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medical billing services, medical billing companies, outsourcing medical billing companies, Revenue Cycle Management, medical billing and coding, professional medical billers, HIPAA compliant billing services,

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.

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 the 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 update.

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.

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

Medical billing and coding, healthcare industry, medical billing companies, healthcare organization, revenue cycle management, healthcare professionals, HIPAA Compliant, medical billing outsourcing services, medical billing services, medical practice

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.

Medical billing and coding, healthcare industry, medical billing companies, healthcare organization, revenue cycle management, healthcare professionals, HIPAA Compliant, medical billing outsourcing services, medical billing services, medical practice

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.

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’s acceptance rate they have, the more revenue they generate, and the smoother revenue cycle management process becomes.

Medical billing and coding, healthcare industry, medical billing companies, healthcare organization, revenue cycle management, healthcare professionals, HIPAA Compliant, medical billing outsourcing services, medical billing services, medical practice

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.

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.

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.

Visit our website for further details – https://www.p3care.com/

healthcare providers, medical practitioners, HIPAA Privacy and Security, HIPAA Security Guidelines, Telehealth Communication, healthcare workers, telehealth services, HIPAA regulatory requirements, HIPAA Compliant, MIPS reporting, QPP MIPS, MIPS 2020, QPP 2020, HIPAA medical billing, telehealth medicine

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?

healthcare providers, medical practitioners, HIPAA Privacy and Security, HIPAA Security Guidelines, Telehealth Communication, healthcare workers, telehealth services, HIPAA regulatory requirements, HIPAA Compliant, MIPS reporting, QPP MIPS, MIPS 2020, QPP 2020, HIPAA medical billing, telehealth medicineProviders don’t have to worry about which products to use as long as they are not public-facing software applications. Products like Facebook Messenger, Skype, Apple FaceTime, Google Hangouts, or Zoom are good to go for care audio & video chats.

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

3 Qualities a Good Medical Billing Company Must Have

In what cases do medical practices think of hiring a medical billing company? Maybe they don’t have resources to spend on the denial management system. It may be possible that their submitted medical claims keep on coming back to them due to poor coding and billing techniques. Or, despite their utmost efforts, they don’t get reimbursements for all rendered services.

There can be many situations for healthcare organizations, where they feel themselves in troubled waters. Instead of ranting over issues, the least they can do is to hire medical billing services. The dream of getting the reimbursement rate up to the mark can only be true with a professional medical billing company.

Either the clinicians don’t have medical billing and coding experts or time and budget to spare for in-house medical billing; medical billing companies seem like the best option.

Medical Billing Company Helps Stabilize Cash Flow Efficiently

Medical billing services have the responsibility to get clinicians their rightful reimbursements. The goal is to improve revenue cycle management to such extent that physicians face no trouble incurring expenses.

Moreover, when physicians are relaxed from the tension of handling the medical billing process, they focus attentively on their patients.

Whatever reason encourages physicians to consult a medical billing company, it is important is to research well about them. Where an experienced, medical billing service takes your revenue journey up the ladder, an immature and unprofessional one can restrict your growth.

Here are 3 qualities upon which you can choose the ideal medical billing company.

Specialty- Specific Billing Solutions

Experienced medical billing companies offer billing solutions, which are compatible with your practice. The documentation and billing codes are different for each specialty.

It is advisable to choose a medical billing company that has experience in your specialty. Their staff is often well familiar and trained with the related new trends and rules. They generally have an understanding of mistakes that can cost a lot and rectify them on time.

For Instance, P3 Healthcare Solutions is one of the leading names in the healthcare industry. Their experts have skills and training to create and submit accurate medical claims to insurance companies, and happy clients are the proof of their success.

Learn more at https://www.linkedin.com/company/p3-healthcare-solutions

Working Experience in Medical Billing

There is always the first day for every company, but physicians can’t rely on any immature medical billing company, who doesn’t know about the healthcare industry. The entire revenue cycle management system of medical practice depends upon their performance. If you hire a minnow, you can’t expect to have 100% results.

Especially, when the healthcare industry undergoes several changes to facilitate patients and physicians, you can’t go to a company, which doesn’t have an accomplishment record. Such companies don’t know how to manage risk factors and often don’t perform HIPAA-compliant medical billing.

They may not have the latest technology or knowledge to create medical claims with 100% accuracy with poor follow up services. Then, why choose them and risk your revenue process.

 Adequate Medical Billing & Coding Staff

Medical billing and coding services

When you hand over your medical billing process to another company, make sure that they have adequate staff to handle your all burden.

A professional and experienced medical billing company not only knows how to handle the bulk of data, but they have proper infrastructure and equipment to implement strategies. They also are able to streamline operations and enable interoperability seamlessly. They have a secure way of exchanging data between patients, physicians, and insurance companies.

Their error rectification system is faster, and they can help medical practices save a lot of money.

There are also some other factors that demonstrate the success of a medical billing company, such as, how well they communicate with their clients or if they train their employees with up-to-date skills and knowledge.

A healthcare organization hires a medical billing company to strengthen its revenue cycle management. It is indeed a great decision. If the chosen medical billing company has a good reputation in the healthcare industry, you can set an appointment with them and proceed to have an official contract.

Do you think that the above-mentioned qualities should be important in a medical billing service provider? Or, there are some other qualities, that you deem necessary.

Let us know.