Medical Billing Blogs

  Did you know? Ambulance codes and guidelines apply only to non-physician providers. As the CPT codebook lacks procedure codes relevant to  emergency medical service (EMS) providers , this makes Bill for Ambulance Rides services even more difficult.  Instead, ambulance and EMS transport coding guidelines are primarily derived from Medicare transmittals and MedLearn updates. Payers typically cover ambulance services, including fixed and rotary-wing services, for patients whose medical condition necessitates air transport. To ensure that transportation is medically necessary, consider both the patient’s condition and the mode of transportation.  This can be a difficult process that is dependent on the documentation provided by paramedics and emergency medical technicians (EMTs) covered in this blog. Bill for   Ambulance Rides Guidelines The CMS-1500 is used to bill for ambulance rides services provided by an independent ambulance provi...

  The intricacies of medical billing appear to have no end in today’s complex and difficult reimbursement situations. Regardless of the challenges, you must be ready to guarantee that collections are optimized and streamlined. As a result, keeping track of your practice’s financial performance while providing excellent patient care is critical to the success of your medical billing practice. How do you know if your business and the people you choose to execute your medical billing practice is running at full speed? Creating a dashboard of key performance indicators might help you stay focused on your goals. Medical billing metrics, also known as Key Performance Indicator (KPI’s), assist practitioners in gaining a better understanding of their revenue cycle and providing insight into how to boost collections. This is why so many practices will concentrate on medical billing key performance indicators. 1. Identify bad debts One of the most important medical billing KPIs to ke...

  Outstanding Accounts Receivable (AR) in healthcare are one of the most pressing issues confronting the practices. In fact, healthcare providers are frequently looking for the best solutions to reduce their receivables for more than 30 days, as well as ways to prevent them from happening in the first place . Accounts receivable (AR) that is more than 90 days old is a key industry metric for determining the health of your cardio practice. According to healthcare data, AR over 90 days is in the average 15-20% range. If you have a greater percentage of AR that is more than 90 days outstanding, you obviously have a severe cardiology billing problem on your hands. Lesser the number of days in A/R means greater efficiency and faster payments. That’s why the majority of cardiologists want to strive for an average A/R cycle of 30 days for smooth cash flows. Reasons for Increased AR Days: ·          Delays in filing claims ·   ...

  Due to the sheer complex procedures required to make the bills accurate and compliant, pharmacists were never at easiness with pharmacy billing requirements. The problem has been exacerbated over time by recent trends of declining reimbursements and rising DIR fees . To counteract the dual impact, pharmacists are now providing clinical care to patients. In the process, they have added another problem to their list, i.e., billing in lockstep for a service that is vastly different from pharmacy medical billing. Unlike hospitals and clinics that have full-time billers and coders to deal with billing and coding issues, pharmacies have to bill without the assistance of these dedicated experts. Furthermore, billing for clinical care is a detailed and time-consuming task that pharmacies cannot afford to spare. In such a scenario, the only and simple solution for pharmacies is outsourcing pharmacy billing services to an experienced pharmacy billing company. These providers have phar...

  The old saying "the best defense is a good offense" has been applied in a variety of fields. To achieve the maximum first pass acceptance ratio, you must be cautious when filing insurance claims. Even if you believe that everything was submitted correctly, there are a plethora of reasons for insurance claims to be denied. Lack of specificity in code usage, incorrect application of modifiers, and a variety of other factors may result in a lower percentage but outweigh the total charges submitted. According to the American Medical Association, insurers deny between 1.38 percent and 5.07 percent of claims. Even the best-performing practitioners have a 5% denial rate as per the Medical Group Management Association. Failure to work on insurer denials results in revenue loss for your medical practice. Though it's easy to point the finger at someone else, it's critical for a pathologist to develop and optimize proven techniques for getting claims paid. Let’s disc...

  You are an orthopedic practitioner who wants to be compensated properly but are you stuck with an inefficient billing process? Your medical billing for the revenue cycle is one of the most critical functions in your orthopedic practice which means you will need to ensure your billing needs are completed accurately and promptly. Not just that, it’s essential to keep up with all the latest medical billing and coding updates so that you stay compliant. With a proper medical billing system, your practice can gain continuous revenue with minimal delays and lesser stress for cash flow issues.   When it comes to orthopedic billing, there are important processes and standards that are to be followed to ensure the billing is specific with minimized chance of claim denials.   Accurate Patient Information   We are aware of the practice of having accurate patient information but often we disregard the importance it holds and how it affects the billing service. It’s es...