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Best things you need to know about Medical Billing
The US healthcare industry is complicated system of interconnected activities and organizations. The legal and technological environment entailing the healthcare industry is continuously evolving. When medical billing used to be done on paper, often doctors or their assistants did the complete paperwork themselves. However, with changes in US healthcare laws, electronic health records (EHR) became almost a necessity for healthcare providers, which in turn led to the emergence of specialized medical billing services in the US.
There are some organizations which are still using the paper-based systems, but they are at a substantial competitive disadvantage. Furthermore, due to an aging US society and the disease becoming more and more complicated, clinics and hospitals are becoming jam-packed with patients. Not only doctors and their support staff do not have time to delve into the complicated medical billing process, but it is also not a job of multitasking office assistants anymore. Neither can organizations afford to hire specialized staff and technology needed to do the medical billing in-house.
Many clinics and most large hospitals are outsourcing medical billing and coding functions to specialized third parties. These medical billing companies have made considerable investments in custom-made certified EHR technology and retain full-time specialized staff that processes tons of claims on a daily basis. It enables them to reduce the inefficiencies that creep up into the in-house medical billing. Medical coding is a process which deals with assigning standard codes to the various diagnosis and procedures performed by health service providers. It is done per ICD-10-CM or ICD-10-PCS coding systems developed by the WHO and modified by the centers for Medicare & Medicaid services (CMS) and National Center for Health Statistics (NCHS).
Medical billing services, The processing of medical claims may span over just a few days to several months. On occasions, there are numerous forward and backward movements in the process, and this can occur due to errors in the initial registration and confirmation. Therefore, patient verification and authorization is a crucial step that may be performed on every visit. The primary objective of patient verification is to confirm financial responsibility for the medical services performed. Insurance coverage and plans differ significantly from carrier to carrier depending on the state and the premiums paid. Many healthcare providers hire medical billing and coding services providers to utilize their state-of-the-art technology and to avoid costly errors.
Registration & Confirmation of Financial Responsibility:
By passing just one required area and leaving it blank on a claim form might result in a medical billing denial. Demographic and technical mistakes, that can be a missing modifier, the incorrect plan code or no Social Security number, induce 61% of initial medical billing denials and also 42% of write-offs.
HIPAA Code Set Requirements:
While the HIPAA law eradicated all custom-made and local code set requirements and standardized most of the medical data, this does not eliminate all of the complexity of the system. The US-modified version of ICD-10 contains over 70,000 unique codes for disease, symptoms, abnormal findings, and various internal and external causes of injuries or illness. The complexity can be made clear from the following list of code set requirements mandated by HIPAA Law:
Health Care Common Procedure Coding System (HCPCS)
Current Procedural Terminology (CPT)
National Drug Codes (NDC)
The Code on Dental Procedures and Nomenclature (CDT)
International Statistical Classification of Diseases and Related Health Problems, 10th Edition, Clinical Modification and Procedure Coding System(ICD-10-CM, ICD-10-PCS)
With so many code-set requirements, claims forwarded to the insurance providers are occasionally returned due to missing codes or incorrect data. It can be overcome by hiring professional medical billers who specialize in filing proper claims.
MIPS Score & Physician Initiative:
Medical Billing services are not only about filing claims for the services delivered. Under the Quality Payment Program (QPP), the Merit-based Incentive Payment System (MIPS) score also depends on the medical billing records. A MIPS score can increase or decrease claim reimbursement by 5% in 2018, which will grow to 9% by 2022. People now have better access to information related to the quality of health care service provided by a particular physician or a physician group. This will lead to better healthcare service and drive down prices as patients value reputable physicians more than those with lower ratings.
AR & Medical Billing:
“Days in AR” is a financial ratio found by dividing the total account receivables for a certain period by the average daily sales for a certain year. It’s also termed as a DSO ratio. It is believed by financial experts that a DSO ratio of more than 60 is dangerous for the financial health of an organization. Good medical Billing companies strive to achieve DSO ratio of less than 30.