blog contains information regarding Medical
billing outsourcing news, HIPAA news,
recent information and changes to
the medical billing & medical
coding industry, as well as the thoughts
of our authors.
The word "outsourcing" has become a dirty word for many physicians that have been burned by medical billing companies that either outsourced their claims to medical billing companies that use neither secure networks nor adhere to HIPAA regulation in order to maximize their profits; or the outsourcing company just turned out to not be reliable and it wound up costing the practice money to utilize their services.
Don't let a bad experience keep you from partnering with a legitimate medical billing company that can not only help you get your reimbursements faster but also realize great profits by maximizing every single medical billing claim that is filed to make sure that all services and procedures are counted by the carrier and reimbursed.
If you've been hesitant about outsourcing your medical billing because you aren't sure it would actually help your practice or you've been burned; do a little research on your own and ask for references. Ask the medical billing company what they will do for you. OMG will not only help you get the best reimbursements on your medical billing, they will also help you manage your practice by keeping your and your staff informed of coming CPT coding changes that will affect your practice as well as helping keep your patient accounts organized and you can log in and see where a patient's account stands for insurance payments versus out of pocket. This is a very efficient way to run your practice and when you have the extra time due to partnering with a competent medical billing partner, you will finally be able to help your practice really grow!
If you haven't already, make sure that your staff is using the updated CPT codes that were released in October 2008.
Not doing so can lead to kick backs that will require more staff hours to research, redo and resubmit and if this happens on a number of claims it can seriously affect your reimbursements and in turn - slow your revenue flow to a mere trickle.
One way to avoid this dilemma is to outsource your medical billing and yes, there are some horror stories out there about outsource companies that threw away patient billing, had lax attitudes towards billing submissions and wound up costing the physician a lot more money than they made through reimbursements. However, that's not how it has to be.
Do a little research and find the best fit for your practice. Your best friend may also be a colleague but the medical billing company he uses may be a terrible fit for your own practices. How do you find the right one? First of all decide what services are most important to your practice. Make a list of the tasks your office staff is performing the most in relationship to medical billing and see if a medical billing partner could possibly lighten the load. Also, find out if your potential medical billing partner can do your credentialing for you - it's a great way to maximize the amount of insurances you can take as well as cut the paper chase for yourself.
When a patient reports to the ED and requires laceration repair, the medical billing claim needs to address the length of the wound in order to be a properly filed claim. If the wound length is either not addressed or addressed incorrectly, the claim may be either denied, rejected or only partially paid. Additional factors can include whether or not there was a separate evaluation and how the service was managed during the encounter. Make sure all of these factors are documented in your medical billing claim.
Laceration repairs are very common in the ED, in fact a nationwide survey showed that every one in fifteen patients presenting in the ED needed some sort of wound repair; knowing how to file them correctly to get the maximum allowable reimbursement for the procedure will make a big difference to your practice. This will bring you into delicate territory, you want to be sure you bundle all the procedures however you don't want to overcode the claim which will almost always cause a denial of the entire claim and you want to be careful not to undercode as the physician will wind up not getting properly reimbursed and this too will affect the bottom line of the practice.
There are three basic complexity levels: simple, intermediate and complex. First of all use the documentation to ascertain which level the wound is and then apply the proper coding from there. Use modifiers as necessary and always make sure that your medical documentation of the procedure is iron clad. Using these tips, your medical billing claims should always be accepted and reimbursed!
Are you swamped? So overwhelmed with patients, billing, invoices, emergencies and other day to day practice worries that you don't even have the time to get yourself credentialed with all the carriers possible. No one has to tell you that the more insurances you accept, the more patients you can see and the more revenue you can generate for your practice. Credentialing is the key. Did you know your medical billing partner can take some of the heat off you and not only compile and submit your medical billing, they can also get your practice credentialed with any carrier you choose.
If you have a busy practice, you may be putting off getting credentialed with additional insurance companies because you just don't have the time to fill out the forms, questionnaires and other information in order to get approved with additional carriers.
You know from previously getting credentialed that the process can take months for the carriers to process the paperwork and you just do not have the time to fill out the detailed forms and then call the insurance company for follow-up on your application. Wouldn't it be great if someone else could take over the hassle for you?
Your medical billing partner can do this as well as your medical billing and coding. They have the knowledge and expertise to not only get your claims paid but to also get you credentialed with as many carriers as you want to be able to provide services through. This includes Worker's Compensation, most large insurance carriers and Medicare. Whether you want to be credentialed through an individual carrier or one large network, the choice is yours.
Once your application is submitted, your medical billing partner will stay on top of your credentialing request and keep checking the status and make sure your application is handled in a timely manner. This will enable you to do what you do best- service your patients without the headaches of getting yourself credentialed and chasing your medical billing claims.
One thing you learn quickly when you establish your own practice is that there are many types of insurance plans as there are patients and in order to get paid for the services that your render, you must be approved or rather "credentialed" to do business with your patient through that particular insurance company.
The process of getting credentialed with each insurance company is a little different as to what each carrier will require from you but each will require a lot of paperwork and following up. That's where a third party partner can help you.If you want to get credentialed with as many different carriers as possible but you barely have the time to efficiently run your practice as it is now, consider enlisting the services of an outside agency to help with the paperwork and follow up. There will be additional things that are needed as well certificates to get approvals.
Getting approved with as many insurance companies as possible will increase your revenue flow as it will allow you to deal seamlessly with several different carriers and expand your practice to provide services to more patients. Remember, the more insurances you accept, the more patients you will be qualified to service. If you're looking to build up your practice, this is a marvelous and financially smart way to do it.