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Medical Billing Audit – A Way to Optimize the Billing Process

Medical billing and coding services serve as the backbone for any medical practice. If the process does not go as per the latest guidelines, medical practices can suffer from an unstable financial situation.

Thus, to secure efficient revenue cycle management (RCM) and reduced accounts receivable (AR), healthcare organizations must consider medical billing auditing.

What is the Billing Audit?

It is a process that helps highlight the problematic areas in the clinical documentation of rendered services. The goal is to rectify those issues and improve the revenue cycle.

Why Medical Billing & Coding Audit?

Medical billing audits allow healthcare service providers to review their billing practices, coding semantics, and claim submission approach. It is a way to see if your system runs smooth or need an upgrade for improved performance in medical billing and coding.

Moreover, medical billing auditing also gives insights into the inconsistencies that might not be a problem at the moment but can be disastrous after a while.

Save Your Medical Practice from Penalties

If your medical billing and coding services are not compliant with HIPAA (Health Insurance Portability and Accountability Act), there is a chance of a government strike. They can penalize your medical practice if your billing standards are not up to the mark.

Thus, to improve the medical billing and coding standards and streamline the financial situation, billing audits are crucial.

Why Claims Get Rejected or Denied?

Medical billing audits are an opportunity to improve claim performance. Generally, claims get denied due to the following reasons.

  • Improper or false payment adjustments
  • Patient eligibility and verification issues
  • Wrong documentation of healthcare procedures
  • Lack of necessary medical information

There can be many other reasons that can make government or private insurance payers deny the claim. And, if you rectify the potential errors, you can have the following outcomes.

Advantages of Conducting Quality Medical Billing Audits

  • Improved coding accuracy as per the latest guidelines
  • Identification of the potential problematic errors
  • Enhanced reliability and transparency of the billing system
  • The streamlined workflow of your medical practice
  • Strengthened relationship between medical practices & insurance companies

These are just a few general examples of how internal and external audits can help you improve the revenue cycle.

Professional Billing Audit Upgrade System 

We cannot stress how risk analysis of the billing and coding process helps generate revenue. Administrative benefits, coding efficiency, higher claim acceptance rate, clinical benefits, thus, healthcare organizations’ performance owes to the auditing.

Thus, improvement in the medical billing services does not just enhance revenue generation. It also leads to improved quality and transparency in the following manners.

  1. With upgraded billing and coding practices, the claim compilation and submission process become smooth and instant.
  2. The cost-efficiency is improved as there remains no need to invest effort and time in processing claims again and again.
  3. The upgraded system is more reliable to generate timely reimbursements; the workflow becomes consistent.
  4. Data management and documentation become easy.
  5. We can design data-driven medical billing and coding strategies.
  6. A robust system allows a proactive approach towards the medical billing and coding services rather than being reactive (when some problem occurs).
  7. The analysis report helps to take strategic decisions & improve the quality of the medical billing and coding process.

Medical practices stay relevant with the latest billing and coding practices by removing vulnerabilities in the system.

Conclusion

The regulations have become stricter over time, and there is no margin for inappropriate or false services. Even if your medical billing and coding practices works fine, medical billing audits help to avoid mistakes, ensuring reliable revenue cycle management.

Thus, you become compliant with the government’s regulations and policies. Ultimately, the compilation of the claim gets effortless under an expert team.

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10 Steps of Medical Billing Services for Effective Revenue Cycle Management

Revenue cycle management is an integral part of medical billing services. Every company has its own process of catering to claims, but for effective revenue cycle management, certain steps must be in order.

These steps when are performed systematically enhances the performance of your revenue cycle.

Patient Registration

The process of medical billing and coding starts with patient registration.

The front desk staff takes the necessary data and information from the patient to set an appointment for the doctor before the treatment. As soon as the patient registers with the physician, medical billing companies take their medical record to cleanly create the claim.

Moreover, professional medical billers ensure the accuracy of the information provided in the first step.

Patient check-in and checkout are an integral part of the patient registration process. To be precise, the front desk staff hands over a form to the patient for the information collection. Even if the medical billing staff has the information, they confirm the relevant information via the passport or the driver’s license to verify the patient’s identification.

Once the patient checks out (after the appointment), the information and the rendered services are compiled as a superbill. The actual medical billing and coding process starts from here.

Insurance Verification by the Medical Billing Service

In this step, outsourcing medical billing services verify patient’s insurance completely. The Healthcare plan is thoroughly analyzed to check eligibility and policies’ compliance.

After the verification process, billing experts also check patient’s responsibilities such as, deductibles, copayments, and out-of-pocket expenses that they have to bear.

In some cases, prior authorization is necessary from the insurance companies before the service is rendered. It also takes place in this step.  Most medical billing services use digital mediums to store and verify the information.

Recording of Patient’s Encounter

The physician-patient encounter is generally recorded or documented to keep a record of the patient’s health condition. It helps medical billers and coders to bill and codes the performed services for accurate claims.

Medical Transcriptions

Medical transcriptions refer to the documentation of transferring video or audios of the patient’s encounter with a physician in an appropriate billing format.

After the billing company receives all the necessary information, they start with the actual billing of the services. The accuracy of information is always regarded, and outsourcing medical billing companies also ensure HIPAA-compliant billing services.

Medical Coding

As obvious, now is the time to assign medical codes to medical transcriptions.

The process is to simplify the billing process as it is hectic for payers to read the complete medical history of patients. Therefore, medical coding is important and saves time.

Only experienced coders are allowed to code who are familiar with the CPT (Current Procedural Terminology) codes, and ICD 10 codes.

Charge Entry/Medical Billing

Before sending claims to insurance companies, it is important to bill rendered services in proper order. Patients’ records are again monitored to rectify any errors. In case of any error, insurance companies deny claims or simply reject them, which dent the revenue cycle and increase the rate of accounts receivable (AR).

Charge Transmission

It is the step in which claims are submitted to payers either government or private via EDI (Electronic Data Interchange).  Extra measures are taken to compile clean claims when sent through EDI.

There come three situations in cases of claims with errors.

Mandatory fields are to be filled, otherwise, the system rejects the claim – a process known as scrubbing.

Claims with invalid information are also rejected by the system.

The system also rejects the claims that are not compiled as per the payers’ policies.

Here, the billing teams have to double-check every measure that no secret information gets leaked.

Accounts Receivable Management

The AR calling team checks up on every claim after it is submitted to respective insurance companies. The purpose of this step is to ensure payment posting in an efficient manner. This team is also responsible for sharing any additional information like account details and helps remove errors in claims.

They also correspond with the physicians, patients, and insurance companies and inform them about any updates.

Denial Management

This step caters to denied claims by the insurance companies. Sometimes, some claims are not compiled up to the mark. Denied claim management deals with such issues. Constant follow up services are part of denial management that timely acknowledges errors, rectify them, and reimburse physicians.

Follow up services, being part of the denial management, keep track of the claim performance. It is done to maximize the reimbursement rate. Ultimately, no claim goes to waste or gets rejected over minor issues.

When medical billing services submit claims to payers, the follow-up team analyzes the processing of claims systematically. They are responsible to segment denied claims with the accepted ones and communicate with stakeholders (insurance companies, patients, clearinghouses, and more).

Payment Posting

This is the end of the medical billing and coding process that helps the team to be updated about the payment situation.

EOB (Explanation of Benefits) and ERA (Electronic Remittance Advice) all are provided to the concerned patients. The team concerned with the Payment Posting also checks if the payment received is accurate.

These ten steps describe the complete process of medical billing services and are crucial to keeping the revenue cycle running smoothly. For more information, visit our website – www.p3care.com

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What’s New in Medical Billing Services for Cardiology?

Cardiology is tough and encompasses new techniques and technologies every now and then. Therefore, its medical billing services require special understanding to adapt to changes in the reporting requirements.

Cardiologists have to work under several conditions and deal with intensive bloodwork and other invasive procedures. The varied conditions reflect on charges as they depend on the rendered service location, i.e., a hospital, a private clinic, or a same-day surgery center.

An important thing to maximize revenue for cardiologists is that outsourced billing services drive abstract physician operational notes. It helps them to compile claims with accuracy and exact information on medical procedures.

The efficiency of medical billing companies for cardiology also extends to the knowledge of CPT (Current Procedural Terminology) codes, expertise-related codes (cardiology-related), and HIPAA compliance.

Before diving into the updates for cardiology billing and best practices, we must be aware of the fact that cardiology medical billing and coding comprises of twenty-six new CPT codes with eleven topped up codes. In addition, there are four hundred and fifty changes in the ICD-10-CM coding system so far.

Code Changes for Cardiology

Medical billing services can use the following codes for the leadless pacemaker.

Leadless pacemaker 33275 includes imaging guidance, transcatheter removal of a permanent leadless pacemaker, and right ventricular is revised. Should you choose to find end-to-end medical billing outsourcing, a company that updates itself to gain knowledge of new procedures is the right company. It is wise to ask them if they serve any cardiologists currently.

New code 33275 includes imaging guidance (For Instance, fluoroscopy, venous ultrasound, ventriculography, femoral venography), transcatheter removal of a permanent leadless pacemaker, and right ventricular is revised.

Pericardiocentesis (33016, 33017, 33018, and 33019) are the four new codes for pericardiocentesis. The code 33010 is removed from the list.

Changes for Cardiology ICD-10 Codes: Medical Billing Services Near Me Does the Trick

There are some minor changes in the ICD-10-CM codes for cardiology that can affect the performance of medical billing services (if they don’t pay attention). For Instance:

New codes are Introduced for Cerebral Infarction (I63)

  • 89 – For cerebral infarction.
  • 81 – For cerebral infarction due to occlusion or stenosis of the small artery. It also accounts for lacunar infarction.

Cerebrovascular Disease (I67) Has a New Subcategory 

  • 858 – For other types of hereditary cerebrovascular diseases.
  • 850 – For cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. It also accounts for CADASIL diagnosis.

Hence, search for the phrase ‘medical billing services near me’ to find the best companies near your practice in Google.

Now, let’s move towards the best billing practices that cardiologists or medical billing services may incorporate within their system and see remarkable results in their account ledgers.

Best Medical Billing Practices

Use of Dedicated and Correct Codes

Incorrect documentation and improper claims can risk your reputation and finances. Even, they can make you suffer from audits and increase your expenses. A simple practice is to keep a check on your mistakes and obsolete practices that might restrict the smooth motion of the revenue cycle.

EHR (Electronic Health Records) are used for the purpose to collect patients’ data and maintain accurate records.

Cardiac procedures are complex. Therefore, the inability to provide accurate documentation can result in lacking important codes.

For more on dental billing services, check out this blog post: Medical Billing Services for Dentists by P3Care, Ontario, CA

Use a Combination of Codes to Report Conditions with Precision

ICD-10 codes are modified to include a set of combo codes to state patient’s conditions. Medical billing services should have the knowledge of using codes in their places. For Instance,

  • 0 is only for hypertensive heart disease with heart failure
  • 2 is for hypertensive heart, chronic kidney disease with heart failure, and stage 5 chronic kidney disease, or end-stage renal disease.

Document Diagnostic Procedures Carefully

Billing services should not include diagnostic procedures only because of assumptions. Avoid using false codes and only document procedures that were performed based on the symptom codes.

Do not use codes that are generally associated with the disease and are not conducted specifically. However, claims can have diagnostic codes as per the ICD-10-CM reporting guidelines. 

Check into Different Medical Conditions (Comorbidities)

Reimbursements somewhat depend upon the patient’s health status. For instance, a patient with comorbidities can cost more as compared to a patient with no comorbidities.

Medical billing services should state the actual medical condition of the patient depicting the complexity of the case. When insurance companies get to know the complexities, they can also estimate the actual expense.

Cardiology medical billing is certainly difficult; therefore, many professionals prefer to outsource their billing to segment every data and adjust each code accurately. We also suggest it is the right option, instead of ruining chances of sending clean claims.

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4 Powerful Ways to Improve Medical Billing Services

Medical billing services are a vital player in the US healthcare industry. Without them, physicians would have to face dire consequences in the revenue cycle. However, when the focus is upon refining the quality of care, the healthcare providers demand the same quality criteria for medical billing companies as well.

Outsourcing medical billing is a way for dedicated billers to take control, but it also supports the whole revenue cycle management process. When we talk about taking the healthcare industry ahead, medical billing companies must equally go through the process of screening according to set standards. It will benefit physicians and patients alike.

Two physicians from Johns Hopkins University researched in this sector and concluded the following arguments.

Let’s find out!

Medical Billing Services Should Be Transparent

Medical claims should clearly state the codes to get an estimate of the total bill without difficulty. Not only physicians but also the patients can read the claims. They must have the facility to check if the rendered services are accurate and billed correctly.

Firstly, it empowers patients and then the doctors, making them independent financially. Secondly, it checks costs as they turn out to be accurate for patients, useful to both doctors and patients. Ultimately, it leads to increased transparency in the billing procedure.

Opt for Price Transparency 

Another suggestion by physicians is to make prices public for patients. Although some medical practices in the US offer this facility to patients, it is still not the norm everywhere. The vast majority haven’t made them public yet.

Allowing patients to view prices of diagnostic and surgical procedures is to offer them price transparency. Moreover, patients would know their out-of-pocket expenses beforehand, and physicians would know their bills.

To know more about quality medical billing services, this might be a good read:

10 Steps of Medical Billing Services for Effective Revenue Cycle Management

Involve Patients in the Billing Process

In order to improve medical billing services, it was suggested to encourage patients to speak with the concerned person in case of any ambiguity in the bill.

With this facility, bills would often be correct, on time, and accuracy would increase while preventing errors resulting in reduced denials. Moreover, patients would get more involved in the billing process, and their input can be utilized to compile cleaner claims.

Another thing that can help patients empower is informing them about their financial obligations beforehand. Often, clinicians have trouble getting reimbursements from patients. The reason remains patients are oblivious of the out-of-pocket expenses.

If there is a team, be it the front-desk department, that stays in touch with the patients since the appointment phase, the communication gap reduces significantly. Consequently, the payment process becomes speedy, resulting in smooth revenue cycle management.

Don’t Burden Patients Unnecessarily

Looking into the payment system, patients have to pay higher than the insurance plan devises for them. This approach is actually unfair in terms of the transparent flow of money. Furthermore, medical billing services should consider complications that may occur while the patients receive care.

The idea is to offer value-driven healthcare services to the patient alongside an optimized healthcare expense.

The financial aspect is crucial for the healthcare industry. The focus has to be only on the quality of services, but also on optimization and transparency of prices. It is observed in a survey that a large population of patients thinks of delaying healthcare services due to concerns in medical bills.

Thus, CMS and other governing bodies have to empower patients in the billing process for better outcomes. Let’s do that right away.

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P3Care Investigates HHS Report for Providers Relief Fund Concerns

We understand that this time is difficult and hospitals, healthcare professionals, medical billing services, insurance companies, clearinghouses are working on top of their abilities.  Of course, no one is undermining the efforts of the healthcare industry. However, the pandemic is not an excuse to not keep clean records of healthcare attributes.

What HHS Has to Say About It?

The U.S. Department of Health and Human Services (HHS) has cleared the sense of the notion that the disparity in data transmission or data incompleteness is not negotiable.

Inconsistencies in Data Requirements can Effect Physicians’ Revenue Cycle

To follow through with the CARES Act Provider Relief Fund money, physicians must abide by all the terms and conditions.

Important clauses for this relief fund are:

  • The fund is only to be used to avoid or respond to coronavirus effects.
  • The fund is only to be used as compensation for the lost revenue or the endured healthcare cost during the COVID-19 pandemic.

Physicians were quite unsure about how to act to these facts. Of course, medical billing outsourcing companies can’t proceed without their clients’ consent. Therefore, HHS took it upon itself to explain all the complications that restrict healthcare professionals to benefit from this program.

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HHS Explains the CARES Act Provider Relief Fund Requirements

A few weeks back, HHS issued a draft as in FAQs (Frequently Asked Questions) that answered all the physicians’ concerns. Moreover, medical billing services get a chance to look into attributes that were most wanted, especially the documentation of items that home care providers need to record in their records. For Instance,

  • Medical supplies to offer healthcare service for possible or actual COVID-19 positive patients
  • Medical equipment to offer healthcare service for possible or actual COVID-19 positive patients
  • The training/education of workforce offering services for COVID-19
  • Getting access to training, resources, equipment, recruitment, etc. to streamline the workflow

Although the expenses should be with respect to the COVID-19 treatment or response, HHS stated that it is highly unlikely that the COVID-19 expense goes back to the date before January 1, 2020.

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What are the Lost Revenues that are Attributable to COVID-19?

HHS also explains this phrase. Lost revenue will subject to any financial loss that is incurred due to coronavirus.  It also includes cases where medical billing companies couldn’t generate revenue for healthcare professionals due to fewer patients visits, canceled or delayed elective medical treatments and procedures, or surging uncompensated loss.

According to HHS, the dedicated fund can also be used to recover costs as long as they are subjected to coronavirus prevention, response, or planning. It implies that the expenses don’t have to be specific to coronavirus positive or possible patients, but it just has to be lost due to the pandemic.

These funds can also be used to maintain the quality of healthcare services and their timely delivery to the patients.  For instance, to pay for the payrolls, insurance plans, or EHR (Electronic Healthcare Records) fee.

Fund Allocation for Different Sectors 

As per the HHS report:

  • $11 billion is for rural hospitals, including Rural Acute Care General Hospitals, Rural Health Clinics (RHCs), Critical Access Hospitals (CAHs), and Community Health Centers
  • $4.9 billion to skilled nursing facilities (SNFs); an additional $2.5 billion to skilled nursing facilities and nursing homes
  • $500 Million is for Tribal Hospitals, Clinics, and Urban Health Centers

Conclusion

This fund can be a ray of hope during the financial crisis period. HHS tried their best to give relief to patients. Now, it is up to medical billing services to strategize and compensate for the losses.

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How Accuracy of Medical Claims Could Save Your Revenue?

Medical billing and coding is an important step in the physician’s payment model. Depending on the compiled claims by the medical billing outsourcing services, insurance companies decide if the rendered services are valid and if physicians should be reimbursed. Therefore, the accuracy of the claims and medical billing services holds a crucial place in the healthcare industry.

Why do Experts Stress on Accuracy of Claims?

If physicians want to get reimbursed on time, the accuracy of the claims should be maintained. The wrong documentation or manipulation of data results in denied claims, even when the physician has provided the service to the patient.

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Another issue is the under-coding when physicians are not paid as much as the service cost because of coding errors.  Over coding can also dent the reputation of your healthcare organization. You can be charged with fraud and can bear financial and legal complications.

The survival of the medical practice can become difficult if medical billing companies don’t pay attention to the accuracy, resulting in revenue loss.

It’s also about the reputation of the medical billing companies, the high claim acceptance rate they have, the more revenue they generate, and the smoother revenue cycle management process become.

Is Medical Billing and Coding Complex?

Medical billing services are a serious profession. The sensitivity of this field can be analyzed by its impact on healthcare professionals. There are several code sets and monitoring authorities, from which billers and coders can take guidance. Anyone, who is responsible for creating claims, must know about the exact diagnostic procedures, surgeries, documentation of symptoms, age, gender, pre-existing conditions, and all. Not just the claims must be accurate but also the HIPAA-compliance needs to be there to ensure the confidentiality of the information.

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Staying up to date with the latest knowledge and creating claims accordingly is the skill and handling the bulk of claims at the same time is tricky. It is also a fact that leaving medical billing and coding responsibilities to in-house staff can cause financial problems.

Check and Recheck

Before filing medical claims with insurance companies, it is wise to check and recheck since there is no room for mistakes. A slight error could easily result in denial; and, denied claims use up time to get reimbursed, eventually, leading to delayed collections. Hence, a practice needs trained people to work on their claims for a breezy cashflow. One of the ways to achieve that is to look for billing companies with EHR knowledge.

Clean Documentation or Technology-Driven Documentation

EHR (Electronic Healthcare Record) technology is a savior in making the medical billing process smooth. It works on the basic formula:

  • EHR allows physicians to document details accurately
  • Medical coders can accurately error-free claims, which can be billed easily

Thus, medical billing services can create clean claims with precise available information. Ultimately, it takes lesser processing time at clearinghouses. As a result, physicians can get timely reimbursements with a reduced rate of account receivables.

So, What Option is Left.

We suggest outsourcing to medical billing services is the best option for a seamless revenue cycle. They have dedicated staff to handle all the accounting information and tasks, which certainly, can’t be managed in-house when you have patients to take care of.

P3 Healthcare Solutions is a professional medical billing service that has years of experience in creating claims and helping hundreds of physicians in maximizing their revenue cycle. It is our way to share their administrative burden.

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COVID-19: HIPAA Security and Privacy Guidelines Relaxed for Providers

The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services has announced relaxation in HIPAA rules for covered entities and business associates who participate in good faith in the COVID-19 testing site operation.

It doesn’t stop there, but HIPAA penalties won’t apply to covered healthcare providers for practicing telehealth medicine using third-party applications such as Skype or Facebook Messenger. OCR exercises its power to stall some of the HIPAA provisions, momentarily, in connection with the good faith provision of telehealth during the state of a national health emergency.

Provided we stand in the middle of an epidemic and our country is under attack, rightly so, such steps seem to be the only way out. Governor, Andrew Cuomo, of New York State, was a constant media personality during this crisis briefing us on developing stories every day. He was relentless in front of an unseen enemy.

The fact is, OCR holds the right to exercise enforcement discretion, and they did so on April 9 in an immediate press release. It goes to show their determination to eradicate the novel coronavirus from the US. Also, it speaks of their active role in the recovery process.

Director OCR, Roger Severino, narrates and I am paraphrasing it; It is time to empower medical practitioners to serve patients across the United States during this public health emergency period. We are concerned about the health of the vulnerable the most, including older Americans and persons with disabilities.

Why the Relaxation in HIPAA Rules?

First, the HIPAA rules were relaxed to provide immediate assistance to healthcare providers, including some large pharmaceuticals and their business associates that would like to participate in community-wide testing site operation. Second, it is officially called the Community Based-Testing Site (CBTS) operation. In short, it involves mobile, drive-through, and walk-up sites where they would conduct COVID-19 specimen collection or testing in abundance.

Before COVID, telehealth products had to follow the HIPAA Privacy and Security Guidelines. Now that this virus has spread all over the country, to stop it, the exception of extreme circumstances comes into play and brings flexibility to those guidelines.

In a time, when doctors are overburdened with the surge of patients, the administrative burden can only add to their worries. Therefore, CMS and OCR on their behalf have given breakthrough in strict conditions.

However, it doesn’t mean that HIPAA has been totally swept under the carpet. The importance of HIPAA cannot be undermined, and risking data is not compensable.  It’s just that the strictest rules are made flexible for guanine reasons.

What Products Are Safe for Telehealth Communication?

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While you can use the above applications, some applications such as TikTok, Twitch, and Facebook Live come under the public-facing criterion. It means they are not permissible.

Therefore, before dispensing care, use applications in the allowed category.

As the nation is in dire need of healthcare workers, OCR exercises enforcement discretion for care to reach the farthest areas of the country in connection with the good faith provision of telehealth services. It means providers won’t face penalties in case of non-compliance with HIPAA regulatory requirements.

HIPAA Compliant Technology Vendors

Since malpractices in desperate times have their odd way to creep in, it is best to choose technology vendors who are HIPAA compliant. In addition, they should be willing to enter into a business associate agreement (BAA) with the provider. As a result, any audio or video communication that occurs through such vendors will not result in an intrusion or put PHI at risk.

The following list of vendors provide a haven for secure telehealth services; moreover, they are HIPAA compliant and willing to enter into a BAA with covered entities.

  • Skype for Business / Microsoft Teams
  • Updox
  • VSee
  • Zoom for Healthcare
  • me
  • Google G Suite Hangouts Meet
  • Cisco Webex Meetings/Webex Teams
  • Amazon Chime
  • GoToMeeting
  • Spruce Health Care Messenger

Now, that is the list of software for safe and complaint-friendly audio and video communication.

A word by OCR

OCR doesn’t endorse, recommend, or certify the above applications but simply suggests their use for guidance. It has not reviewed the BAAs that they have come up with. In reality, there may be other vendors out there who are HIPAA compliant and willing to enter into a BAA with a covered entity. The names above do not suggest any kind of affiliation with the above-mentioned products.

P3 as a business associate comes under the obligation of HIPAA too. We are, in fact, trying to help our healthcare heroes as best as we can by the use of HIPAA rules. One of our services, security risk analysis, uses HIPAA to conduct a risk assessment of practices. In addition to that, HIPAA medical billing, our principal service, follows the provisions of HIPAA accordingly. As providers make their way out of the pandemic, we are here to support them on every twist.

Please hit the follow button on Instagram for more insights: @p3healthcaresolutions

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P3 Defines the Role of Medical Billers and Coders

Any person who thinks there is a difference between medical billers and medical coders is right.

Because there is a difference. With defined roles, they bring the right charisma to a physician’s revenue cycle. Nevertheless, one depends on the other for the completion of the billing process.

Medical billing services hire both professionals to carry out an effective revenue cycle management process on behalf of healthcare providers. Theoretically speaking, both professions require the professionals to read, interpret, and comprehend Electronic Health Records (EHRs) and doctors’ notes. Hence, their education in science is a must.

We all know that medical billing is a complex process. But with medical coders and billers assigned to claims, medical billing becomes all the more manageable. Their capabilities provide all the help a healthcare provider needs to process medical billing claims.

For you, as a primary care physician or a specialty-specific clinician, an authentic team of health IT experts may, rightfully, carve the way to a successful practice.

Coding: Where Medical Billing Services Begin

Medical coding is a definitive structure of the medical bill. It becomes an integral part of medical billing service which reflects each and everything in a proper, organized, and coded form. At times such as this pandemic, the healthcare sky is lit with updates; new codes for COVID-19 have surfaced, so coders have a responsibility to stay in touch with CMS updates.

Moreover, they must remain proficient and knowledgeable in the ICD-10 coding system – the coding system that classifies diseases. The other one being the CPT set of codes identifies the treatment aspect of received cure.

The above systems help convert medical jargon into easier alphanumeric codes. For people inside and outside the medical industry, it may be hard to understand the names of diseases and certain procedures. Thus, the availability of these coding systems provides a comprehensive path to diseases and their solutions.

Since there are thousands of diseases, symptoms, and cures, it is not possible to write to them in complete form all the time. The only way possible is to design a coding system that classifies them.

Medical coders are required to manifest the knowledge of thousands of CPT and ICD-10 codes accordingly. Moreover, coders translate medical records for reimbursements later.

This gives us an overview of what coders are responsible for.

Medical Billing is the Social Part of Coding

After proofreading the claims, next comes the job of billing professionals to forward them to insurance companies.

A claim that is prepared by the coder has to go through a process; the person who carries it out through to the end is a medical biller. If it is a small practice, usually, there will be a small group of medical billers. However, to tend to a larger practice or hospital, there’s a whole team of billers and coders. Their times often concur with the time of the practice, but they can also work remotely to address claims as they come.

Without experienced billing personnel on your side, a health care facility, or a primary care physician’s revenue cycle would fail to function. Here, at P3, we have a whole team dedicated to medical billing outsourcing, so feel free to reach out at this number: 1-844-557-3227.

Purpose

Billers to devise the billing claim use information emanating in the form of codes by medical coders. That claim becomes the first-hand information for insurance companies to release payments. A well-written billing claim without errors has a higher first-time acceptance rate. Furthermore, collections occur fast, almost within 2 weeks.

If patients have outstanding bills, the medical billing experts are required to contact them as part of the following-up process. They will walk them through the process and inform them about any deductibles, copayments, or other insurance liabilities.

Besides, medical billing and coding teams coordinate with insurance companies to get providers on board if they are not enlisted with them. Sometimes the patients visit providers who are out of network, and not on their health plan. Then, the medical billing services have an additional role to play, to enlist such providers with insurance companies. To speed up things, doctors must provide any documentation that is urgently required to complete the registration process.

Filing appeals and conversing with patients is part of their job. There is little time between denial and resubmission; therefore, we must act fast, recompile, proofread, and resubmit.

Where Do They Work?

‘Medical billing services near me’ is one of the search terms often searched on Google. Why?

Because, one, physicians are in search of someone nearby; second, if they can find them nearby, they are physically reachable. However, the remote nature of work has popularized the job amongst outsourcing companies. Therein, we hear the term, medical billing outsourcing.

Most billers and coders are present on LinkedIn with incredible job portfolios. Often you’ll find abbreviations such as CPC – Certified Professional Coder – besides their names. Also, you’ll find abbreviations such as CCA – Certified Coding Associate – and CCS – Certified Coding Specialist – with their names.

Prerequisites

The prerequisites for this job are at least a high school diploma with a science background. However, an associate degree in medical billing helps convincingly in the long run.

You have four studying options:

  1. Bachelor’s degree in a health-related subject (4 years)
  2. Associate degree in medical billing & coding (2 years)
  3. Diploma (1 year)
  4. Certification (a couple of months)

All of these studying programs lead towards a bright future that is well-respected and well-paid.

Pro Tip – Choose schools that are recognized by AHIMA or AAPC.

For readers who like this article, please do comment. We love to read your feedback, and, also don’t forget to follow us on Instagram @p3healthcaresolutions.

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4 Health IT Recommendations for Remote Healthcare Under HIPAA

Working from home is a new reality. The novel coronavirus has left us at home while it continues to affect the human race. It doesn’t differentiate between humans based on their race, wealth, color, sex, or religion; moreover, it treats the young and grownups alike. That is how ruthless it is.

In such overwhelming times, when healthcare workers face the challenge of a growing number of COVID-19 patients on one side, they are required to follow the rules of HIPAA remote care on the other. They are under obligation to meet HIPAA security and privacy requirements no matter how big or small their practice is. In fact, it is not something new to them in the best interest of Protected Health Information (PHI).

Therefore, we will know in today’s article that how physician practices, with the help of health IT, can address the HIPAA security risk analysis issue head-on, especially when it comes to remote care.

Implement Technologically-Advanced Measures to Ensure Data Safety

Under HIPAA, it is obligatory for hospitals and practices in the US to protect sensitive patient data from violators or from going public. The new norm of diagnosis and treatment coupled with the support of health IT ensure remote healthcare fall in line with the rules of HIPAA.

Telemedicine moves forward with a bubble of protection to safeguard patient information. Let’s see some recommendations for technologists supervising remote care communication:

  1. Set Clear Instructions for Remote Use of Healthcare Devices

One thing that we should remember is that healthcare providers are not IT experts. While they know the importance to protect the confidentiality of patient data, they don’t always know how to achieve that stage. Besides, they are too busy with their patients to worry about the laws that govern remote healthcare access.

Here comes the role of the technologists of practices who have the responsibility to provide clear instructions on how to use devices or software securely.

When developing the guidelines, come up with step-by-step execution of the process that simply describes what to do. Too many options or vague advice lead to confusion instead of clarity. HIPAA security risk analysis of remote healthcare ensembles with the list of recommended tools and how providers may use them to provide care.

  • Set Access Restriction on Remote Devices

Another factor that extends the security feature is to restrict access with multiple passwords on remote devices. For instance, the pandemic has made many medical billers and coders work from home. Healthcare information is sensitive and should be protected at all costs.

Here to ensure HIPAA-compliant medical billing, the administrative authorities must put several security measures along with a proper monitoring system to control unauthorized use.

Such measures add to your credibility and align with the organization’s privacy objectives.

  1. Know HIPAA Requirements Before Suggesting Tools

For a technologist, knowing the requirements of HIPAA are one of the essentials they cannot ignore. Since many healthcare practices now turn to new teleworking technologies facilitating video chats, data share, and follow-ups, it comes on you to explain to them which tools are allowed under the Health and Information Portability and Accountability Act (HIPAA).

Providers can only choose a selected bunch of tools that adhere to the HIPAA privacy and security guidelines to communicate. They are not at liberty to use just any tool that they find on the internet and download it for free. Hence, it is of utmost importance that the health IT experts handling your practice’s remote communication are aware of the provisions of HIPAA. Moreover, they must show the will to enter into an official contract as a business associate.

Zoom is an example of a tool that is allowed for healthcare professionals to see their patients. However, there is a specific version that is permissible under HIPAA. Licensed Specialized Zoom for Healthcare solution is the version that fulfills the requirements of HIPAA. Hence, business associates can carry out PHI transmission through Zoom’s specified version.

Also, the above version integrates with electronic health record (EHR) systems seamlessly.

  1. Supply Compliance-friendly Devices for Safety & Management

 When remote care is at play, the idea is to create a safe passage for patient-provider interaction. The healthcare IT teams have to supply healthcare workers with compliance-friendly correspondence devices because that is far less burdensome than manifesting security in each of the employee-owned devices. So even when they go home, they may use only a secure line of communication.

Preconfigured gadgets guarantee adherence to policies that govern PHI safety.

Additionally, for IT teams it is much easier to manage a system that they are familiar with; it is the same mobile device management system they work on at the office.

  1. Use of VPNs to Secure Online Connectivity

Virtual Private Networks (VPNs) are software applications that offer encryption of any data that travels through them. Health IT teams have a job to do; they must remember to equip devices in the use of practitioners with enough security controls to counter unauthorized access.

Two networks need to be secured: providers’ home network and the Internet between the home and the practice.

Management of device configuration solves most of the problems, but it still leaves room for intruders to jump whenever they want.

Hence, suggested is the use of VPNs to ensure safe online connectivity. Any communication that happens between the office and home is secure. A VPN develops a secure encrypted tunnel across the communication channel from the practitioner’s device to the receiver’s end.

It further provides content filtering, firewall safety, and end-to-end encryption to home users just as it would for workers within a hospital or clinic.

With the above four recommendations, we conclude this article in the hope that it is sufficient information regarding telemedicine’s safety standards for health IT. If you want to hire services of professionals who can offer HIPAA security risk analysis to remote medical practices, please get in touch with P3 Healthcare Solutions. We are also a HIPAA medical billing company that takes extreme caution when it comes to protected health information.

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Telemedicine Emerges as Cure Outlet Amid the COVID-19 Outbreak

Got allergies? You can still see a healthcare professional if you are at home during the coronavirus outbreak.

U.S. health officials, clinics, hospitals, and insurance companies are insisting on people to try telemedicine for minor health problems such as ear infections, rashes, and earaches and skip the doctor’s office.

It is also a way to get screened for COVID-19 if you think you have the symptoms.

The Goal: Prevent it from spreading, especially to the elderly, infants, and those who are most vulnerable with existing health conditions.

Instead of waiting for the doctor for days, virtual care has long been a solution for the Americans; it is just that they have been slow at adopting it. Now is the time to embrace and make use of it in our best interest.

Let’s take a closer look at how Telemedicine functions.

What is Telemedicine?

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Telemedicine is a means to connect with a healthcare professional via smartphone, tablet, or computer. That is all you need to hop on this train. Sometimes, we use words like telehealth and virtual visits to describe it.

Ordinarily, it connects you with a provider like a doctor or a therapist remotely over a secure line. As a matter of fact, the patient makes use of an app to connect with them.

Sometimes telemedicine portals use a version that involves texts only for patients who may not speak or see each other.

Telemedicine often serves as a tool to diagnose and treat a new health problem, but it is also used to see a long-term diabetic or chronically ill patient. It is more than going for a prescription refill, although doctors can write prescriptions, if needed, after a virtual visit. That involves antibiotics, anti-allergies, or dietary supplements.

Where Can I Get Telemedicine?

Providers such as individual practices and hospitals are rich outlets of telemedicine. Providers are urging the patients to see them using telehealth channels during the outbreak. Search by calling your local hospital or simply put a query in Google to search for the best telehealth companies.

The federal government is committed to helping people with Medicare, i.e. citizens aged 65 and above as well as the younger slot who qualify due to disability through telemedicine. This trickles down to the state level where local governments are urged to expand telemedicine access to help people with Medicaid, i.e. people with low incomes.

Until now Medicare coverage of telemedicine was limited to rural areas where patients did not have care facilities like state-of-the-art hospitals and private clinics. Many Medicare Advantage plans also provide support for telemedicine. While the providers are busy treating the patients, telemedicine returns in the form of collections are good enough. Medical billing services play their part to full effect.

How Much Does It Cost?

Prices are variable. However, since the telemedicine initiative is being promoted, the prices are being waived off by many companies. It is to inspire them to use this outlet as their health companion.

It helps to check with your insurer or employer to see if it is part of your health plan. The plan may not offer specialty services like virtual therapy sessions or include only limited access.

For people without insurance, some telemedicine providers do give the option to pay out-of-pocket. The charges differ from provider to provider. Whichever company you choose, under the law of HIPAA, the texts of diagnosis and treatments are completely secure.

What Illnesses Can Be Sorted Out by Telehealth Services?

Some of the illnesses under telemedicine include sinus infections, seasonal flu, minor injuries, fevers, etc. Before you begin to doubt it, let me assure you that telemedicine saves you physical visits to the doctor’s office or pharmacy store.

Dermatologists can use it to treat moles and warts. Acne, pimples, blisters are additional examples for which they can offer their services. Moreover, therapists can be a source of calmness to patients suffering from anxiety, depression, and stress episodes during the pandemic.

Cyber consultation in case the patient has flu-like symptoms can be a relief. They have preprogrammed questions to gauge the health condition, and, immediately prescribe a remedy.

The Limits

With benefits come certain limitations.

A virtual doctor is unable to treat medical conditions in which the patient suffers from chest pains, fractures, or wounds in need of stitches. The virus test is also not available through this source.

Patients Need Time to Adapt

The association of gadgets such as your smartphone with healthcare has been there for a while but it is put to use with the spread of coronavirus nationwide. It will have lasting effects on the future of healthcare; patients who will get better will become its promoters.

If it doesn’t involve their regular doctor, they may be reluctant to try it all together. Additionally, awareness to make use of telemedicine in routine when the pandemic is over could send help where it is needed the most.