Posts

Medical billing services, Medical billing service companies, Medical billing services near me, Revenue cycle management

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.

News

CMS, medical billing company, medical billing services, healthcare services, healthcare solutions

CMS Plans to Expand RSNAT All Across America

CMS (The Center for Medicare & Medicaid Services) works for quality care and optimized performance in the healthcare industry. The healthcare industry leaders are focusing on every aspect and taking measures step-by-step to simplify operations.

Apart from announcing advancements in medical billing services and other healthcare operations, they also consider aspects of non-emergent care.

Recently, CMS announced to expand Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) across all America.

According to CMS, before the expansion process, RSNAT Prior Authorization Model will test the need for prior authorization of services.

What will be the outcome if outsourcing medical billing services seek approval before the service is rendered or before they send the due claim to the payer? Will it save cash for Medicare while trying to achieve quality healthcare for repetitive, scheduled non-emergency ambulance transportation?

Let’s find out.

CMS implemented this model in several states of America

An Overview

Such as New Jersey, Pennsylvania, South Carolina, North Carolina, Virginia, West Virginia, Maryland, Delaware, and the District of Columbia during different years to test out its implications.

The results were quite astonishing and encouraging to say the least. The quality of care and easy access to essential services were maintained as expected. Statistics show that Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport saved around $650 million over four years.

The Need to Implement a New Model

Medical billing services used to face problems related to improper/inconsistent Medicare payments for non-emergent ambulance transports. There was a much-needed room for a new payment model that promotes cost efficiency and counters risks related to payments.

And, CMS wants to ensure proactive measures that minimize fraudulent activities.

Is the New Model Successful?

healthcare industry, medical billing services, CMS announced, outsourcing medical billing, healthcare system, medical billing experts, medical billing outsourcing companies, medical billing companies

The first evaluation report of this program came under analysis in 2018 and based on that, CMS is hopeful to expand it nationwide to curb down Medicare Spending. The recently released second evaluation report also highlighted that the use of RSNAT is reduced by 63% and its respective spending is reduced by 72% overall. (The report results were concerning the end-stage renal disease and/or severe pressure ulcers during the first four years of the model.) However, it supported the previous assumption that it is safe to implement this program everywhere. There was also no evidence against this system that reflected poor healthcare quality.

CMS has made clear that across the board accountability, lesser loopholes for frauds, simplified solutions, and expanses in check will make a progressive healthcare system. Moreover, with the new plan, medical billing services, physicians, and patients, all will be benefitted in one way or another.

CMS administrator, Seema Verma says that although medical billing experts complain about the complexity of prior authorization. But, with a proper plan of action and accurate deployment of the model, Medicare can ensure that its requirements are met even before the start of the service.

One more advantage of this system is that billing experts on behalf of physicians don’t have to indulge in extra administrative work afterward.

Henceforth, the program will continue to run in the currents states although they were expected to end this year. But, the success of the new model of non-emergency ambulance transportation changed the whole view.

CMS will release new guidelines regarding the expansion in every state. The model will remain the same as the existing model.

It is expected that medical billing outsourcing companies will find this new model accommodating with respect to maintaining cost.