Medical Billing Blogs

  In the healthcare system, denial management and on-time submission are essential to warrant seamless cash flow for the hospitals and patient satisfaction. Many healthcare facilities use third-party medical billing company to reduce billing errors and claim denials, enhance the cash flow, and warrant medical billing compliance while improving patient satisfaction. With outsourcing medical billing, healthcare practices can save immensely on employee expenses and the overall infrastructure costs that often come with hiring and employing medical billing staff. This blog will explain how any healthcare facility can increase its profit in 2023 by outsourcing medical billing. Interesting Statistics on Outsource Medical Billing Before going into the details on how outsourcing medical billing can ramp up the profits for healthcare facilities, here are some figures that can help you to understand why it is an essential step to move ahead in 2023. Grand View Research reported on t...

  The healthcare system has undergone an immense transformation in the last couple of years. With the rise of technology and the implementation of virtual care, medical billing has also undergone a significant change. It can be proved by the statistics in medical billing, which point toward advancing several new trends. It includes a substantial rise in the adoption of virtual payment systems and new medical billing technology implementation. As the year 2022 ends, and we move into 2023, it’s time to look into some of the top five trends in medical billing services in 2023 that will revamp the healthcare system. Knowing the latest trends will help you understand where your facility lacks and implement them for better revenue for the following year. 1. Autonomous Coding A report by Kaufman Hall stated that operating margins for hospitals were down by 80% in 2021 compared to the pre-pandemic phase. The number indicates that hospitals and other healthcare facilities need encourag...

  From the initial appointment stage to the collection of the claims after the services are rendered, a healthcare facility goes through a lengthy process that includes several organizations and people. The result is of having a scenario of too many cooks in the kitchen, which can open the medical billing process to mistakes. In medical practice, errors in billing coding are thus most common and occur often. It eventually affects the facility’s income, exposing it to scrutiny by the authorities. Many healthcare providers hence prefer to work with medical billing partner. It decreased the in-house burden of medical billing and training the staff while increasing the revenue with proper claims. However, the impact can be tremendous when the wrong medical billing partner is chosen. Some of the effects are: 1. Coding & Billing Errors In medical practice, one of the most complex but vital steps is to do correct coding, documentation, and billing to ensure the facility gets paid for ...

Whenever any healthcare facility hires a new healthcare practitioner, such as a nurse, physician, or any other new healthcare staff, they must undergo a credentialing/ re-credentialing services. Credentialing is the process that allows the medical facility to verify the skills, qualifications, and other credentials listed, along with getting approval from the medical insurance providers with whom your facility works often. However, if you think credentialing is done once the payer’s network accepts them, then you are wrong. Mainly, when it comes to healthcare providers, they have to undergo regular screening and verification to warrant that they comply with federal and state medical guidelines and comply with them. Screening and verification are also accompanied to ensure the providers can give quality care to the patients. Such a process of regular screening and verification is known as re-credentialing. Why Credentialing/Re-Credentialing Is Important? For any healthcare facility to e...

Skilled Nursing Facility (SNF) differs from nursing homes, so their services are also different. Many confuse the two, but nursing homes can have experienced nurses who do not require professional care like SNFs, which marks the difference between the two. In most cases, the care provided by SNF is by occupational therapists, physical therapists, speech-language pathologists, and common and licensed practical nurses. Though the list is not exclusive, patients in SNFs that are part of the Medicare practice can be admitted to skilled nursing residents in several cases. Thereby, the billing process resulted in problems that were eventually rectified with the SNF consolidated billing (CB). SNFs Billing Issues The confusion between nursing homes and SNF often results in claim rejection and denials. In the Balanced Budget Act of 1997, Congress mandated that most nursing services be provided under the SNF in the potential payment bundle. The bundle was to be paid through Part A of  MAC (M...

  Did you know that 35% of the claims made in Orthopedic surgery are incorrect, and 25% of them get rejected? If you ask an orthopedic medical professional, they will tell you that orthopedic coding and billing are tedious and, in medical schools, they aren’t taught very well. However, when practice starts in real life, it is essential to get knowledge for getting paid for the services provided while dealing with the following complexities. Orthopedic Billing Complexities The new ICD-10 has revised 134 codes, deleted 143, and added 264 new codes in orthopedic coding. Furthermore, the introduction of modifiers like XU, XE, XP, and XS is quite pathbreaking in the field, accompanied by the new rules for  modifier 59 . All these recent changes and the existing coding and billing practices in Orthopedic make the process quite complex. As a result, the Orthopedic biller and coder need to document the treatment carefully and ensure proper codes are used and charges are placed for the...

  A new set of Current Procedural Terminology (CPT) codes are to be released by the American Medical Association for 2023. The update aims to reduce the burden of coding regarding the E/M (evaluation and management) visits. The E/M coding and documentation changes can be termed as once-in-a-generation guidelines restructuring in 2023. With several deletions, alterations, and additions in the coding and documentation guidelines, many providers believe it will be a game changer. This blog will provide concise guidelines for the new E/M coding and documentation released by the AMA. The Deleted E/M CPT 2023 Codes This revision will delete several codes, and new 2023 guidelines for the  Evaluation and Management coding  will transform the medical billing and coding industry. They are as follows: Codes from 99217 – 99220 and 99224 – 99226 will be deleted under the hospital observation services. Though the 99217 code is for the services of observation care discharge, 99218 – 992...