Medical Billing, Coding and Documentation Services

Advantages of Outsourcing Medical Billing Services

Posted by Harold Gibson on Thu, Sep 18, 2014

BENEFITS OF MEDICAL BILLING OUTSOURCINGThe medical industry has been undergoing significant and rapid changes over the past several years. With the passage of and increasing implementation of the Affordable Care Act (also known as “Obamacare”, or the ACA), the business of medicine is developing at a pace not seen since the federal government involved itself in the medical industry over a generation ago.

While the benefits and problems of the ACA are still hotly debated, the fact of the matter is that the law has brought with it a significant increase in the amount of paperwork and regulations that medical offices must contend with on a daily basis. At the same time (and partially as a result), the expenses associated with running a medical office have increased, while margins has subsequently decreased.

For example, according to a recent study, the profit margins among not-for-profit hospitals has fallen to just 2.2%, which is due to the fact that their overall expenses have increased by 4.6 percent. This increase in expenses and decrease in overall profit margins is repeated in many segments of the overall medical industry, and the majority of experts expect it remain the same (or get worse) over the next several years.

How changes in the medical industry are negatively impacting medical offices

While many consumers of medicine are complaining about increasing costs, it often seems as though it is the practitioners themselves who are being squeezed on both sides. Not only are expenses going up, but insurance companies have new tools and methods to decrease payouts to practitioners. At the same time, the increase in administrative work for front office staff is increasing staffing costs for the front office.

Medical coding and billing has become more complex and accident-prone as well. While it is true that medical billing and proper coding has long been a sore subject for medical administrative staff, the new regulations from the passage of the ACA have made it so that same administrative staff must learn a largely new coding and billing process, which many consider to be more complex and difficult than before.

All of this leads to lost revenue, partially from increased administrative costs, and partially due to incorrectly coded records. In fact, according to a study by the Department of Health and Human Services, it is estimated that more than 42% of Medical records are incorrectly coded. This equates to billions in misappropriated revenue.

Reaction to changes in the medical industry

The dust certainly has yet to settle in the medical industry, and it will be years before the long-term direction of the industry is truly known. However, in the meantime, local hospitals, doctor’s offices, and medical facilities throughout the United States are adapting to the changes as effectively as possible.

One of the more effective changes within the industry is the increased outsourcing of medical billing and coding to companies that specialize in performing those specific tasks. The reasons for this are numerous, however the two primary reasons are that it reduces liability and increases margins.

For a long time, the medical industry seemed to resist the idea of outsourcing medical coding and billing to other companies. Part of the reason for this was the fact that many believed the cost of doing so was prohibitive for their business. Medicine has never been a particularly high-margin industry, and many medical facilities believed that they simply could not afford the lost margins that would come from hiring such a service. One of the other reasons was a desire to retain control of the administrative workings of the office. By ceding control of the medical billing and coding process to a third-party, some hospitals and doctor’s offices believed they would lose control over the patient’s overall experience, and would have to deal with an additional bureaucracy.

However, the implementation of the ACA has compelled medical facilities to reconsider outsourcing, and many of them have found it to be a worthwhile endeavor. Contrary to earlier beliefs within the medical industry, outsourcing medical billing and coding turns out to be a positive experience overall. As a result, the Bureau of Labor Statistics projects that the outsourced medical billing industry will grow by more than 20% over the next decade. As more and more medical facilities reap the benefits of outsourcing, that projected number could increase even further.

To know more about M-Scribe medical billing and coding services.

Advantages of outsourcing medical billing services

Outsourcing medical billing to experts significantly reduces overall provider liability since certified billers and coders keep themselves abreast with changing laws and regulations. Instead of being solely responsible for miscoded records - corresponding procedure and diagnosis codes (CPT and ICD-9), practices can share that responsibility with the billing company who has coding expertise on board. Providers can discuss all the changes with certified coders to educate themselves as well as help billers to prepare cleaner claims. If nothing else, this offers peace of mind for administrative staff and medical professionals, so they can focus on their jobs instead of being distracted by medical billing and coding ever changing requirements.

Most significantly, however, is the fact that properly billed and coded records will mean prompt and maximized payments from insurance companies.

Tags: Atlanta Medical Billing, Boston Medical Billing

Intricacies involved in Dermatology Billing with pathology

Posted by Harold Gibson on Tue, Sep 16, 2014

Dermatology BillingIt is likely that most dermatology practices strive for higher rates of reimbursement. When providing medical billing services in any specialty, you should be aware of how serious the national increase in bad debt write offs is. Coupled with Medicare's reduction in provider fees, extreme care must be taken to ensure reasonable return on investment. To avoid denials and lost revenues, it's imperative that procedures be accurately reported and coded and that the consequences of both state and federal regulations are adhered to. 

Direct Billing Laws for Dermatopathology 

Direct billing laws vary from state to state. In some states the dermopathologist must be an employee, owner or partner of the practice. This means that a practice must provide such a staff member with expensive benefits like holiday pay, health insurance, retirement benefits and perhaps profit sharing. Other costs of in-house Dermatopathology include the expenses of producing necessary reports. The technical component includes creating a laboratory with equipment such as cryostats, fume hoods and slide baths. So in the states where such practice requirements are legislated, a large startup investment is most certainly necessary. Please call us at 888-727-4234 to know more about your state laws about dermopathologist.

In practices that want to avoid building a laboratory but still want to charge for professional treatment and analysis, hiring a part-time dermatopathologist can work. In this case, the outside lab bills Medicare and other third-party payers directly for technical work. The dermatopathologist must read the slides in an onsite office to avoid the Medicare anti-markup restriction and also fulfill the "Stark same building" criteria. Three salary restrictions are Stark, Medicare safe harbor rules and Medicaid's anti-kickback law. 

Awareness of government regulations and payer regulations will lead to a minimization of claim rejections and a reduction in bad debt. Anyone with a dermatology practice must be aware of the complex network of laws and regulations governing billing and provisioning of laboratory and pathology services. In many cases private payers may impose restrictive policies on these services as well. 

The American Academy of Dermatology (AAD) has made a position statement on pathology billing.

Here are some of their main points: 

1. The Association supports the right to bill for one's own work: The ability to bill for pathology work and technical work whenever when there is a lab is essential. 

2. Board certified dermatologists should continue billing for pathology work whenever they interpret their own slides. Outside reference labs should be relied upon for preparing slides outside the office. External reference labs bill for the technical work they perform.

3. Dermatologists must continue to select any qualified dermatopathologist they choose. This should include any dermatopathologist that works in the same group practice as the referring party. This should be true even for small single specialty groups. The dermatologist and dermatopathologist must work together to deliver the best care for the patient. It is necessary for the dermatologist to be able to choose the dermatopathologist with whom they work best, based upon their confidence in that dermatopathologist's ability and their ability to communicate.

4. They cautioned against dermatopathology lab requirements interfering with the ability of dermatologists to run their own in-office labs. 
They also warned against risks posed by several different lab models, including those involving outside pathology labs that markup fees for work not performed by the billing dermatology practice. This type of billing action is considered egregious by the AAD. 

It's clear that the laws surrounding dermatopathology are deep and murky, with the many fingers of governments both federal and state muddying the waters. To tread them safely, you might enlist the aid of a dermatology billing expert. This type of expertise can help you avoid costly errors and protect your hard earned revenues. 

To know more about intricacies involved in Dermatology Billing with pathology please visit M-Scribe dermatology billing services or call us to talk to one of our Dermatology Billing specialists at 888-727-4234.

Tags: Medical Billing, Atlanta Medical Billing, Dermatology Billing

Five Steps to Easy Physician Credentialing

Posted by Harold Gibson on Tue, Sep 09, 2014

Credentialing1. Start the credentialing process early. Most credentialing can be completed within 3 months, but that doesn’t mean you should take that long, as complications can arise. Payers have recently been merging into larger organizations. As a result a practice's ability to expedite an application has diminished. You’re working on the payer’s internal timeline for application processing, so it makes sense to allow additional time for any difficulties that occur.   

2. Ensure that you application is complete. According to Joellen Scheid, an Anthem for Virginia credentialing manager, only 15 percent of applications are complete, while the rest are missing critical information required for processing. The most common areas of application deficits are missing data and obsolete data. Examples are:

  • Missing work history and current work status
  • Physician's practice and effective date with the practice
  • Hospital privileges and covering colleagues
  • Attestations
  • Malpractice insurance details

3. Update and attest with CAQH for quicker processing that is easier to access. The Coalition for Affordable Quality Healthcare started its uniform credentialing program about 15 years ago. Since then, most payers in the nation have adopted this program. Physicians who regularly update and attest with Coalition for Affordable Quality Healthcare find credentialing and re-credentialing much easier. The Universal Provider Data source is a part of CAQH's credentialing application database project. Its goal is to make provider credentialing more efficient for providers as well as for healthcare organizations. CAQH’s online database collects all provider information necessary for credentialing, with the goal of eliminating much of the administrative overhead, paperwork and errors that providers face during the process of credentialing.

Billing and insurance tasks contribute to a major portion of administrative costs for both providers and hospitals. Federally mandated CAQH CORE EFT and ERA Operating Rules also streamline and simplify provider payment and claim reconciliation.

4. Prepare for telemedicine credentialing. Some say telemedicine is the future of the healthcare industry. More than 36 million Americans have already used some form of it. It’s estimated that 70 percent of doctor visits can be handled over the phone — costing far less than an in person visit. The US military is one of the largest users, with about 55 percent of the Army's telehealth programs focused on behavior health.

When your goal is to provide widespread patient services in both rural and urban communities, you’ll be able to offer services to more people at lower cost with telehealth. But this type of credentialing can be especially tricky when granting privilege to practitioners for either first-time procedures or disaster service. More information about telehealth credentialing is available.

5. Abide by your state’s regulations. Each state has its own laws for timely credentialing, including in-state credentialing and reciprocity.  Your state Medical Group Management Association can help you ensure you are adhering to your state's standards and using them to your advantage. Your credentialing process will be easier when you gather all the information you need on new providers up front. State requirements are quite varied.  For example, in accordance with HCQA, NJ carriers must be willing to accept the NJ universal physician application form. Oregon’s universal credentialing application, created and maintained by the ACPCI eliminates the need to complete multiple unique applications for each health plan, hospital and insurer. Ironically, this state’s credentialing is not governed by the state. 

In short, compiling all the information well ahead of time and making certain that it is both accurate and complete will save you from delays and administrative nightmares that can delay your credentialing. Assembling your information to meet state, national and practice requirements and completing your documentation correctly the first time is likely to be the swiftest way to attain your goals.

How to Avoid Balance Billing Your Patients

Posted by Harold Gibson on Thu, Sep 04, 2014

Medical practices need to have procedures in place to lessen the risk of not being compensated for patient care. It's more than just checking insurance cards - that's but the eligibility verification starting point. That card's not a guarantee that the patient is covered for the visit and the related costs that may follow from it. Not only must the insurance coverage be verified, but also the patient's identity. 7 percent of all identity theft involves the fraudulent use of someone else's medical insurance card - a fast growing figure.

Verification of identity and coverage can be time consuming and costly, adding to the administrative burden of a practice. Yet to not do so is very risky. Providing services to a bogus patient creates an uncollectable debt, even should the impostor be arrested. Likewise, if it's later discovered a patient wasn't covered due to policy exclusion or limits, the patient may not be able to pay.

There are many automatic services available that simplify eligibility verification. The American Medical Association (AMA) estimates that eligibility verification costs $3.70 per patient when done manually, but only $0.74 when done electronically. Given that a single physician in the US has on average 1,200 patients, that's a savings of approximately $3,700 in annual savings in processing alone. The gain in having patients' eligibility and coverages properly verified is significantly higher. Some electronic verification systems also can check patients' financial responsibility history as part of the verification process. This enables practices to know who should be required to pay any balance due before walking out the door. The AMA notes that about half of the better performing practices are those that collection 90% of payments due before the patient leaves the office. Doing so also helps a practice lessen its use of third party billers, whose use only ads to administrate costs and lessens revenue - part of the 12% of "administrative excess" noted by Health Affairs.

Collecting at the time of service can also improve a practice's relationship with its bank. Banks often monitor a practice's debt levels and cash flow. Ideally, they see more money coming in from patients at time of service and a concomitant reduction in a practice's debt, note various consultants. If this isn't happening, it may affect a practice's banking relationship, especially when a line of credit's in place.

The simplest, least costly and most profitable solution to eligibility verification is having a system that performs automatic verification. 
Government funded insurance, such as Medicare and Medicare Tricare also have an array of automated systems available through vendors to verify patient eligibility. Some of these systems are now accessible through mobile devices, with at least one vendor providing verification access through an iTunes app. 

Avoiding Balance Billing
Balance billing issues are a large challenge for practitioners and patients, and a growing social policy issue. Obamacare's state exchanges and metal coverages (bronze, silver, gold) are bringing millions of unsophisticated medical insurance consumers into practices across the land. Many believe that their insurance coverages are as stated in their policy and that all services are so covered. They may not realize this isn't true only when they receive a huge balance billing statement, which they can't or won't pay. 

When referring a patient to a colleague, Obamacare insured or not, it's prudent to first determine if that practice accepts that patient's medical insurance. It only takes a moment and can reap dividends: Medical bankruptcy is the primary cause of personal bankruptcy in the US. If your patient walks into a balance billing scenario, referred by you, he may just angrily walk on all his medical bills. Help your patient, help yourself, by confirming eligibility before making the referral.

Tags: Obamacare, Medical Billing Service, Insurance Eligibility verification

Top 5 Medical Claim Denials in Medical Billing

Posted by Harold Gibson on Thu, Aug 28, 2014

Family and internal medicine denials

In the shifting seas of medical claims billing requirements, the general categories for claims denial are reasonably stable. We thought it might be helpful to review some of the major ones. Some are simple, some are impacted by the changing landscape of government mandates in general and the ACA (Obamacare) in particular:

1. Noncovered charges
2. Coding errors
3. Overlapping Claims
4. Duplicate claims
5. Expired time limit

Noncovered and Excluded Charges: Marketplace Plans

The Essential Mandates portion of the ACA governs all levels of the marketplace metal plans: Bronze, Silver, Gold and Platinum. Despite the publicity surrounding the conversion of marketplace coverages from private insurers to the various insurance exchanges, Excluded Charges are overall proving remarkably stable from year to year. 80% of the top ten of them remained unchanged from 2013 to 2014, according to an analysis by HealthPocket, which surveyed data from 3,094 health plans in the 2014 individual family health insurance market

The private health plans replaced by ACA metal plans mostly covered essential services such as office visits, tests, ER care, and hospitalization and therefore these services don’t appear among excluded items. Maternity care (Prenatal and postnatal care), though not covered by 81% of private plans, ranked 15th among uncovered services in 2013, so it isn’t reflected in 2014 ten top listing for the ACA’s marketplace plans.)

The attempt at consistency in the marketplace plans at the federal level isn’t reflected in the state exchanges, where the coverage of some services excluded by the federal plans by illustrates the current fragmented nature of marketplace coverages. 20 states’ exchanges cover infertility treatments, for example. Only by being conversant with the marketplace insurance coverage provisions of their individual states can practitioners know what services are covered.

1. Noncovered Charges: Medicare

Medicare is at least consistent and not subject to the coverage vagaries of the individual insurance marketplace. CMS states clearly what it pays for and what it doesn’t pay.

Medicare-covered services are those services considered medically reasonable and necessary to the overall diagnosis or treatment of the beneficiary’s condition or to improve the functioning of a malformed body member.

The claims payment issues with Medicare lie not in what it covers for, but in the claims process itself, notably the ICD-9 ICD-10 diagnostic code conversion mandate, which is touched on below.

2. Coding Errors in General

Claims edit functions ensure that claims data submitted to a payer are correct. If it not, the claim is returned unpaid. Attributes that are verified include format, allowable values, required presence and data integrity. This processes determines whether or not the claim was properly coded by the provider.

The AMA issues an annual National Health Insurer Report Card that details claims accuracy and the costs of inaccuracy. Medical practices spent 14% of their income on ensuring that they’re paid. Claims returned to practices for “rework” i.e., error correction, by the top 7 commercial insurers in 2013 cost practices an average of $2.28 per claim to correct, with 10.7% of all claims returned for rework. The AMA study didn’t address ICD codes specifically, instead defining all Medicare claims submissions as “CMS,” which could include both ICD and CPT codes. (CMS Publication 100-04).

3. Duplicate Claims

A duplicate claim is one that’s resubmitted for a single encounter on the same date, by the same provider, for the same beneficiary, for the same service or item. It’s denied as a duplicate with error code CO18. Duplicates are one of the largest reasons for Medicare Part B claim denials, According to Government Accountability Office (GAO) study its as much as 32%. CMS notes, however, that claims rejected as duplicates may be valid claims for payment, if the correct condition codes or modifiers are applied to demonstrate a claim isn’t really a duplicate.

4. Overlapping Claims

Not as straightforward as a duplicate claim, CMS defines an overlap as occurring: “... when the date of service or billing period of one claim seems to conflict with the date on another claim, indicating that one of the claims may be incorrect.” Some codes that can indicate an overlapping has occurred are:

N347: Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing the payer

M86: Service denied because payment already made for same/similar procedure within set time frame may be incorrect.

Overlaps require some research to resolve, especially when other provider’s involved.

5. Expired Time Limit

Some practices hold smaller claims and batch processes them later—sometimes too much later. All insurers have time limits on claims submissions. Medicare requires all claims be filed within 12 months following the date of service. Its rules as noted below do allow three possible areas of exception:

  • Administrative Error: failure to meet a filing deadline caused by error or misrepresentation of an employee, the Medicare contractor, or agent. In these instances, Medicare will extend the timely filing limit through the last day of the sixth month following the month in which the beneficiary, provider, or supplier received notice that an error or misrepresentation was corrected.
  • Retroactive Medicare Entitlement: Occurs when a beneficiary receives notification of retroactive Medicare entitlement to on or before the date the service was furnished. In such cases, Medicare will extend the timely filing limit through the last day of the sixth month following the month in which the beneficiary, provider, or supplier received notification of the retroactive Medicare entitlement.
  • Retroactive Medicare Entitlement Involving State Medicaid Agencies: where a State Medicaid Agency recoups payment from a provider or supplier six months or more after the date the service was furnished to a dually eligible beneficiary. In these cases, Medicare will extend the timely filing limit through the last day of the sixth month following the month in which a State Medicaid Agency recovered the Medicaid payment from a provider or supplier.

Tags: Medical Claims Denials, Obamacare, Medical Billing Service, Internal Medicine Billing

Five simple steps to streamline your medical billing process

Posted by Harold Gibson on Tue, Aug 26, 2014

Medical Billing stategiesMedical billing service is perhaps the most important administrative tasks a doctor's office or medical facility has to contend with on a regular basis. One of the challenges facing administrative staff is the increasingly complex and ever-evolving laws and regulations surrounding medical billing service.

In order to keep the office running smoothly in light of these developments, it is important to make the medical billing process as efficient and streamlined as possible. The following are a few suggestions on how to make that happen. 

1. Make sure all patients sign all relevant medical forms

One of the biggest headaches that can occur during the medical billing process is having a claim rejected or delayed due to missing patient signatures. Creating a standard process through which front office staff can get every necessary patient signature before they leave the office can save a significant amount of time and difficulty later on. 

2. Have a dedicated staff member for medical billing

Properly medical billing requires a significant attention to detail. Constantly being interrupted by other office tasks or by incoming and outgoing patients can cause distractions that lead to mistakes. If possible, try to have one staff member whose sole responsibility during a particular period of time is taking care of all medical billing and coding. Since this can be fairly monotonous if it is their sole job, offices are probably better off giving the responsibility in shifts, say one morning or one afternoon per staff member per week. Bureau of Labor Statistics estimates that the medical billing industry as a whole will increase in 2015 as well. In fact, it is estimated that the industry will grow by about 22% between 2012 and 2022.

Outsourcing medical billing service entirely is also a good option for various reasons explained here.

3. Have a standard process for following through on delinquent claims

Allowing delinquent claims to pile up can have a significant impact on the revenue and overall cash flow of a doctor's office. Implementing a standard process through which all delinquent claims are handled can save time and ensure that all claims are being paid on time. For some offices, this means outsourcing medical billing to a third party. For those who are unwilling or unable to take that step, software that helps handle delinquent claims can be very helpful.

4. Use technology and software whenever possible 

This is similar to the suggestion above, but a bit more general. Computers, tablets, and software can save a doctor's office a lot of the time they would otherwise be spending on medical billing. When used properly, technology and software can reduce the number of human errors that are possible, and take some of the burden off of administrative staff. One essential key to using technology is making sure that the administrative staff knows how to use it properly, as there are few things worse than having hundreds of patent files incorrectly generated.

5. Have all relevant patient data 

This suggestion is good for more than just efficient billing, it is just a general best practice for medical offices overall. Today, patients have much more relevant data than simply their insurance provider, phone number, and physical address. Incorporating information such as email addresses, preferred method and time of contact, and other data can help ensure that the relationship between the doctor and patient is as efficient and hassle-free as possible. This is beneficial for the office because it increases the likelihood that they will be able to contact the patient about important information in as timely a fashion as possible. It is also beneficial for the patient, as they also appreciate being contacted in the self-selected method that they prefer. At the same time, however, it is imperative that every doctor's office ensures that they are complying with HIPPA and any other relevant regulations, particularly the ones regarding privacy. 

    Efficient medical billing is more important than ever before. Fortunately, with some foresight, it is possible to make an office efficient without completely changing the way things are done within it, so that everyone can focus on what is most important: providing best possible patient care!

    Tags: Atlanta Medical Billing, Medical Billing Service, HIPAA Compliance

    Improper E/M coding leads to loss of revenue for practices

    Posted by Harold Gibson on Thu, Aug 21, 2014

    Improper E/M coding leads to loss of revenue for practicesIt is no secret that E/M claims, also known as Evaluation and Management claims, have been causing major problems for the medical industry over the past several years. According to a study by the Department of Health and Human Services, as much as $6.7 billion was inappropriately paid in 2010. That amounted to 21% of Medicare payments and a staggering 42% of incorrectly coded claims. In fact, the $6.7 billion that was inappropriately paid disguises the extent of the problem, due to the fact that the incorrect coding included both upcoding and downcoding, with the majority of incorrect claims being downcoded.

    How improper E/M coding affects the medical practices

    Evaluation and Management (E/M) miscoding is expensive for the entire medical industry. Not only is Medicare paying out billions more than they should, but doctor’s offices and other medical facilities that are downcoding are losing out on revenue that they are legally entitled to as well. While many of the downcodings are in fact mistakes, a significant number of them are entered deliberately by doctors who want to counteract the upcoding they presume (or know) has also been entered on their behalf.

    Improper E/M coding can be broken into two major categories. The first is due to upcoding, which ultimately costs Medicare billions of dollars on higher fees. This in turn impacts the long-term viability and solvency of the entire program, and burdens taxpayers and other parties within the medical industry unfairly. While some of this improper upcoding is done purposefully, a great deal of it is simply the result of administrative mistakes or a lack of appropriate knowledge in medical offices.

    The other major problem with improper E/M coding occurs when doctor’s offices and medical facilities accidentally downcode their billing reports. Much like improper E/M upcoding, this results misallocated revenue, however in this instance it is the doctor’s office or medical facility that suffers the consequences. Although downcoding does not cost Medicare additional revenue, it does result in a loss of revenue for the medical facilities themselves, many of which are already dealing with shrinking margins as it is.

    Solving the problem of improper E/M Coding

    According to the Department of Health and Human Services, there are already mechanisms being put into place to counter improper E/M coding. With the cost already in the billions of dollars, and with such a large percentage of medical facilities and doctor’s offices committing these mistakes, Medicare contractors are starting to focus on E/M coding and documentation, particularly among doctors who have a high percentage of their billings as E/M billings.

    Industry leaders are also recommending that doctors begin the practice of self-audits on their own offices. In addition to hopefully reducing the number of E/M errors, this practice can also ensure that the office is billing properly and in full compliance with the relevant regulations. In addition, for offices that have been inadvertently downcoding, there is the possibility of increased revenue from the correction of improperly coded E/M claims. However, even if a particular office finds that it is actually upcoding, this can still be a financial benefit to the office, as it prevents the possibility of expensive legal action; it is also of course the right things to do.

    In addition to the recommendations by the Department of Health and Human Services listed above, doctors and medical offices should also learn to document their patient encounters more accurately and in more detail. This can help in the self-auditing process and is also a smart best practice to utilize in general.

    E/M claims are an important part of the medical industry, and in particular for doctors whose patients are on Medicare. With the problem of improperly coded E/M claims rising rapidly, now is the time to make sure that your own office is in order. Utilizing M-Scribe’s medical billing and coding services is one of the best ways to ensure that your office is complying with and properly coding E/M claims. Their services will give you the peace of mind you need to run your practice effectively. For more information about how M-Scribe E/M billing and coding services can help you, please visit M-Scribe E/M coding services. 

    Tags: medical coding, Atlanta Medical Billing, E/M Documentation, E/M coding

    Increase Revenue By Avoiding Common Medical Coding Mistakes

    Posted by Harold Gibson on Tue, Aug 19, 2014

    common coding mistakeWith the first year of full Obamacare implementation nearing its end, doctor's offices and healthcare facilities are still working on streamlining all of the new administrative and regulatory rules and requirements that the law imposes. While medical coding mistakes are nothing new, now it is even more important to prevent them from occurring, since the administrative delays and insurance company hold-ups they cause can have even more of a significant impact. Although there are plenty of possible medical coding and billing mistakes, the following are a few of the most common and most important to avoid.

    Illegible handwritten claim forms

    It might seem unbelievable in today's age of technology and computers, but there are still numerous medical coding mistakes that occur simply because they are handwritten in such a way that they are misread and mis-entered into the system. One of the best ways to avoid this is to simply ensure that all medical coding and billing is done using a computer and a printer. With more than adequate printers available for less than $100, there is simply no reason for any medical facility, no matter how small, to still be using any handwritten forms.

    Certified coders help medical billing and increase revenue.

    Failing to add necessary modifiers

    Modifiers are more important today, with the implementation of the Affordable Care Act (also known as Obamacare) than ever before. Failing to add necessary modifiers will often lead to delays in payment, and can sometimes even lead to an outright refusal for payment to be made. While there are many important modifiers to keep in mind, one of the most important times to use one is when a healthcare facility performed multiple services in a single patient visit. Modifier 25 is used specifically for this situation, as it helps differentiate a "significant, separately identifiable evaluation…service by the same physician…or other service." Failing toutilize Modifier 25 can lead to significant delays in payment by insurance companies, and administrative staff in a medical facility should always make sure they are checking for cases in which Modifier 25 is applicable. Linking medical necessity codes to treatment codes Insurance companies have long been sticklers about having a documented medical need anytime a procedure is performed. One of the ways that insurance companies attempt to get out of reimbursing a medical facility for services rendered is by claiming that the procedure was not properly linked to a medical need. It is more important than ever before for doctors to properly document their patients' medical issues, so that when treatments are performed, they can easily be linked to without any hassles from the insurance company. One of the other important considerations is making the diagnosis codes are specific as possible. For example, hypertension is coded as 401, but that coding will almost always result in a claim denial by an insurance company. It is absolutely imperative that any and all diagnosis codes include the maximum number of code specifics. In the case of hypertension, this involves adding a period and an addition number. Malignant hypertension, for example, is coded as 401.0, while benign essential hypertension would be coded as 401.1. It is important to specify these differences not only to avoid hassles with insurance companies, but also to ensure that the proper treatments are given to the patient. While many medical administrative staff members are familiar with the importance of properly coding claims, it is always worth spending sometime refreshing one's knowledge so that as few mistakes as possible are made. This will save everyone involved time, frustration, and unnecessary hassle.

    Accurate medical coding is a critical component of any medical practice, and is at the heart of the practice billing process. Without proper coding, a practice can lose considerable amounts of money and may even face fines and penalties when codes are repeatedly used incorrectly.

    Tags: medical coding, Obamacare, modifier codes for medical billing, Affordable Care Act

    Benefits of Outsourcing Medical Billing Services

    Posted by Harold Gibson on Thu, Aug 14, 2014

    Outsourcing Medical BillingOutsourcing your medical billing and coding to an experienced professional organization has a variety of benefits.

    "Patient privacy" is a big buzzword in the medical field these days, with a number of countries including the United States putting medical professionals under strict legislation to guarantee patient privacy protection. With compliance more crucial than ever, medical facilities now have the added work and responsibility of ensuring their organizations comply with the stringent regulations. 

    This adds up to a large number of additional considerations medical professionals are now required to stay on top of on a daily basis. Is everyone in your organization up to speed on all of these privacy considerations? This is one of the primary reasons to outsource your medical billing, coding and documentation to an experienced professional organization who can make sure you're always fully compliant with patient privacy considerations and regulations. 

    Industry Experience and Adaptation 
    The best medical billing and coding services are firmly rooted in and informed by the medical field. They are in tune with what medical professionals and organizations need and provide it in an efficient, intuitive and thorough manner. Experience counts, but so does the ongoing flexibility to stay in touch with the latest industry trends and technologies so that services can always be provided in the easiest, best and most economical ways possible.

    Professional medical billing and coding company helps to simplify potentially overwhelming tasks for medical organizations, staff and patients. Cutting-edge technologies and processes assist medical organizations and facilities in taking care of medical billing and coding while also staying in compliance with relevant privacy regulations. Staff can then manage larger document loads, and patients appreciate the easy and rapid accessibility to their records. Coding audits and pre-RAC auditing services help to ensure your ongoing patient privacy compliance. Other benefits of outsourcing your medical billing and coding to an experienced professional include: 

    Practice Management (PM) and EHR Adoption
    Your outsourced medical billing and coding team will be prepared to work with your EHR and PM right away. They do not take time to learn new system because of their experience but in case of in-house employees it takes painfully long to train and sometime they become indispensable for this very same reason.

    ICD-10 refers to the 10th modification of the International Classification of Diseases. Physicians, medical providers, clinics and private practices must change the code they currently use to record and document symptoms, diagnoses and procedures to comply with the new system by 2015. A medical billing and coding expert will be up to speed on these changes, allowing you to keep this consideration off your list of things to do. 

    Faster Payments 
    The accurate, compliant, and timely return of your organization's documentation will conveniently expedite and in some cases increase your revenue because of efficient coding denials will be minimal, claims will be cleaner.

    Attentive Customer Support 
    Instead of having to go it alone and navigate your way through billing, coding and documentation snafus, you'll have access to 24/7 customer support to take care of it for you. That way, you can spend more time seeing patients instead of buried in documentation. 

    Streamline Your and Operations and Workflow 
    Documents handled include patient documents, medical publications and other multimedia resources. Optimized search and retrieval tools can be seamlessly integrated into your existing office system. Existing documents (including EOBs, and other billing related paperwork) can be scanned and organized into a secure system and even be accessed from mobile devices from anywhere in your facility. With admin outsourced, staff members can focus more on providing outstanding patient care. 

    Paperless Option 
    A paperless digital option can help to streamline your process even further. Organization, patient privacy, and ensuring client satisfaction are all facilitated with outsourced medical billing and coding services. Digital documentation means less of your own storage space is needed and you'll be able to reduce costs spent on office supplies such as toner and paper. 

    Accuracy and efficiency are crucial in the medical field. With a well-established core team of over 500 healthcare professionals assisting over 25 hospitals and 200 clinics in the U.S., M-Scribe is ready to bring all of the benefits of outsourced medical billing and coding to your facility.

    Tags: medical coding, Atlanta Medical Billing, Boston Medical Billing

    How Obamacare will impact medical billing in 2015?

    Posted by Harold Gibson on Tue, Aug 12, 2014

    Obamacare and Medical BillingIt's now been over four years since the Affordable Care Act, otherwise known as "Obamacare", officially went into effect in the United States. However, we are just now learning the wide-ranging impacts the legislation has had on the healthcare industry, and in particular on medical billing in hospitals and doctor's offices throughout the country. While we still don't know the scope of changes that are yet to occur, there are some undeniable trends that seem to be making their way down the pipeline, particularly as we prepare for the oft-mentioned "employee mandate", which, if all goes according to the (often revised) plan, goes into effect in 2015. 

    Medical Billing Will Increasingly Become Outsourced 
    Medical billing has never been a particularly popular activity in doctor's offices and in hospitals. Now, with the increasing number of medical coding requirements resulting from the Affordable Care Act, medical professionals are continuing the trend of outsourcing this work to companies that specialize in it. According to a report in Seeking Alpha, large outsourcing companies such as Firstsource Solutions and WNS are increasing their domestic US presence to accommodate a growing number of medical professionals who are choosing to outsource medical billing to them. 
    By 2015, more doctors and hospitals are projected to outsource their medical billing than ever before, in large part thanks to Obamacare and growing administrative costs. The other less discussed (but no less important) consideration is that outsourcing medical billing reduces liability on the hospital or doctor's office. 

    The Number of Medical Billing Professionals Will Grow Dramatically 
    While outsourcing is certain to increase in 2015, The Bureau of Labor Statistics estimates that the medical billing industry as a whole will increase in 2015 as well. In fact, it is estimated that the industry will grow by about 22% between 2012 and 2022. While some of this increase is in fact due to regulatory and administrative burdens resulting from the Affordable Care Act, many experts also believe that the changes from the ACA will actually reduce administrative issues, increase efficiency, and ultimately grow the medical billing industry at a slower rate than it otherwise would have in the absence of the Affordable Care Act. 
    The other key reason why the medical billing profession is expected to grow is the simple fact that, under the Affordable Care Act, more people will have access to healthcare, which means more medical coding and medical billing will be required. While increased access to healthcare for the overall population (and particularly the poor) is a worthy goal, it comes at the very real cost of increased administrative and regulatory issues, at least in the short-term. 

    Precertification and Eligibility Verification Will Continue to be Cumbersome 
    While it's true that one of the original promises of the Affordable Care Act was reduced difficulty for hospitals and doctor's offices that needed to pre-certify or verify eligibility of a patient for a particular procedure, reality has proven itself to be more complicated. Early reports indicate that, at best, this process is as slow and cumbersome as it has always been, while critics claim that it is in fact less efficient than before the ACA was passed into law. Part of the problem stems from the fact that many insurance companies and medical offices still aren't even sure how to properly code procedures and medical services; a problem that, while severe, should hopefully improve gradually in 2015 and onward if all goes well. 

    Obamacare is causing significant changes in the medical billing industry. Hopefully the negative aspects will diminish over time, while the promised benefits of the law start to take hold. 

    Tags: Medical Billing, Medical Documentation, Obamacare, Atlanta Medical Billing, Affordable Care Act

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