for medical billing and coding, but it’s true that many employers will list it as a required skill. By passing the CPC certification exam, you will position yourself well for an entry-level job in the medical coding and billing industry.

Conduct a job search

Having passed the CPC certification exam, your next step should be to begin researching potential job opportunities in those areas of the country where you would consider working. You will also need to prepare a resume, to practice your interviewing skills, and to write cover letters as needed, so you can introduce yourself to prospective employers. When looking for job opportunities, you can use several sources online, or you can associate yourself with an employment agency. It should not be difficult to find a good employer in almost any region of the country, since this is a booming field with many available opportunities.

Use all available avenues

When conducting your search for employment, you should also make use of as many other options as are available to you. Apart from agencies and online research, there are a number of ways you might find a suitable employer, and you should take advantage of these as well. Referrals are a great way for you to get your foot in the door somewhere if you happen to know someone already in the field.

Your academic mentors and instructors may also have contacts in the field, and might be willing to recommend you for a specific position. Networking is another great way to learn about openings, and to find contacts who can be influential in helping you land a job. At the beginning of your career, it’s important that you use all avenues available to you to land that first job.

When you’re ready

Once you’ve followed the steps above to prepare you for a career in Medical Billing, you’ll just need to find the right employer to get things started. If you happen to live on the East Coast, you should inquire about opportunities with Medical Healthcare Solutions of Andover, MA. With decades of experience in serving the medical community throughout the entire region, this company stands head and shoulders above the competition, and would be an outstanding beginning to your career.

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Why MHS is a Leading Boston Medical Billing Company

Medical Healthcare Solutions, Inc. is a Boston medical billing company which evolved in 1995 from the foundation of an earlier company called Medical Billing Service Division, which had been formed four years previously. MHS was formed at that time because the two owners felt there was an urgent need for a high-quality professional medical billing service which could accommodate the greater Boston region, and that any company which could provide superior solutions and service would have a strong chance for success.

Since its 1995 founding, Medical Healthcare Solutions has always demonstrated a strong commitment to its clients, and to providing state-of-the-art solutions in medical billing which most other companies simply could not offer. Part of this commitment to superior service involves staying abreast of all developments in the area of medical billing, as well as having the capability to interface with all the current EMR software solutions, so that information can be easily obtained and used in billing. Here are a few of the reasons why MHS has managed to stay on top of the industry in providing outstanding service and solutions as a medical billing company in the Boston area.

Flexibility in serving clients

MHS has always been as flexible as possible in serving clientele in the medical industry. In fact, the company has gone out of its way to extend high-quality service to Accountable Care Organizations (ACO’s), nationwide individual practices, hospital-based practices, large group practices, Management Service Organizations (MSO’s), and even university student health centers. With this broad array of clients being served, MHS has gained a wealth of experience which it has put into practice to better solve the needs of its diverse pool of clients. This flexibility extends to the specialties which our numerous clients have, and which we can support:

  • plastic surgery
  • podiatry
  • psychiatry
  • pain management
  • pediatrics
  • orthopedics
  • ophthalmology
  • oncology
  • obstetrics / gynecology
  • dermatology
  • general surgery
  • family practice
  • cardiology
  • dermatology
  • internal medicine
  • chiropractic
  • interventional radiology
  • urology
  • transplants
  • neurosurgery
  • pulmonary
  • gastroenterology
  • vascular surgery

As you can see, there’s quite a list of specific areas that our medical clients are involved with, and our staff has the skill and the knowledge to arrange for medical billing in all these areas. That calls for a very diverse understanding of codes and procedures, but our well-trained personnel are more than equal to the task, and that’s why we are routinely called upon by such a wide diversity of medical specialists in the Boston area and around the entire country.

Billing software diversity

We pride ourselves in being able to work with many different software platforms, and even in the medical industry, there is a tremendous diversity of software programs in use by various facilities. Being able to work with these different platforms has kept us on top of the medical billing game, and has allowed us to service a great many different healthcare organizations. Some of the software platforms that we can easily interface with include Athenahealth, Cerner, eClinical, EPIC, GE Centricity, IDX, and virtually all of the biggest and most popular Electronic Medical Records products which are currently on the market.

Our preferred software platform is the Allscripts product line, but we are equally adept at interfacing with all those mentioned above as well as a few others. We can also provide cooperative billing for those organizations which operate as health insurance cooperatives, and allow patients some direction in providing their own care. The point of all this is that MHS is a company which can adapt to almost any system in place at a medical facility, and still provide outstanding and accurate medical billing services.

Motivated staff members

One last reason why MHS has a reputation as a leading Boston medical billing company is the people we employ. Each member of our team has the same company attitude we have tried to instill in everyone from top management on down to individual employees. That attitude calls for a strong commitment to providing accuracy and the most professional service to all our clients, and to understand their needs regarding medical billing. When you have your medical billing done by MHS, you can count on having minimal denials and minimal mistakes on all your billing, so that payments are not held up, and your cash flow can remain strongly positive.

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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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