Outsource Medical Billing Services help medical groups avoid costly billing mistakes, improve revenue capture and reduce patient anxiety

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Medical Billing

Providing healthcare services is a responsibility we take very seriously because of the vulnerable patients who are reliant on us for appropriate medical interventions. Patients are both medically vulnerable since they’re often coming to us with life-threatening conditions, and financially vulnerable, meaning they might not be able to afford their care.

Patients who need serious medical care have a lot on their minds. They are usually focused on what’s most important to them: getting the medical attention they need. They might not have all the information they need to work with providers and hospitals on billing, which can be bad for both sides.

It’s important for our healthcare providers to provide medically necessary services that are well documented and billed to the proper payer for the proper amount. We work hard to preserve your medical and financial records and protect you from high costs. Your needs must always be our top priority, regardless of any issues or circumstances.

Lately, it seems as though more and more patients are finding themselves in a financial bind due to climbing healthcare costs. This is where the five steps we offer can be handy. These steps can help keep the patient from having to pay a lot of money out of pocket, and they can also help you get the most money possible for your services.

Avoid Costly Billing Errors

Take a look at some of the measures you can implement at your practice to avoid medical billing errors.

Always check your insurance.

Can you tell me what the main reason is that most medical billing claims get turned down? It’s critical for you and your staff to be diligent with both new and returning patients when verifying insurance, because failing to do so can cost you time and money.

Patient Information Errors

Do you recall how your teachers used to deduct points from your grade for tardiness on assignments? Given that hindsight is 20/20, Mrs. Kerbopple was probably wise in this case: According to studies from the University of Minnesota, 30 to 40 percent of invoices have errors.

Implement a practice management system

A practice management system can help you reduce human error by automating as much of the process as possible. Don’t hold the system responsible for issues, though, as it won’t go so far as to post the charge and print reports for you.

Mistakes in Coding

Receiving payment is incompatible with the unbundling of codes, failing to enter the diagnosis code at its highest level, or failing to comprehend operative reports. But we don’t blame you. Because there are so many confusing codes and charges on medical bills, a very busy day at your practice can cause a big delay in your payments.

Collect patient data at the time of service

The best time to collect patient information is when they are in your office for service. This is often referred to as ‘pulling information’ because the information comes to you, instead of you having to drive over for it.

During your appointments and while the appointment is going on, you need to get as much information as possible about the patient’s demographics and insurance. This includes getting the correct spelling of their name, address, and social security number, and getting their phone number wherever possible. When you can’t get all the information you need about a patient, your staff should be taught to politely ask again and stress how important it is to get accurate information.

We follow the necessary guidelines for patient signatures, including:

As a requirement of Medicare or insurance, you need to sign an Assignment of Benefits form, which is a legal declaration assigning your payment coverage to the healthcare provider providing your care. This form also includes a patient consent statement.

Without a proper AOB signature, your claims for patient services may not be processed properly. Your bill for the services you offer may then need to be sent to the patient, which can cause tension and anxiety for that person. There are, however, times when you can get information from a patient even if they are unable or unwilling to sign. In such cases, a patient’s agent may sign on their behalf.

You need to decide who is going to pay you.

When you come in to see the doctor, there are many rules as to who can pay for your visit. If you’re covered by Medicare, Medicaid, or have health insurance, then the insurer is responsible for paying your bill. Our insurance discovery technology searches for billable coverage options and prevents the misclassification of patients as “self-pay.” It also provides listings of charitable options like Medicaid. Knowing which payer should be billed and getting it right the first time can decrease payment days and take away worry and stress when money is tight and patients get the bills they weren’t expecting.

You need to know your patient’s insurance so you can make sure they get the treatment they need.

We know that it can be frustrating for staff members to ask patients for information, and the responsibility often gets passed down the line. An electronic search of their profile will pull up up-to-date information, so they don’t have to make idle conversation. Electronic tools for verifying details can lead to mistakes that result in a denied claim. Now, the patient has to deal with not only the unpaid bill but also the hassle of dealing with their insurance carrier or provider, who may not refund their deductible payments in a timely manner.

Some things will never change. For example, right-day billing practices always pay off.

Healthcare providers are in a difficult position because patients expect their services to be high-quality, but they also want them to be affordable. In this era of high-deductible plans, it is essential for healthcare providers to monitor their deductibles. New technology makes chasing self-pay accounts easier, making the process less painful and more effective.

Have you been looking for revenue cycle software for your healthcare business? There are many programs to choose from, but it can be hard to find the right one. Make sure that your patient is insured, and the likelihood of being paid will increase exponentially. Timing your bill appropriately will also reduce costs and increase revenue for you.

When your organization follows these five simple, common sense approaches, your patients’ anxiety about their finances can be reduced and their financial vulnerability can be monitored.

Outsource Medical Billing Services

It’s difficult to calculate how much revenue cycle management will cost you if you outsource it versus keep it in-house. The number of claims you submit annually, your reporting needs, and the size and expertise of your team are all factors that can affect how effectively you bill.

Here’s a Medcare MSO number of benefits that you get from Outsource Medical Billing Services:

  1. When compared to outsourcing the revenue cycle management process, the complexity of on-site billing can end up costing medical practices more time and money than it’s worth.
  1. Doctors who want to increase their organization’s revenue flow might discover that outsourcing their RCM meets their needs better than doing it in-house.
  1. Medical billing and coding services help you to result in faster bill payment because the third party has access to a broader range of knowledge than your own financial department.
  1. The error rate should decrease if a third party handles your medical billing. Reimbursement is expedited in this way.

What could go wrong?

All of these steps may appear simple, but if one thing isn’t done correctly from the time a bill is generated, every step could go wrong and lead you on a merry dance, and that too in a loop. Medical coding is the most important and integral part of this whole process.

Medical coding is the process that transforms healthcare diagnostic, procedure, and service codes into universal medical alphanumeric codes. These codes come from different places, like doctor’s notes and lab results. Medical coders then process these codes. This helps make sure that insurance companies handle your claims correctly and pay you the right amount.

How Do Medical Billing And Coding Services Transform Healthcare Diagnosis, Procedures, And Equipment Into Universal Medical Alphanumeric Codes?

Medical coding happens every time a physician sees a patient and will act as documentation of their history and diagnosis. The code is needed on the patient’s record by the physician, who can get paid for this documentation through reimbursement procedures.

Healthcare revenue streams are based on the documentation of what is learned, decided, and performed.

The diagnosis and treatment of a patient should be recorded so that their future visits are smoother and of higher quality. The personal health information of the patient must be easy to understand, and these records must follow them throughout subsequent complaints or treatments. This is especially important because there are hundreds of millions of visits, procedures, and hospitalizations in the United States every year.

According to a new report by Grand View Research, Inc., the global market for medical coding will reach $25,4 billion by 2025. The need for a universal language that reduces fraud and misinterpretations associated with insurance claims is driving the market’s growth at a CAGR of 10%.

Medical coding is in its infancy, with new classification systems introduced every so often. At the same time, the number of coders will continue to rise as a result of career opportunities in this field. Along with these other factors, the growing demand for coding services will also drive market growth.

This form of coding is used to identify information about health care services and procedures.

Medical coding is the process of transforming medical data into universal, international codes. These codes include diseases, injuries, and procedures.

Whether you’re looking for medical coding training or you need help with medical coding, the course materials include detailed documentation of patient cases as well as deep knowledge of anatomy and physiology. We have certified medical coders who can provide training or support to get your business certified.

How does a coder take medical reports and turn them into a set of codes?

Medical coders are tasked with understanding what each of the codes represents, and there are three main types: diagnosis classifications, which all follow the International Classification of Diseases. These codes are diagnostic and provide a uniform vocabulary for describing a person’s injury, illness, or death. There are classifications for procedures that document the majority of procedures performed in a physician’s office. 

There are various versions, including Current Procedure Terminology, developed by the American Medical Association, and the Australian Classification of Health Interventions (ACHI), created by the University of Sydney. The last type is used to describe not only procedures but medical devices, consumables, and supplies as well. There’s the Healthcare Common Procedure Coding System (HCPCS), developed by the Centers for Medicare Medicaid Services (CMS) in the USA.

Changes of CPT Code In 2023

The CPT code set will experience 393 editorial changes overall in the coming year, including 225 new codes, 75 deletions, and 93 revisions. On January 1st, 2023, the code set will become effective.

Why is coding medical reports so important?

When different healthcare providers are using the same medical coding system, which is the code for the diagnosis and procedures of a patient’s care, it allows governments and agencies to track healthcare trends more efficiently. This can help them understand their healthcare system needs better, set policies, understand the effectiveness of a treatment or the prevalence of a certain disease, and make informed data-backed decisions for the betterment of citizens’ health.

We use a system of artificial intelligence and big data analytics to monitor the progress of patients, reducing the waste caused by technology inefficiencies. It also integrates current technologies to reduce healthcare costs, leading to better clinical outcomes from a value-based healthcare system in an economy where healthcare isn’t seen as something that should be expensive.

Accurate documentation is always needed when filing claims in the healthcare industry also in all specialties FQHC billing, DME billing, etc as it is a key part of the revenue cycle process. When there is a problem with a claim, providers will use these documents as proof to get their money back. If information isn’t properly documented or any details are missing, an immense amount of time will be spent on correcting that documentation, and this could have major consequences for the provider’s bottom line.

Accurate documentation is key to helping with the flow of the revenue cycle. This means that healthcare administration costs can be kept down, which is always a win-win situation.

How can medical billers benefit from this?

Medical coding’s main purpose is to collect accurate, meaningful, and actionable clinical data so that procedures are billed to insurance companies in a way that is as fair as possible. Medical coders work with physicians to properly document different patient visits. This ultimately guarantees the accuracy of all codes assigned. These codes can then be tied back to medical billing so they are accurate, making sure doctors will be incentivized to record everything a patient needs and ensuring accuracy in payment.

This rapidly developing technology has many benefits for the healthcare sector, such as the ability to exchange information electronically.

Because your billing process is the heart of your revenue process management, it’s important to have one that is efficient and effective.

Registering patients at a healthcare facility is the first step of a complex process. Patients will need to share their personal and insurance information with the facility in order to determine if they meet the requirements for treatment.

Patients must first be determined eligible by a physician who will then order diagnostic procedures in order to diagnose the case. The multi-step authorization process begins with a medical coding specialist entering the patient’s diagnosis and then submitting it to the insurance company for review.

If a medical billing service is approved, after the work they provide, they send the medical report to the medical coder. The code is then packaged into a “superbill,” and includes details of patient-specific medical history. Once it’s been transformed into an understandable code, it will be sent back to the medical biller. The biller then either submits this information on paper or uploads it to practice management or billing software before transmitting claims to the payer on behalf of the client. Once a claim has been received by a payer, it goes under adjudication: where the payer evaluates whether the claim is approved or not, and decides how much of that claim can be reimbursed back to you. Once adjudication concludes, reports are sent from pays back to billers who will create statements for patients

If a claim is rejected by the insurance company, it will then need to go through the healthcare facility specialized team for review and potentially reapproval.

To close the bill cycle effectively, it is essential to not overlook any important tasks such as collecting payments and co-payments. It is also essential to avoid revenue leakage and ensure that the billing process is closed efficiently.

Depending on the country, it can take up to 180 days for a healthcare provider to receive payment from the date of service. If claims are denied and have to be resubmitted, this period may last up to 300 days.

All the reasons to choose Third Party as your medical billing services provider

As a leading provider of medical billing services, Medcare MSO offers a wide range of features and benefits that can help you manage your medical practice more effectively. Here are just a few reasons to choose Medcare MSO as your medical billing services provider: 

  • We offer a comprehensive suite of services that can be customized to meet the specific needs of your practice.
  • Our team of experienced professionals can help you maximize reimbursement for the services you provide.
  • We offer convenient online tools and resources that make it easy to submit claims and track payments.
  • Our commitment to customer service means you can always count on us to be there when you need us.
  • We’re always here to help. Our knowledgeable customer service team is available 24/7 to answer any questions you may have about your account or our services.

We also provide services to the following healthcare providers:

  • Medical Billing services
  • Laboratory Billing
  • Physician Billing
  • AR Recovery
  • Imaging Billing
  • Hospital Billing
  • Ambulatory Surgery Billing
  • Coverage Discovery
  • Staffing and Workforce Services

Contact us today to learn more about how we can help you streamline your medical billing process and improve your bottom line.

Author Bio

Isaac is content writer at Medcare MSO. He holds a current medical billing & coding certification and is member of the American Academy of Professional Coders. He has worked in medical billing and coding for over 6 years, working in a wide variety of medical specialties like evaluation/management, physical therapy, mental health, acupuncture, outpatient and inpatient care, nursing home care, radiology, and wound care. Isaac has worked in a provider’s office and for professional medical billing services.