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Archive for December, 2011

The Key to Successful ICD-10 Conversion

Tuesday, December 27th, 2011

The key to successful ICD-10 transition is planning and preparation.

It is an exciting time in Health Care, but will take time and effort to make the transition a success.  The federal government announced that the implementation date had been pushed back to October 2013. This should allow  physicians, medical facilities, and billing services time to ensure that their systems are fully up-to-date with the new codes.

Using a trusted third party billing service can help with a successful conversion.  All reputable billing services will be working hard to make sure that their systems are completely converted to ICD-10. This includes not only making sure that software and systems are updated, but also that their full range of staff has been educated and trained on using this new vast array of diagnosis codes. This includes both physician and procedure codes (ICD-10-CM) as well as hospital based codes (ICD-10-PCS).

It may seem that October 2013 is a long way off, it will be here before we know it.  Now is the time to make to decide about allowing a competent, reliable and efficient medical billing service  handle the details for your practice and provide your office not just with claims processing, but also peace of mind.

The Countdown Is On For ICD-10.

Tuesday, December 20th, 2011

The World Health Organization (WHO) developed ICD-9 in the early 1970’s, now thirty years later, it is time for the US to join the rest of the world and implement  ICD-10,  a diagnostic coding system to replace the current coding system, ICD-9.

There are many reasons the United States is moving to this coding system, one, the current system is out of room.  The system needs more codes to assign to new medical diagnoses. Improved technology will allow ICD-10 to improve analysis of disease patterns and  treatment while streamlining the medical process.

The organization and process of ICD-9 is similar to ICD-10 but the ability and number of codes available increases- ICD-9 has 13,600 codes while the ICD-10 has 69,000 codes.

The Centers for Medicare and Medicaid Services(CMS) announced in January of 2009 that ICD-10 will be implemented into the The Health Insurance Portability and Accountability Act (HIPPA) mandated code set on October 13, 2013.   This is exciting news for the Health Care industry, but the Clock is ticking will you be ready?

Reasons to Outsource Your Medical Billing

Monday, December 12th, 2011

The decision to outsource your medical billing is not always immediately clear. There are a lot of factors to consider including efficiency, staff costs, technology and a variety of other circumstances that may or may not make outsourced medical billing your best option. The following are some points to consider before making a final decision.

Your billing process is inefficient. You may have noticed that your in-house billing department processes claims too slowly and recovers far too little money. Outsourcing your medical billing will typically decrease the time it takes to process claims and increase the amount of money received.

You have high staff turnover. Employee turnover is a problem in almost all industries but it can be particularly damaging when it comes to medical billing labor. Claim processing is the  life blood of revenue for a medical practice and constant cycling of employees can slow down the process immensely.

Important Information about Medical Billing

Monday, December 5th, 2011

Medical billing companies are primarily responsible for the timely and complete processing of payments from both patients and insurance companies for doctor’s offices. Once a claim is filed with an insurance company, medical billing staffs are required to follow up on claims in order to make sure that money is received so that medical practices can thrive. The cycle of billing can take anywhere from a couple of days to as long as a few months. How long the cycle takes depends on how complicated the claim is and the insurance company that is being worked with.

The medical billing process starts as soon as a patient enters the office, whereby information is collected and kept up to date whenever the patient reenters the facility. The patient is then seen by the doctor and any work done is broken down into a five digit code from the CPT (Current Procedural Terminology) database. The diagnosis is then translated into a code that can be filed electronically known as the ICD-9-M database. These codes are transmitted by the Electronic Data Interchange; this is the most effective way of getting claims and payments processed as quickly and accurately as possible.

Claims are often rejected by insurance companies and the medical billing department and the process will have to start over again. If there are coding errors, those can be fixed and the claim refilled immediately. Otherwise, a patient will be sent an Explanation of Benefits sheet. Patients can always request that the insurance claim be filed again. Many insurance companies deny claims because they believe the procedure was not medically necessary. Payments for accepted claims will be received by the medical facility and the patient will be responsible for the balance of the bill. Regulations regarding these medical billing procedures have been instituted by the HIPAA (Health Insurance Portability and Accountability Act (HIPAA). Universal standards and practices are essential for an efficient and functioning medical billing system.

Coding and Billing Errors Can Decrease Revenue

Friday, December 2nd, 2011

Mistakes are unavoidable in most professions, but when it comes to mistakes in medical billing and coding, errors can end up costing a lot of money. Medical billing mistakes need to be addressed immediately in order to avoid a lot of lost revenue. Overlooking these mistakes can be a revenue disaster for any medical office in the long run. The following are some examples of medical billing and coding mistakes.

  • A physician performed an arthrocentesis on a 74 year old female. The biller billed the CPT code 20605 without the modifier-50. The insurer processed the claim and paid for unilateral service (100%) instead of bilateral service (150%). Medicare allowable for the procedure is $52.41 for unilateral service and $78.61 for bilateral services. In this case, the potential loss of this mistake if repeated over time can add up.
  • An ophthalmologist performed an excision of an eye growth with a graft but failed to document this on the chart. The staff didn’t know and used the CPT code 65420 (excision or transposition of a petrygium without a graft) in place of CPT code 65426 (excision or transposition of a petrygium with graft). The difference between these codes with Medicare is over one hundred dollars. This loss could have been avoided if the physician had documented in the chart that petrygium was done with a graft or if the staff had questioned the physician about the procedure.
  • A Chiropractor provided spinal manipulation on a Medicare patient and coded CPT 98940 (1-2 body area) but forgot to put in modifier-AT on the bill. The billing staff missed the fact that the modifier was absent. Medicare denied the claim saying that the procedure was maintenance therapy. The chiropractor missed out on about $25, which can easily add up over time if the mistakes persist.