Medical billing specialists and insurance companies work hand in hand. The bill or claim begins when a patient visit his or her physician. Office staff create a chart on said patient. This chart includes the demographics of the patients. In addition to this there is also the patients physical/ medical information. All medical procedures, treatments and diagnoses are listed in this chart making it a highly private piece of information. After the patient finishes with the visit, the physician or qualified staff will assign a CPT code to the visit for medical billing. This CPT code (Current Procedural Terminology) defines the level of care that the patient received. This assigned code is based on the extent of the physical exam, the complexity of the medical visit and the patients medical history. The physician will also offer a diagnosis for this patient and the visit. The diagnosis will have an attached number called an ICD -9-CM.
Both the CPT code and ICD 9 - CM along with the claim are then submitted to the insurance company by the Medical Billing specialist. The insurance company will then have their medical director review the claim. This review will determine the legitimacy of the claim based on the patients eligibility, medical necessity and the providers credentials. If the claim is approved then payment, at a percentage, will be made to the provider. If the claim is denied then a notice is sent to the provider with an explanation attached. This has to be researched, corrected and then resubmitted. This process can be repeated many times until the insurance company agrees to pay or the provider agrees to accept little or no payment for the service.
Due to the increasing complexity of claims and data entry errors, it is not uncommon to see claims denied about 50% of the time.
May
01
2010
Software Advice recently penned a post, “Should You Outsource Your Medical Billing,” which we blogged about recently. They have a follow up article on selecting a medical billing service which we also wanted to mention.
The first article compared outsourcing the revenue cycle management process to managing that function in-house with medical billing systems. Assuming you go for the former option – outsourcing – this post will help you make the right choice of medical billing service companies.
How can a provider tell the difference between a fly-by-night medical billing company and one to which they can hand over their patient’s medical information with confidence? If a physician knows what criteria by which to judge a medical billing service, they’ll be able to select a company that will significantly decrease their time spent on billing issues and increase their time spent on patient care.
To choose correctly, a provider will need to evaluate these five key criteria when choosing a medical billing company:
- Level of service;
- Industry experience;
- Use of technology;
- Pricing model; and,
- Capacity to take on new clients.
You can read the full article here.
Mar
26
2010
This past week, Chris Thorman of Software Advice sent me this great article on whether or not a practice should outsource their billing to a medical billing service.
In the article, both the in-house approach and the outsourced approach are compared in terms of costs and convenience for the provider. The results? The outsourced approach came out on top in terms of generating a higher net revenue for a practice but Chris had a point I agreed with wholeheartedly:
It’s important to note that a medical billing service isn’t a silver bullet for in-house billing issues. Billing services can vary widely in their efficiency and accuracy when processing claims. If a provider chooses a billing service that is lax and prone to errors, the headaches surrounding billing issues won’t get better – they’ll get worse.
The percentage of the billed amount a billing service can collect is the major difference between different third party billing services and doing your billing in-house.
Chris also went over a few of the reasons that a provider may be motived to outsource their billing:
• The provider is new to running a practice;
• The practice has high staff turnover;
• The provider isn’t tech savvy; or
• The provider simply isn’t focused on the business side of his practice.
For more information on medical billing, take a look at Preferred Health Resource’s medical billing service page.
Aug
09
2009
Since I was in fourth grade I’ve had glasses, it general has never bothered me. When I hit my 40’s I had adjust because I had problems reading so my prescription lens became progressive lens. I never ever was tempted to switch to contact lens, seemed like much to much work and when people had problems it didn’t seem like it was worth it. So I’ve veen wearing eyeglasses for almost half a century!
But a couple of months ago I started to talk to a local New York LASEK service and it seemed like a solution because it deals with both near and far sightedness. But even with this total solution for my eyesight that’s not what got me to decide. It was conversation with two very rational people not prone to exaggeration. These are people have measured responses to most questions you would ask them and they BOTH used the phrase “It changed my life”.
So I am excited about the LASEK and will be reporting on my progress from both a personal and healthcare IT prespective.