During medical coding all verbal descriptions of diseases, injuries, and procedures are converted into numeric or alphanumeric designations. How did the medical coding originate? Coding was originally performed to classify mortality (cause of death), data on death certificates, besides being used to classify morbidity and procedural data. Since the early 1970’s, the HCFA (Health Care Financing Administration) has asked the American Medical Association (AMA) to work with physicians of every specialty to determine appropriate definitions for the procedure codes and to try to determine accurate reimbursement amounts for each code. Such type of coding is very useful especially as it helps us today to get easy access to medical records by diagnoses and procedures so that in can be used in,

Hospitals/clinics etc

Research work

Education

The federal government introduced The Medicare Prospective Payment System (PPS) in October, 1983, for better management of medical care. Each patient was classified into a DRG (Diagnosis Related Group) depending on the information from the Medical Record that appears on the bill. Under PPS, hospitals are paid a pre-determined rate for each Medicare admission. Since then there has been a great deal more emphasis placed on medical coding.

At present assigning of medical codes is the backbone for reimbursement of claims for Medicare patients. Codes are given for diagnoses, services, and procedures provided. Thus healthcare providers today have to comply with different medical coding guidelines.

Source: http://maryanngarth.easyworldwidemall.com/2010/07/06/the-origin-of-medical-coding/

Incorporating medical billing in dental practices has turned out to be a win-win situation for everyone. Patients are going forward with treatment, doctors are being paid, and satisfied patients are eagerly referring their friends and family. No doubt, a dental office will enjoy the rewards that come from happy, patients, profit stability, and a team that will receive compliments on a daily basis.

Here is a current list of some dental procedures that can be filed with medical carriers:

• Trauma procedures
• Medically necessary oral surgical, laser, and periodontal procedures
• Medically necessary implant, endodontic, and prosthodontist procedures
• Appliances to treat sleep apnea
• Screening to detect oral cancer
• Medically necessary exams and x-rays, including CT scans, associated with any of the procedures listed above

In fact, staff members at dental offices have been amazed at the number of cases that meet the criteria for filing a medical claim. While some similarities exist between preparing a dental claim and a medical claim, such as patient demographics and insurance demographic sections, there are also some significant differences, such as in coding systems. For instance, medical carriers ask for more than just a procedure code, which is all that is required by dental carriers. Medical carriers also require the reason (which is the patient’s diagnosis) why the particular procedure was done. Therefore, medical necessity is probably the most important element of successful dental-medical cross coding.

Dental practices that choose to implement a dental-medical cross-coding system will undoubtedly experience a positive impact on their day-to-day operation. Patients will certainly appreciate the fact that you are willing to help them obtain medical benefits and word of mouth is one of the most effective marketing tools that exists in any service business.

Source: http://www.medicalbillingcourses.com/blog/2010/02/billing-dental-procedures-as-medical.html

Initial Patient Contact – Front office staff or the patient scheduler should capture ALL pertinent information when a patient calls to schedule an appointment. Capturing general information like name, phone number and reason for appointment is a good start, but make sure you’re catching payor information as well. Does the patient have insurance? If so, who is the carrier, what’s their plan number? If not insured, are they prepared to pay up front and have they been briefed on your payment terms? Either way, answers to these questions will help in the insurance verification step and/or set proper expectations for payment at the time of service.

Insurance Verification – Either the scheduler or billing representative should use the information from initial patient contact to confirm with carriers BEFORE the office visit. This opportunity offers the chance to confirm enrollment, coverage levels, co-pays/deductibles, etc. Traditional verification of benefits over the phone is effective but time consuming; remember that you can usually save a lot of time using on-line interfaces offered by many carriers today. If the result is “no coverage” for this visit, or the carrier is unable to verify coverage, a follow up call to the patient should yield updated coverage information or at least guarantee everyone is aware of payment responsibilities.

Patient Registration – When the patient arrives at the office, the receptionist or a member of the front desk staff should verify ALL registration forms are accurate and complete. If it’s an existing patient, the receptionist should re-confirm that records are up to date. This step is the key to obtaining/confirming the detailed demographic data required for insurance claim submission – if anything is incorrect or missing, reimbursements can be delayed as much as a month or more. It’s also helpful for front desk staff to reiterate co-pay or self pay obligations at this time to confirm the patient is prepared to remit payment once the visit is complete.

Provide Care & Document Services – While the patient is in the exam room, or immediately following the visit, all diagnosis and care should be clearly documented on encounter forms. Patient forms are then forwarded to the front to cross reference with information gathered during insurance verification in Step 2, and the bill for co-pays and self-pay patients is generated.

Collect Co-payment – All patients should be required to stop by the cashier or reception desk to remit payment for co-pays, self-pay, etc. BEFORE they leave. If preceding steps are completed properly patients will already be aware of obligations, so there shouldn’t be any surprises. A receipt can also be generated now for the billing representative to document exactly how much was remitted by the patient, should any later balance billing be necessary.

Claim Generation, Submission, and Carrier Review – Clean claim submission is not just dependent on the information gained in steps 1 through 5, but also on processes that manage data efficiently. A good practice management or medical billing software will address this need, but remember that you usually get what you pay for – it’s usually best to not cut corners. The alternative to spending thousands on software is teaming with a professional medical billing company for, usually, a nominal percentage of receivables. Either way, if information is missing at initial claim submission, denial can add several weeks to the reimbursement process. If all moves smoothly, reimbursements can be forthcoming in as little as 1-2 weeks!

Insurance Reimbursement Received/Documented – Hopefully, all of the preceding steps have progressed smoothly and a clean claim was submitted. Our next step in managing claim information is proper documentation of reimbursements in the medical billing record. This step can often be simplified through electronic remittance and EOB notifications. If you’re not able to use electronic EOBs, then it becomes critical the billing representative is thorough in manual entry of all EOBs received. Keeping close eye on your EOBs – timing as well as reimbursement rates – can also identify which carriers are paying quicker and which might require a follow up call.

Patient Invoicing – This step is about communication with patients. Just like carriers, providing patients with thorough information will further help to reduce turnaround time and minimize questions. Be clear and note dates of service, insurance payments, fees collected at time of service, and total amount due. These statements should be sent out as soon as an insurance determination is confirmed. Many statistics have shown the sooner an invoice is sent, the more likely, and faster, it will be paid.

Enter Patient Payment – Upon receipt of the patient payment, the billing representative should enter payment information into the billing system and prepare to close out the charge. If payment is not received within a reasonable amount of time (i.e. 30 days), the practice should have clear policies in place for next steps. Small balances of say, under $5, might be taken as a write off; for larger balances a second invoice might be sent or the patient may be sent to a collections agency for further action. Regardless of your policies, don’t delay in taking action. A/R suffers most when these balances go unaddressed, carrying forward month after month.

Close Out Charge – Once final payment has been received, or a determination has been made to write off or send to collections, the billing representative should waste no time in closing out the charge.

These steps can generally be applied similarly with any patient visit in almost any specialty. Whether you have a staff of 20 or just one person, keep these opportunities in mind as you consider ways to improve the flow of information and reduce your practice’s A/R turnaround.

Above article publish on http://medicalpractice.touralive.com/10-ways-to-improve-your-healthcare-practices-ar/

•    Insurance authorization and verification

•    Cash posting and reconciliation

•    Weekly or monthly evaluation

•    Billing and enrollment

•    Coding

•    Updating anti-virus soft ware

HIPAA complaint software packages

HIPAA complaint medical billing software ensures easy way of sending electronic claims at a faster and cost effective way. It reduces claim rejection, increase collection and avoids delays. It provides a variety of functions like:

•    Electronic medical billing

•    Preparing patients ledger

•    Processing billing information and insurance payments

•    Claim submission electronically

•    Rebilling of insurance claims

•    Electronic medical records

•    Covering patience insurance authorization

•    Recording patients notes

•    Medical coding

•    Statement cycle billing

Hiring   HIPAA Compliant Medical Billing Service

HIPAA compliant medical billing service provides track for patient statistics and diagnoses with security of health details. It provides medical billing and coding services, quick turn around time and high level of security. Those medical billing companies following HIPAA regulation protocols can assure services confidentially.  So it’s better to hire a company that strictly follows all HIPAA protocols prescribed for medical industry. Such a medical company reduces work load and improve cash flow.

Above article publish on http://www.articlesbase.com/outsourcing-articles/medical-billing-service-hipaa-compliance-1963102.html

There are many good software applications that are available on the market and choosing the right one can be a daunting task if you don’t know what to look for.

Below are some features to check for when doing your research:

Medical Codes

One of the biggest advantages of using billing software is that you can eliminate cumbersome paper manuals on coding. Medical billing software gives you and your staff the ability to quickly search and insert billing codes with the simple click of a mouse. This vastly simplifies the process of claims preparation.

It is important however, to ensure that the medical billing software comes with an exhaustive and updated list of CPT, ICD, and HSPCS codes with a reliable system for periodically updating this list. Most software companies provide annual updates that can be bought for a small fee and installed either through a disc or downloaded from an online location.

It is also advisable to test-run the software to check for ease of use. The software should ideally offer a simple graphical interface for creating claims with easy search options and point-and-click functionality for choosing codes from a list.

HIPAA compliance

Apart from improving efficiency and reducing the number of errors, medical billing software can also help your practice meet HIPAA regulations related to individual privacy and security of healthcare information. There are many tools employed by different software development companies to meet these regulations. While these tools may not make your practice 100% HIPAA compliant, they can make a significant contribution. Most good medical billing software applications have several or all of the following tools built in:

Data encryption – This ensures that any information transferred online is intelligible only to the authorized recipients. 128-bit encryption is considered the industry standard.

Multi-level user authentication – This includes measures such as password protection, role-based access to restricted areas of the software/database, and automatic (timed) log off in case a workstation has been idle for some time.

Audit trails – Audit trails are records of all system activities including login information, files accessed, changes made to patient data, etc. These records are crucial for internal security audits.

Scheduled backups – These are necessary to prevent data loss. Most medical billing software comes with scheduled backup systems that allow you to periodically download critical patient data onto your hard drive or other secure location.

Claims Management

Electronic claims transmission not only speeds up the payment cycle but also reduces the number of rejected claims. Medical billing applications come with several time & cost saving features that can help practices improve their claims management system.

Visual Editors

Visual editors allow users to create and edit insurance claims forms through a graphical interface. Users can quickly add notes, make changes and submit claims at the click of a mouse.

Error Correction

This feature helps in minimizing rejected claims by highlighting missing information, mismatched ICD/CPT codes, and invalid insurance policy numbers, etc. before a claim is submitted for processing. This is a big time-saver and naturally reduces the possibility of claims being declined due to incorrect/incomplete forms.

Claims Submission

Submitting claims electronically can save hours of labor, reduce the number of rejected claims, and also speed up claims processing. Some insurance companies delay paper claims to up to 28 days, while electronically submitted claims can take just 24-48 hours.

Depending on the medical billing product you choose, there are several methods available for submitting claims electronically. One option is to send all claims to a clearinghouse. The clearinghouse will then forward the claims to the appropriate insurance carriers. This may, however, turn out to be expensive because of the per claim fee charged by the clearinghouse. Costs can be reduced by submitting claims directly to Medicare and Medicaid and processing the remaining through a clearinghouse.

Another option is direct online billing at the websites of the insurance carriers. Although there are no additional fees involved in this method, you must be an in-network provider with the relevant carrier to be able to submit claims at the carrier’s website.

Revenue Management

Medical billing software can significantly improve the payment cycle of any practice. This is through the account receivable module that comes with most software applications. This module helps practices keep track of payments received and payments outstanding. The software application also helps with faster payment applications to specific claims/charges, tracking how much of a payment remains to be applied, reporting payments receivable, automatic calculation of the write-off amounts, tracking billing, and other activities for improving the A/R cycle.

When choosing medical billing software, it is advisable to look for applications that either have these accounting features built-in or allow for easy integration with external accounting software such as Quicken or Peachtree. It’s also a good idea to thoroughly test the software to see if it has all the features required for your particular practice.

Medical Scheduling

Many software packages come with medical appointment schedulers that allow for easy management of patient appointments. Multiple features such as making or editing appointments, viewing daily, weekly, monthly appointments, viewing relevant patient demographics along with appointment details, scheduling recurring/multiple appointments, etc., can make these schedulers very useful for busy practices.

Trial period and Training

Most medical billing software developers offer trial versions of their software. Some also include on-site training for staff members who handle billing for a practice. These features give you the opportunity to not only check if the software has all the features advertised but also to test the suitability of the application for your particular practice. The usual trial period is of 30 days and provides you ample time to thoroughly test the software.

Technical support

As with all software applications, you and your staff would need ongoing technical assistance for the correct use and maintenance of the medical billing software. It’s therefore important to choose a vendor who can provide the necessary installation, training, and technical support. Most vendors provide an initial period of free support and then monthly or annual paid services.

There are many other features that can be compared and considered when deciding on the perfect medical billing software for your practice – software applications are constantly evolving to include more and better functionalities – but keeping these basic features in mind can help you make a reasonable choice.

Above article publish on http://www.emrconsultant.com/education/medicalbilling

Types of Medical Billing Providers

There are many medical coding and billing services in the market vying for clients. Healthcare provider needs to assess their own needs first, and then look for a service that serves their purpose. Most providers offer only billing services; they collect bills by submitting claims accurately and follow up on the payments. Some providers work only for small businesses, which are usually individual setups that offer specialized medical services. Large practice management companies offer comprehensive medical coding and billing packages that include administrative services for running the medical practice effectively.

Policies of the outsourced service providers

A professional medical billing provider follows business practices that ensure high quality of services. Healthcare providers should check the processes followed to ensure effectiveness of the service:

Persistent follow-up of bills

The service provider must follow up on payments aggressively and persistently. Insurance carriers are very fussy and reject or deny claims on administrative technicalities. The provider needs to ensure forms are filled in correctly so that insurance carriers do not get an opportunity to reject them, monitor government programs to ensure accurate payments and pursue all collections with tenacity.

Compliance with regulations

The Health Insurance Portability and Accountability Act (HIPAA) mandates the privacy, security and protection of patient data. Medical coding providers are also privy to confidential patient information, and should comply with HIPAA regulations.

Timely submission of claims

Medical billing providers should be well versed with the process, types of forms and the deadlines for each type of form. Claims must be filed within specified timelines or the insurance company will reject them.

Cost of service

Medical coding and billing service providers charge a flat fee for their services or a percentage of the claim they collect for the healthcare provider. The healthcare provider should examine which fee structure suits them best, and select a service accordingly.

Specialization

Some services providers have a specialty focus in a particular protocol. They promise better collections than general medical coding and billing providers do.

Communication with healthcare provider

The medical coding and billing provider and the healthcare practitioner should communicate openly and clearly to have an effective relationship.

Skills of the workforce

An efficient provider should have trained staff. Healthcare practitioners need to verify the following about the provider’s workforce:

* Are the agents trained in medical insurance coding standards?

* How much experience do the agents have?

* Are the agents updated about changing processes through regular trainings?

* Are the agents familiar with both Windows and UNIX based medical coding and billing systems?

* Does the provider work with employees or contractors? A provider that supports its own staff is preferred.

Technologies adopted by Medical Billing Companies

Providers have a better chance of getting results if they are supported by latest technology and tools. Electronic submission of forms is more effective and less error prone than manual submission. Incorrect forms are one of the main reasons claims get rejected by insurance companies.

Billing services can potentially increase the revenue of medical practitioners by almost 30%. An effective provider frees healthcare providers from the burden of administrative tasks and allows them to focus on patient care.

Above article publish on http://naturalguideforhealthyliving.com/?p=1089

Medical billing providers are using industry standard software that offers clients the advantages of cost, customization, efficiency, accountability and financial reporting. Healthcare providers should examine not only the services of the Medical coding and billing provider but also the quality and features of the medical billing software they use to ensure it is suitable for their practice. Here are a few guidelines on what to look for in the billing software solution.

Features of a Medical coding and billing software

All billing software must have the basic features to submit claims and manage billing electronically. However, this is just the tip of the iceberg. Efficient software provides flexibility, speed, transparency of data, security, point-of-sale bill tracking, extensive reporting, scheduling of patient visits, scanning, printing, credit card processing, email capabilities, and much more.

Standard features of medical billing software include:

* electronic filing of claims

* editing of previous claims and resubmission

* one platform for charges, adjustments and payments

* sending patient statements

* reporting financial statistics for decision making

* customizable screens for accounting

* user friendly interface

* web-based or wireless access to the system

* data security

* one platform for in-house staff and billing service personnel

* transparent transaction processing

* visible charge balance

* full transaction control

* HIPAA compliance

These features ensure medical providers have access to complete information, the billing service is well organized and accurate, and the entire medical practice works more efficiently.

Medical coding and billing service providers ensure their client’s staff is trained in the software and also take care of maintaining it. They are also responsible for upgrading it when required, and regularly backing up data for data security.

Advantages of using Medical coding and billing software

It makes the medical coding and billing process a lot easier and accurate. The manual process of filing claims is fraught with inaccuracies that cause insurance carriers to reject claims.

Some of the major advantages of medical billing software are:

* Standard electronic forms and codes ensure accuracy of forms, which reduces the chances of the claim being rejected.

* Cash flow increases as the time to payment reduces.

* The software is built on industry standards and ensures HIPAA compliance.

* Time and effort is saved because of easy follow-up of claims through reports and tracking features.

* Better decision making due to extensive reporting of financial statistics.

* Data transparency allows medical providers to oversee the electronic submission of claims.

* Billing providers and medical providers can access the same data and work together to improve collection rates.

A billing provider must use a good quality software solution to give the maximum benefit to its clients. The electronic process of filing claims and managing data through software improves the efficiency and revenue of medical providers.

Above article publish on http://www.goodzines.com/medical-billing-service-how-does-software-aid-electronic-filing-of-claims-and-improve-collections/

To ensure timely payments by insurance companies, medical claims must be processed in a timely manner and submitted to the appropriate insurance companies for consideration.

Some facilities employ medical billers and coders. Other facilities employ individuals who handle both aspects of the claim process simultaneously. A medical biller and coder will generally earn more than a medical biller or coder does. That is because he or she is performing double duties and eliminating the need for the health care facility to hire two different people.

Medical coders provide the diagnostic codes and procedure codes that apply to the patient’s visit. If the codes do not match, a claim may be denied. The insurance company

will more than likely say that the treatment was not medically necessary. That is why it is so important for a medical coder to be precise.

A medical biller obtains the correct codes from the medical coder. He or she uses the codes to fill out a claim form. The claim is submitted to the insurance company, generally in the form of an electronic claim. It is important that the medical biller comply with the requirements of each insurance company. Many have specific guidelines that must be followed. The claim could be delayed or denied, if the claim form is not filled out properly and according to the insurance company’s regulations.

Medical billing software is often used in medical claims processing. The software saves time and eliminates common mistakes. Medical billing software allows medical coders to look up diagnostic codes and procedure codes via the software rather than in a manual. The software also checks databases to ensure that the diagnostic codes and procedure codes match up, eliminating the denial of claims based on discrepancies.

Above article published on http://www.chiroeco.com/chiropractic/news/6718/1100/Medical-claims-processing/