A medical claim refers to the itemized statement of services and costs from a health care provider or facility that is submitted to the insured for payment. In Medical Billing and Coding parlance, claims processing is the overall activities and work which involve submitting and following up on the claims.
Healthcare Revenue Cycle Management is the end to end spectrum of administrative and clinical functions that lead to the capturing, management and collection of patient service revenue. This covers the patient account from its initiation to payment.
Medical coding jobs and medical billing jobs are an attractive career option today.
Medical billing and coding workers are in charge of processing patient data. They are health care professionals who are directly in charge of handling treatment records and related insurance information and tasked with coding patient diagnosis along with request for payments from the insurance company.
As you may already know, medical coding is the very important process of going about converting diagnosis codes to ICD-9 codes and procedure codes to CPT codes. Medical Coding also involves HCPC (pronounced “hick-pick”) codes that identified supplies and drugs for correct billing. The Code Certification credential is a way that distinguishes coders on the basis of their exhibiting commitment and demonstrating coding competencies. This is across all settings, including both hospitals and physician practices.
These days it seems that pretty much everything is evolving at break neck speed. The dawning of the technological age has spurred the wheels of invention and innovation like never before. Medical Billing is just one sector of business that is currently in the spotlight as medical professionals rush to remain current in the face of widespread changes in procedures and guidelines.
Considering the massive overhaul the health industry is currently undergoing, the decision over whether, or not, to outsource your clinic’s medical billing may be something you have no choice but to consider. You may be discovering that your staff is now having difficulty keeping up with day-to-day routines, while also trying to keep current with an avalanche of complicated legislation, and expansive updates to medical billing codes.
For the longest time physicians were advised to keep billing “in-house” no matter what. But times they are a changing.
And What You Can Do to Solve Them
With all of the recent changes in the medical billing arena including the introduction of the updated ICD-10 coding system, it has never been more important to the success of your practice to keep up with the frequent changes in billing procedures. Here are 4 important factors you should take into account to avoid these medical billing issues. as you begin updating and maintaining your offices billing procedures to avoid these medical billing issues.
HIPAA Violations – Ignorance of the Law is Not a Defense
In 1996 the U.S. Congress along with the Department of Health and Human Services passed the Health Insurance Portability and Accountability Act, which, basically “established a comprehensive and uniform Federal standard for ensuring privacy of genetic information.” Over the years there have been several changes to these laws, but the message remains pretty much the same; violations to the HIPPA will not be tolerated.
With the ICD-10 billing codes set to replace the old ICD-9 system on Oct. 1, now may be the best time ever to take a closer look at your offices’ billing procedures and discover ways to improve your practices’ billing efficiency. Your AR department will soon be busy catching up to all the new codes and regulations, so, why not make the job easier for them, and more profitable for you, by implementing a few of these strategies designed to maximize the efficiency of your billing department.
We have all heard horror stories about an insurance company refusing to pay off on a claim due to some oversight by the policyholder. In an effort to protect them against fraud, insurance companies pay hundreds of thousands of dollars annually to investigators and claims adjusters. These employees man the front line against fraudulent, and unscrupulous claims, which, in a perfect world, helps to stifle the high cost of health care insurance and result claim denials in which you spend thousands of dollars dealing with.
The sad part is when honest people with legitimate claims get caught up in the red tape of an insurance claim investigation. Policyholders can often wind up being denied their claim due to some small oversight, or policy stipulation, that they were not aware of prior to the claim being made.
Knowing and understanding how insurance companies and their investigative teams function will be invaluable to you should the day come when you must file a medical claim.
By taking these precautionary steps you may be able to avoid going to battle with your insurer over medical costs you believed should have been covered.
- Examine all provider documents carefully. This is a “cross your t’s and dot your i’s” step you can take to ensure that all of the information on those long forms you fill out at the doctors office is accurate. Name spellings, addresses, insurance policy numbers, date of birth, employee name, etc. As soon as next year, new government standards will allow patients increased access to their health records via computers, and they will be able make online corrections, and updates as needed.
- Understand the new IC-10 Coding System. With over 55,000 additional codes being added the potential for mistakes in this area could be high. Something as simple as a code being given for injury to the left side of the body when the injury is actually on the right side is just enough to disqualify your claim.
- Always carry your most recent health insurance card. Insurance companies will often send out new insurance identification cards when they have made changes to your policy. Discover what changes have been made in their services, and always replace your old card to avoid surprises.
- Make sure that all of the health services being provided to you are from agencies that are in-network. There is an important difference between asking; “Do you take my insurance?” versus “Are you in-network with my insurance company?” The latter will provide you with the greater cost savings.
- Find out if the procedures you are to undergo require prior authorization and make sure the authorization is granted before accepting the procedure. This takes very little time, but may end up saving you thousands of dollars in unnecessary costs.
There are many actions you can take to help protect yourself from a denied claim. It is up to you to do the due diligence, and to understand what your policy does, and does not cover. The best advice is not to leave anything to chance when it comes to understanding your medical coverage.
To prevent having claim denials let HPC Billing take care your medical billing for you! Give us a call today (888)517-4992. Make claim denials a thing of your past!
- Affordable Care Act
- Benefits of Outsourcing
- Claims Processing
- Health Plan Patients
- ICD 9/ ICD 10
- Insurance Benefits
- Medical Billing
- Medical Billing Careers
- medical claims
- Medical Coding
- Physician Practice Management
- Practice Management
- Psychology Billing
- Revenue Cycle Management
- Sleep Apnea