Medical Billing and Coding Blogs:
Your Source for Knowledge and
Expertise

Physician Billing vs. Hospital Billing: Understanding the Key Differences

Physician billing and hospital billing are the two types of medical billing that prevail in the healthcare industry. But what is the difference between hospital billing and physician billing?
This post will cover some essential points regarding the difference between physician billing and hospital billing, which will help you understand what factors come into play while learning about these two types of healthcare claims.

With physician billing and hospital billing, there are specific differences to tackle. For instance, physician billing is based on the percentage of the remuneration earned through procedures or a price for different services rendered. As for hospital billing, its based on the pricier reimbursement model, where the hospital charges the patients insurance plan for the services required and received.

Professional billing relates to physician billing, and institutional billing refers to hospital billing. In the healthcare industry, professionals differentiate between these terms depending on the purpose of the billing process and the services involved. The two methods, however, fall under the general medical billing process.

To highlight the key differences between physician and hospital billing, lets find out how they are used in both cases.

Physician billing: What is it?

Physician billing, or professional billing, refers to the billing process. Where claims submitted by physicians and healthcare providers are reimbursed when performing medical services or procedures on patients covered by insurance, once you decide to become a physician billing service provider, you must help the physicians or healthcare providers with claim submission and other related billing and collection tasks.

CMS-1500 or 837-P is the claim form used for physician billing. The only difference between these forms is that the CMS-1500 is a paper document, and the 837-P is an electronic document.
•    Some insurance companies, like Medicaid, Medicare, and others, only accept electronic claims as payment methods. P stands for professional configuration on the 837-P claim form, an electronic version of CMS-1500. Most of the time, expert physician billing services have more to do than institutional or hospital billing services.
Billing a doctor is an important administrative task that controls many other tasks in a medical office, like making appointments, greeting patients, registering patients, and collecting payments. 
To make sure that the organizations overall financial and operational goals are met, people who work in medical billing and coding need to know a lot about the policies and practices of physician billing. Because physicians bill insurance companies directly for patient services, a medical offices billing department relies on the accuracy of coding and claims processing to ensure that payments are made promptly. 
The organizations ability to stay in business depends on how much money it gets for each service it provides. Medical professionals can improve their ability to collect payments by learning the basics of physician billing.
•    Both inpatient and outpatient services can be billed under physician billing; both types can only be billed after patient verification.
•    All outpatient and inpatient services will be billed based on the patients insurance policy, so its important to check.
•    It is important to keep in mind that physician billing includes medical billing and medical coding as well.
Therefore, medical billers need to learn both billing and coding procedures. Healthcare professionals offices and hospitals employ medical billing and coding teams to handle everyday billing.
The process of physician billing is complicated and detailed. It is also time-consuming and requires a lot of effort and time. Scribe Align makes it easy by connecting healthcare providers with hospitals and insurance companies so they can focus on patient care instead of insurance claim submission. By outsourcing the billing process to a healthcare billing service provider like Scribe Align, you can focus on the doctors practice and patient care instead of worrying about getting paid for the medical services.

Hospital billing: What is it?

•    The hospital or healthcare provider submits claims for inpatient and outpatient services in hospital billing. For the same reason, hospital billing can also refer to institutional billing.
•    A hospital billing system also accounts for the services provided by skilled nurses. They also bill claims for medical facilities and medical claims for laboratory services, medical equipment, radiology, supplies, etc.
•    An institutions configuration is indicated by I. Hospital billing is performed using forms UB-04 or 837-I. In contrast, the UB-04 is a paper-based form, while the 837-I is a computer-based form.
•    A physicians billing is similar to a hospitals billing, except that hospital billing only deals with the medical billing process; it does not deal with medical coding. However, physician billing also includes medical coding.
•    The hospitals appointed medical biller is only responsible for billing and collection in hospitals. It is challenging to handle hospital billing as compared with physician billing.

Billing for Physicians and Hospitals: how to increase revenue?

•    Hospitals and physicians have different billing models when it comes to revenue reimbursements. But their processes have a significant impact on preventing denials and fraud.
•    Keeping track of unbilled and unmissed claims and services becomes the physician billers priority. However, the staff should be aware of any billing or coding errors when submitting claims. Technical errors can also cause mistakes for various reasons.
•    Outsourcing healthcare billing and coding services is often the best option for hospitals and healthcare providers to avoid errors and payment losses.
•    The hospital billing process is quite different from physician billing. A hospital or institutions billing function includes collection and billing.
•    As a result, institutional cases are handled only by coding experts because hospital coding is considered more complex than physician coding.

It is essential to avoid violating HIPAA privacy and security rules since physicians and hospital billing staff have access to private and confidential patient health information.
 
Thank you for reading about Physician Billing and Hospital billing. I am pleased to provide you with information on physician and hospital billing.

Digital marketing can be used to target potential patients who are searching for information on health-related topics online. By providing relevant and accurate information, healthcare providers can build trust with potential patients and encourage them to seek care.

Digital marketing also engages existing patients and promotes healthy behaviors. For example, providers can use digital channels to remind patients about appointments and preventive care services. By staying connected with patients, providers can help them make better decisions about their health and improve overall health outcomes.

Digital marketing also reaches a broader pool of qualified candidates for open positions within healthcare organizations. The industry is projected to grow significantly in the coming years, so attracting top talent will be essential for meeting future demand. You could say that digital marketing is good not just for patient acquisition but for employee retention as well!

Importance of Digital Marketing

Over the years, consumers have become increasingly dependent on technological resources, so businesses must actively reinforce their online presence with great thought and consideration.

Modern patients spend considerable time researching reviews and approval ratings before committing themselves to any practice for the first appointment, never mind their entire medical journey. The chance of converting potential patients into customers can be fatal if a practice has a weak online presence.

To be able to get more patients through their doors, healthcare organizations should make sure they are easy to find online. Directly contacting your patients can be difficult. And what’s worse is when they are unable to book online. An online booking system can make a huge difference to your practice.

Many elements go into a thriving online booking system. However, the common thread is communication. The platform you choose should allow you to communicate with your patients in various ways to get the most out of it. The best solution will enable you to communicate with your patients before booking an appointment. It should also be able to give instant feedback on any reviews posted about your facility, which in turn helps improve your chances of getting more patients through the door.

Just because digital marketing is a relatively new field does not mean that it is any less important than more traditional marketing methods. If anything, digital marketing is even more crucial in today’s business climate, where most consumers spend their time online. Ignoring this fact would be to do your business a disservice.

Now let’s get to the point and discuss some of the best tools for digital marketing. These tools are easy to use and will give you the best results for your online presence and conversations.

Google Business Profile

A Google business profile is a free online directory listing designed to help customers search for your business using their Google accounts. People who use their Google accounts to browse the web or search for places to eat, drink, or shop can find your business with a few quick clicks as long as it appears on the map.

As a Google business owner, you’re automatically subscribed to many Google services at no extra charge. Keep track of your customers, know when they visit or call, and connect better with them in the future from your Google Business Profile dashboard. From here, you can view detailed reports about activity on your listings.

A Google business profile is your online business presence on Google.com, the biggest search engine in the world. With a Google business profile, your business is more accessible online through the various Google products and services designed to help companies find customers and grow. Patient reviews and ratings appear in the listings, which can be used as the basis for the further acquisition of patients.

Google business profiles are a quick and easy way to set up a profile on Google and list your business on Google Maps. A Google business profile is your chance to introduce potential customers to your product or service in a visually stunning and user-friendly format.

The following are some of the benefits of having a Google business profile:

·        Adding your contact information and opening hours for increased customer access.

·        A visual layout presents your business in an easily scannable image to potential customers.

·        An opportunity to display your business’s interior and exterior pictures for increased visibility.

·        The ability to showcase your products or services with up to 10 photos.

·        The option to add a detailed description of your business, including keywords that customers may use to search for companies like yours.

·        Links to your website and social media profiles so that potential customers can learn more about you.

·        Customer reviews and ratings from Google Maps users can help increase trust in potential customers.

Content is King

There is much debate about whether the content is king or not. But who could disagree that quality content is crucial for every business, major or small? If a company wants to thrive in this day and be successful in today’s economy, it needs to be able to create content that is unique, interesting, and engaging. The fact is that content is what drives business and what helps a business to reach its audience.

The success of your business is dependent on content. If you can’t produce it, you won’t be able to establish a relationship with potential customers. But what is the content? How can it help your business?

Let’s start with a definition. The internet puts power in your hands. You can write about anything, from your company’s products and services to a restaurant’s breakfast menu, and there’s no limit to what you can put out there and get information about.

When you search for something online, your results are generated using algorithms that capture your search behavior patterns, previous purchases, and website domains. This information helps search engines determine your needs and match them with the best options.

Content is why people come back to your website repeatedly, and it’s what makes your website stand out from the crowd. Having high-quality content on your website engages your customers, promotes your brand, and builds trust.

However, blogs aren’t the only place where you may find material. It should also contain photographs, videos, graphics, and other media. In reality, visual and animated resources are significantly more effective at capturing the attention and minds of viewers than written text alone.

Social Media Management and Marketing

A thriving social media presence is vital for any business to stay relevant and communicate with customers. Social media management is the best way to stay in control while still moving forward.

Social media management, also known as SMM, is all about creating content, engaging with your audience via social media channels, and listening to and responding to their comments, likes, and shares.

Social media marketing is gaining traffic and attention through social media sites. Using these tools, organizations can engage customers personally and earn their confidence faster. These methods reduce the need for large sums to be spent on marketing strategies.

Email Marketing

Email marketing is the process of sending emails to potential or existing customers to promote products or services through direct contact.

It is one of the most effective and reliable ways to connect with your customers. It is one of the most efficient ways to deliver a message to your customers in real-time and on demand.

The idea of email marketing is straightforward; you develop an email campaign, create your message, deliver it to your customer base, and measure the results. When people receive a promotional email from you, they don’t want to look at it and delete it. Email marketing aims to get the customer to do something actionable. This action could be: visiting your website, watching a video, making a call, subscribing to a newsletter, or any other desired action.

Email marketing is a great marketing strategy for promoting products and services. It’s also one of the most cost-effective. Email marketing is a form of electronic direct marketing that allows companies to reach customers via email. Email marketing can be used anytime, though it is most commonly used to send newsletters and promotions to existing customers.

24/7 Consultancy is a digital marketing agency that uses the power of the latest technologies to create innovative solutions for healthcare companies. Our highly skilled digital marketing expert team has a decade of experience creating digital strategies for client organizations of various sizes. Our work helped to facilitate the growth of our client’s businesses and make the organizations more popular on the Internet.

Close collaboration with our clients and communication through all stages of work are the foundation of our business model. We keep in mind that no two businesses are the same, and what works for one might not work for another.

Our services include web design and development, search engine optimization and paid search management, social media management, email marketing, internet marketing, and mobile marketing. To ensure the success of our clients, we are always looking for ways to create innovative projects that not just meet their goals but exceed them.

All acronyms are confusing, but CPT, ICD 10, and HCPCS codes are especially so. When it comes to medical billing and coding, these three abbreviations are used frequently. So, what exactly do these codes mean? In general, CPT codes are used in physicians’ offices, and HCPCS codes are used in hospitals. They are used for medical billing and coding for everything from getting a simple blood test to having a tonsillectomy. Before you can become a medical billing and coding specialist, you will need to know the basics.

In our modern healthcare world, medical insurance is the primary payer for health care. Insurance companies use diagnosis codes to determine their reimbursement schedules. To receive payment from insurance companies, your office must know how to bill the right codes using the correct terminology. To make sure the insurance company has confidence in your practice, all your medical billing needs to be done accurately and consistently.

What is ICD-10, CPT & HCPCS Coding?

To know if they are obligated to pay, an insurance company needs to know whether or not the medical services they provided were medically necessary and, if they were, what the medical code is for these services.

CPT and ICD-10 codes are two of the most common codes used in medical billing. However, they aren’t interchangeable. Doctors use CPT codes to submit claims to insurance companies, while insurance companies use ICD-10 codes to process those claims.

The claims submission process is standardized and follows the rules established by the Centers for Medicare and Medicaid Services (CMS), the country’s largest insurer.

CMS uses the Current Procedural Terminology (CPT) codes and the Healthcare Common Procedure Coding System (HCPCS) codes to identify procedures performed, procedures ordered, and products utilized. Remember that HCPCS codes are for non-physician services; these codes are also used to report physician services if they do not fall within one of the CPT codes.

ICD-10 Codes

ICD-10 was created in 17th century England and is the oldest coding system today, introduced by Sir William Farr, an English physician, and statistician. The original ICD code included 74 categories for diseases, anatomy, and accidents. Due to its comprehensive nature, by the mid-20th century, the ICD had become the most widely used system for occupational injury and disease classification in the U.S.

The modern ICD-10 is still based on Farr’s original model but has expanded to include more than 68,000 diagnosis codes. Because it is so vast, many countries have adopted a portion of it called the “clinical modification,” or “clinical versions”, to help improve clarity and specificity.

CPT Codes

A CPT code, which stands for Common Procedural Terminology, is a five-digit numeric sequence assigned to all medical, surgical, and diagnostic procedures. The American Medical Association develops and updates CPT codes annually to use in reimbursements and gathers information about treatment outcomes to evaluate the quality of care.

HCPCS Codes

CMS developed the Healthcare Common Procedure Coding System, a two-level alphanumeric system.

Level I represent the CPT index. In comparison, Level II is a separate system for coding medical products, such as prostheses and pharmaceuticals, and services, such as radiology and anesthesia. Currently, there are 17 categories, and more are being added; updates may occur as often as every six months.

Why is Medical Billing and Coding Important?

Besides providing medical billing services, medical coding has evolved into an important information tool and offers many benefits.

Medical coding is a universal language that everyone can understand, from billing to clinical specialists. At a glance, records can be cross-referenced. It takes seconds, not hours, to review a patient’s diagnosis at the emergency department, improving the efficiency of care. Even though medical coding is not hands-on care, this profession saves lives.

A paraprofessional can manage billing without the assistance of a clinician through coding. In the meantime, the doctors and nurses will be able to focus on what they do best, caring for patients, while trained administrative staff will handle billing. Payments are processed faster, and clinical resources are used sparingly, making them cost-effective for both hospitals and patients.

Healthcare professionals need a secure mechanism to share patient data across electronic health records (EHRs) and payers. In a world where healthcare privacy is becoming more sensitive, the ability to transfer this data securely is essential. Patients and providers have the right to establish privacy protections for their health information. The Health Insurance Portability and Accountability Act (HIPAA) is a United States Federal law that sets standards for protecting the privacy of medical records and other personal health information.

Despite this, extensive data are shared between insurers, doctors, nurses, office staff, and outside professionals.

In the past, insurers compensated healthcare providers solely based on the costs of their services, but that has changed now. Doctors and hospitals that perform well in today’s reimbursement system are paid more. For patients, this is a win.

Data is essential for benchmarking since it compares provider performance with industry leaders and best practices. Creating a metric tracking structure without the existing coding systems would be too costly.

Benchmark reporting is a valuable tool for consumers today, providing key statistics on hospitals, nursing homes, and physician performance. For example, patients with heart failure may benefit from providers with lower re-hospitalization rates. It gives you the confidence to know which facilities have a successful track record.

Public health authorities use coded data to analyze general health issues and monitor the disease’s prevalence among demographic groups. Agencies like WHO and CDC collect morbidity and mortality statistics. A medical journal always cites ICD-10, CPT, and HCPCS codes when reporting changing trends in death rates from heart disease or diabetes.

Public health planners rely on statistics to support their work at all levels of healthcare. Medical coding enables these tasks during a pandemic:

·        The prevalence of diseases by age

·        Analyze the causes of death

·        Utilization of hospitals and ICUs

·        Monitor the use of medical equipment, such as ventilators

·        Evaluate the outcome of the treatment

·        Providing reimbursement for audits

In near-real-time, officials can monitor and respond to outbreaks.

What will be the future of medical coding?

Investing in education pays off. Will medical coding still be relevant in another ten years? It is essential for students as jobs are being replaced by technology. 

Health experts agree that coding is an essential tool for reimbursement and research since it efficiently conveys expansive volumes of health data. It is impossible to find meaningful data without it. As a result of coding, records become more organized and easier to manage. Coding is a career that offers a future just because of its lower costs.

Medical technology is becoming more dependent on cloud-based applications for medical records, which will require more education and a more complex coding process. With a shortage of medical billing and coding specialists, more and more employers are looking for help from vocational schools that have well-trained graduates.

I will conclude by saying this

In the healthcare industry, billing and coding specialists are key players. Public health is boosted, reimbursement is streamlined, and government policies are strengthened. After a few months of studying in a full-time program at a vocational school, students can be prepared for a rewarding career with plenty of room for professional advancement.

About Scribe Align LLC

With the rise of medical billing services, there is also a rise in the use of medical scribes. What are scribes? Medical scribes are trained medical professionals who help providers with their documentation. Scribes are medical professionals who help medical professionals achieve more in less time.

Scribe Align LLC is a medical billing company located in Las Vegas, Nevada. As medical coding professionals, we manage your complete medical billing cycle, from claim preparation through reimbursement.

Here are just a few of the benefits of using our services:

·        Improve your cash flow.

·        Eliminate the need to hire an in-house billing team.

·        This will give you more time to treat your patients.

·        Improving patient compliance and collections

The challenges encountered by many providers are the complexity of the insurance industry and the numerous accounting requirements for those who employ in-house coders. By outsourcing your billing to Scribe Align LLC, you can be confident that your billing is being done correctly, efficiently, and professionally.

What is Medical Coding? What Does a Medical Coder Do? Starting Your Career as a Medical Coder!

The job of a medical coder is to update the patient record with standardized information for use in billing and data management. Therefore, a code must be assigned whenever a physician, nurse, or other healthcare provider provides a service. As an example, suppose you are a medical coder reviewing the medical record undergoing an X-ray.

Once the technician finishes the X-ray, they will document it on the patient’s chart. An image examination will determine whether a fracture or a sprain caused the injury, and a doctor may prescribe treatment such as a sling or cast.

Your responsibility is to assign specific codes to the medical office to bill the insurance company correctly. Therefore, analyzing medical charts and giving codes are your primary responsibilities.

Codes can aid patients when they need their insurance company to pay their claims, and proper coding can assist providers by ensuring they get reimbursed by the insurer quickly.

It’s imperative to know that medical billing and medical coding involve two different types of work. Depending on the size of the facility, billing and coding may be performed by both people or separate specialists.

While dividing the work between two jobs, the medical coder will be primarily responsible for updating patients’ health records and verifying their coding accuracy; in the meantime, the medical biller addresses claim with insurance companies and follows up on them throughout the day. To understand Medical Billing and Coding Services, check out this article, “What is Medical Billing and Coding Service, Cost, and Reason to Outsource Medical Billing?“

Various titles may be used to describe medical coders. Medical coder jobs are also known as:

·        Medical coding auditor

·        Medical coding analyst

·        Diagnostic coder

·        Medical coding specialist

·        Clinical coding officer

Are there some characteristics common to successful medical coders?

Unlike other professions, medical coders do not have any “typical” prototypes. The field embraces people of all identities, ages, and experiences. Medical coders share some common characteristics that make them successful. Strong ethical standards are essential because the patient data they manage is highly confidential.

One little mistake in a medical code can lead to much larger problems. Medical coders must also be meticulous with their work. As a result, they must also remain focused because their work is repetitive yet essential. Aside from being efficient and even-tempered, their work is often tied to reaching production and accuracy goals.

Is it essential to have skills in medical coding?

There are a few technical skills for medical coders that they need, but transferable skills are also necessary. The data comes from real-time analysis of over 25,000 medical coding job posts from the past year, which revealed some of the top skills employers are looking for.

Medical coding skills to Master:

·        Health Insurance Portability and Accountability Act (HIPAA) compliance

·        Medical coding

·        ICD-10

·        Customer billing

·        Health information technology

·        CPT coding

·        Inpatient coding

·        Anatomy and physiology

·        HCPCS coding

·        Clinical documentation

Medical coders need to be proficient in the following transferable skills:

·        Time management

·        Communication

·        Multi-tasking

·        Research

·        Computer literacy

·        Problem-solving

·        Microsoft Office®

·        Analytical skills

Some of those transferrable skills might make you a promising candidate for a career as a medical coder. The list of technical skills is what a formal education teaches you, so don’t let it intimidate you.

Are you thinking about becoming a medical coder?

The information you just read has helped you gain a basic understanding of medical coding, its skills, and the vital role these professionals play in the healthcare industry. Medical jobs are expected to grow strongly over the next decade, making it an excellent option for those searching for a job in the medical field. However, when considering a healthcare career, you need to be prepared for what lies ahead.

Requirements for becoming a medical coder?

A bachelor’s or master’s degree is not necessary to prove proficiency, though it can strengthen an individual’s career. It would be best if you had a solid foundation in physiology, anatomy, and medical terminology. If you’d like to work as a medical coder, you’ll need to complete a coding course.

Several community colleges offer coding training, and online learning centers offer this service. The majority of training programs are 18 to 24 months long. In addition, the American Association of Professional Coders, a credentialing body for medical coders, offers several medical coding courses.

It would be best to prepare for the certification exam to become a certified professional coder through your study program. The certificate proves your understanding of coding rules and your ability to translate patient charts into insurance billing correctly. Coders with less than two years of experience earn the CPC-A (apprentice) designation until they are fully qualified. In addition, your knowledge of physician offices (CPC), outpatient facilities (CPC-H), or payers (CPC-P) will be tested in AAPC examinations.

Certifications for specific medical specialties are available based on the type of service rendered, including evaluation and management, general surgery, and obstetrics and gynecology. The certification status must be maintained through continuing education.

CPT is a standardized set of codes used to report medical, surgical, and diagnostic procedures and services to various entities, including physicians, insurance companies, and accreditation organizations. Medical bills are billed electronically using CPT codes combined with ICD-9-CM or ICD-10-CM numerical diagnostic codes.

The CPT codes are used to submit claims to federal and private payers when rendering healthcare. As CPT codes provide a detailed description of a procedure or service, they eliminate subjective interpretations of what was delivered to the patient.

The American Medical Association (AMA) developed CPT® codes in 1966 to standardize reporting of medical, surgical, and diagnostic services and procedures provided in hospital and outpatient settings.

The evolution of healthcare – including the availability of new services and the retirement of outdated procedures – is a significant consideration. Every year, the AMA releases new, revised, and deleted CPT® codes and changes to coding guidelines. The AMA also releases more minor updates to various sections of the CPT® code set.

Moreover, the AMA updates CPT® terminology or medical language to reflect advances in medicine. Though the AMA owns the copyright to CPT®, it invites participants to contribute to the ongoing maintenance of the code set and welcomes feedback on the codes and code descriptors.

Understanding CPT® codes

CPT® codes are composed of five characters. In general, codes are numeric, but some codes include a fifth character, such as A, F, T, or U. These are some examples:

92526      Oral function therapy

0638T      Ct breast w/3d bi c-/c+ 

CPT® Code Types: A Quick Guide

Providers assign codes to every service or procedure they perform. It even includes codes for services and procedures not specifically named in another CPT® code, called unlisted codes.

The AMA has organized CPT® codes logically by classifying them into three types based on the wide range of services and procedures they cover:

CPT® Category I: Codes commonly used by providers to report their services and procedures comprise the largest body of codes

CPT® Category II: Additional tracking codes used in performance management

CPT® Category III: Emerging and experimental codes for reporting services and procedures

CPT® Category I:

Most CPT® codes are in Category I. There are a variety of existing services and procedures that are widely used and, where appropriate, approved by the Food and Drug Administration (FDA).

In general, Category I codes, which are typically represented by five characters, are arranged numerically. Codes are resequenced in one discrepancy from the expected order. In order to facilitate quick access to related codes – and help coders select the best codes – the AMA groups similar codes together. Resequenced codes occur when a new code is added to a family of codes, but there is no sequential number assigned to it.

Another exception to numerical code order involves evaluation and management codes (E/M codes). Although E/M codes begin with 9, they are printed first in CPT® code books, as you can see below in the code outline for Category I. E/M services are among the most frequently reported healthcare services, so the AMA chose this order. As with resequenced codes, this arrangement is intended for coding efficiency.

Codes for CPT® Category I fall into six main categories:

Evaluation & Management (99202–99499)

Anesthesia (00100–01999)

Surgery (10021–69990) The code range is further divided into smaller groups by body area or system

Radiology Procedures (70010–79999)

Pathology and Laboratory Procedures (80047–89398)

Medicine Services and Procedures (90281–99607)

CPT® Category II:

Four numbers and the letter F make up Category II codes, which providers can assign in addition to Category I codes. There is no reimbursement associated with Category II codes, unlike Category I codes.

The CPT® code book typically places Category II codes after Category I codes. These codes are listed as follows:

Composite Measures (0001F–0015F)

Patient Management (0500F–0584F)

Patient History (1000F–1505F)

Physical Examination (2000F–2060F)

Diagnostic/Screening Processes or Results (3006F–3776F)

Therapeutic, Preventive, or Other Interventions (4000F–4563F)

Follow-up or Other Outcomes (5005F–5250F)

Patient Safety (6005F–6150F)

Structural Measures (7010F–7025F)

Nonmeasure Code Listing (9001F–9007F)

CPT® Category III:

Category III codes, characterized by four numbers and a letter T, usually follow Category II codes in the code book. Category III codes are temporary codes used to identify new technologies, services, and procedures.

In Category III, temporary codes describing new services and procedures can remain for up to five years. They must meet Category I criteria, including FDA approval, evidence that the procedure is widely practiced, and evidence that it has proven effective. A new Category I code will be assigned to them. Providers can also eliminate Category III codes if they do not use them.

The AMA releases new or updated Category III codes semiannually via its website but publishes the deletions of Category III codes with the full list of temporary codes annually.

Physicians are required to file their annual fee schedules with CMS (Centers for Medicare & Medicaid Services) by January 1st of each year. The physician fee schedule is used to determine the amount of reimbursement physicians receive for services provided to Medicare beneficiaries. In addition, the physician fee schedule is used as a reference point for determining the amount of payment made to physicians under the Medicare program.

To implement the Medicare Physician Fee Schedules, CMS has developed two separate systems: the Medicare Physician Fee Schedule (MPFS) and the Medicare Supplier Fee Schedule (MSF). The MPFS is a national system that applies to all providers of covered professional services, including hospitals, nursing homes, durable medical equipment suppliers, hospices, home health agencies, and certain other entities. The MSF is a regional system that applies to all non-hospital providers of covered professional services.

The Medicare Physician Fee Schedule is published annually in the Federal Register and includes information regarding the amounts payable to physicians for services rendered during the calendar year. In this article, we give you a quick overview of changes to the Medicare Physician Fee Schedule that will take place on January 1, 2022.

A summary of the Physician Final Rule for 2022

In November 2021, the Centers for Medicare & Medicaid Services (CMS) published the Medicare Physician Fee Schedule (MPFS) Final Rule. The Final Rule made further changes to the MPFS, which became effective on January 1, 2022.

Medicare reimbursement assumes-and physicians are expected to provide a full range of services and treatments that meet the needs of their patients. They are updated every year to reflect the most recent scientific evidence, changes in technology, and practice patterns. They are meant to improve quality healthcare, improve patient care, and help people get the care they need.

Medicare payment rates are updated annually based on inflation and other factors. They are subject to change on April 1 each year. More information about Medicare reimbursement can be found on the Centers for Medicare & Medicaid Services (CMS) website.

The RVUs are the relative values assigned to physician work. These values are determined by the Medicare Physician Advisory Committee, which is comprised of doctors and non-doctors with expertise in the field of health care. The RVUs attached to each service determine how much physicians earn from Medicare.

The geographic adjustment factor is based on the difference in costs of providing medical care between practice locations around the country. It can increase or decrease a physician’s Medicare payment, depending on whether the area they practice in has higher or lower practice costs than those nationwide.

Expanded Data Reporting (EDR) 10C and EDR 11C provide physicians with a single report containing their actual Medicare payments, as well as their RVUs, GPCI, adjustments, and other important information needed to submit appeals effectively.

These are the national allowable, calculated based on RVUs:

Two percent Medicare cuts will also affect final payments because Congress won’t be able to stop the cuts. Lab tests, for example, are not part of the physician fee schedule, so these rates will not be affected.

Vaccine Administration

As of 2021, the cost of influenza, pneumococcal, and hepatitis B virus vaccines will increase to $30 from $17.63 on average. G0008 (influenza), G0009 (pneumococcal), and G0010 (hepatitis B) are included here. Geographic adjustments may apply.

As of January 1, the year following the end of the Public Health Emergency (PHE), COVID-19 vaccine administration and monoclonal antibody infusion services will remain at the current rates. Unless and until another extension is made, the PHE will remain in effect until January 16, 2022.

Split/Shared Services

Services that are split or shared depending on the fact sheet from the doctor and the non-physician practitioner (NPP) that was given on the date of service.

Incident-to guidelines must be followed in the office. Shared visits will be restricted to institutional settings starting in 2022.

Telehealth’s new POS

Telehealth services are now available through a new POS added by the Centers for Medicare & Medicaid Services (CMS). With the new POS 10, telehealth services are delivered to the patient’s home. POS 02: Telehealth services that are not provided in the patient’s home are also listed as POS 02. Effective April 1, 2022, this new POS will be available for use.

During the COVID-19 PHE, CMS will cover telehealth services until the end of 2023 while they continue to look at changes to the permanent policy. Practices that use load sharing will see their originating site fee, Q3014, go up a little in 2022. It will go from $27.02 to $27.59.

Physician Assistants

As part of the evolving role of non-physician practitioners (NPPs), CMS will be able to make direct payments to physician assistants (PAs). Payments are only available to the PA’s employer at the moment. Beginning January 1, 2022, PAs will be able to bill Medicare directly for professional services or integrate with other PAs and bill Medicare for PA services.

Addition of Modifier 93

On January 1, 2022, a new modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system) became effective. With this modifier, physicians or other healthcare professionals can report on medical services provided through audio-only communication with patients. As the name implies, synchronous telemedicine consists of a real-time, two-way conversation between a physician or other qualified healthcare provider and a patient located far from the physician. This modifier is intended for payers that prefer E/M codes instead of the time-based CPT codes 99441–99443 for billing calls.

COVID-19 Immunization Diagnosis Codes

Three new diagnosis codes were announced by CMS for April 2022, including two codes for COVID-19 vaccination status. Coding for inpatient reimbursement has primarily been designed for hospital use. A hospital’s reimbursement is based on the most frequently used resources during a diagnosis.

Z28.310 – Covid-19 unvaccinated (To be assigned to patients who have not received one or more doses of the Covid-19 vaccine)

Z28.311 – COVID-19 partially vaccinated (Assignation when the patient has received at least one dose of the multidose COVID-19 vaccine regimen but not the entire regimen)

Z28.39 – Another under-immunization status

New Code Update: 99211 Consistency Adjustment

This code descriptor will be used as of 2022, describing office or other outpatient visits for evaluating and managing established patients that do not require the presence of a physician or provider of health care. 99211 requires that these services be medically necessary (i.e., clinically indicated) and accompanied by a plan of care by a physician or other qualified healthcare professional.

As a leading revenue cycle management company, Scribe Align LLC provides a variety of medical billing services. We can assist you with billing and coding for urgent care services.

A study on HIPAA compliance conducted by Porter Research, NueMD, and Daniel Brown Law Group discovered that approximately 40% of healthcare organizations and healthcare billing companies are unaware of the updated compliance measures. There were 42% of companies in this group without even a HIPAA compliance plan, which is one of the most important elements of the law! It is clear that this study reflects the state of affairs and that the system needs to be examined in more depth. Let’s find out!

By tackling the pitfalls of sensitive health information management, the Health Insurance Portability and Accountability Act aims to improve the security of the system. It is important to make sure that the healthcare billing companies you hire are HIPAA compliant when you contract with them to handle your medical billing and other revenue management needs. Having data protection ensures you maintain your ethical standards and protects you from data breaches. With the constant changes, it can often get confusing.

In this article, we will discuss why the HIPAA law is important to healthcare billing companies and how it impacts them.

In what way does a law like HIPAA serve its purpose?

A person’s medical information is sensitive by nature. Fraud cases can become complicated if such information is mishandled. In one way, the patient’s data is compromised. On the other hand, it damages the reputation of the healthcare organization.

1.       HIPAA acts as an umbrella to keep an organization safe from all forms of information breaches.

2.      HIPAA implements measures that address multiple areas of concern and try to resolve them.

3.      HIPAA regulates the handling of patient data, also called PHI (Protective Health Information).

4.     Information is protected from being compromised and falling into the wrong hands.

5.      In turn, this reduces the number of healthcare fraud cases.

6.     As part of HIPAA, pre-existing conditions are eliminated through health insurance portability.

What kind of information is covered by PHI? How does HIPAA protect the information?

Protection of health information, or PHI, is applicable to even an unborn fetus. The key information under PHI includes:

·        Details about the patient’s demographics

·        Documentation about the individual’s health

·        Any mental health records that exist

·        The patient’s lab results, if he or she has taken any tests

·        Details of the patient’s insurance

·        For a newborn or a fetus, information like body weight, height, temperature, or health problems is written down

The provider and billing teams access electronic health records to view these details. An individual’s privacy can be deeply compromised with a single breach of data security. Thankfully, HIPAA provides a robust electronic system to protect these sensitive data points.

Is HIPAA compliance mandatory for healthcare billing companies?

Yes! Regulations set by the US Department of Health and Human Services deem this as a mandate instead of an option. Following federal policy, these rules are applicable nationwide for healthcare organizations including:

Covered Entities: Any entity involved in the patient’s treatment plan, payment method, or any other medical procedure.

Business Associates: Any organization that assists covered entities in their work.

Since they have access to patient information, healthcare billing companies generally fall under the business associate category.

According to the US Department of Health and Human Services, HIPAA’s security and privacy regulations do not apply to organizations such as life insurance companies, employers, and workers’ compensation managers.

What are the steps healthcare billing companies must take to stay compliant?

Health and Human Services website provides comprehensive information about HIPAA compliance measures. The HIPAA journal suggests the following checklist for those just entering this field:

·        To ensure that the systems are functioning properly, audits and assessments are conducted annually.

·        An analysis of the audit results indicates a need for improvement in workflow management.

·        Implementing the remediation plans aimed at ensuring compliance should be carefully planned.

·        If the company isn’t able to plan out the steps, it can conduct a system check by appointing a HIPAA Compliance, Privacy, and/or Security Officer.

·        A periodic review of the plans is necessary to determine if they are working for each organization. Regardless of the outcome, updates must be made.

·        Companies can also hire Compliance Officers to conduct HIPAA training for their staff. By doing so, they will remain informed about the modified rules.

·        Reviewing staff training is also a great way to find out how well the company is managing its work.

What questions should you ask a company that handles your health care billing for you to make sure they follow HIPAA?

To ensure that healthcare billing companies are trustworthy, check out their reputation before outsourcing revenue management work. Otherwise, you might end up in unnecessary legal disputes. Check if they are HIPAA compliant by asking these questions:

1.       What regular monitoring systems do you have in place to check for potential attacks on your software systems?

2.      Can you explain the kinds of restrictions you follow when you transfer or handle electronic PHI?

3.      How secure are your audit logs across your hardware and software systems?

4.     Are you regularly training your staff to ensure patient privacy?

5.      Are you following proper security protocols when it comes to facility access?

6.     What kind of policies do you follow in terms of authorized access to patient information?

7.      Do you conduct a yearly assessment of security risks as required by HIPAA?

Hopefully, these questions cover most of your potential risk points. You can request a HIPAA compliance certification if you are still unsure about the systems. Take a look at their customer reviews to get a better idea.

This blog intends to provide you with more clarity regarding HIPAA compliance for healthcare billing companies. Please let us know what you think! Whenever you have questions, feel free to contact us and we will get back to you.

Think about Scribe Align Medical Billing.

If you’re interested in outsourcing medical billing for your practice, we can assist you. Practices need to maintain profitability so that accurate billing processes are followed. Our billing experts understand the complexities of revenue cycle management.

As more physicians outsource billing, demand for services is expected to rise by 168 percent

The demand for medical billing specialists is rising as hospitals, and other healthcare facilities struggle to deal with these reimbursement changes. The need for medical coding services has also increased because of the prevalence of electronic medical record (EMR) systems. According to the U.S. Bureau of Labor Statistics (BLS), employment in the medical- and health services industry will grow 13.8% by 2026, faster than the average for all occupations. Several recent reports have demonstrated that the medical billing outsourcing market is expected to multiply due to the growing demand. The number of in-house billings is expected to increase from $6.3 billion in 2015 to $16.9 billion by 2024.

The role of a medical-billing specialist hasn’t changed much over the years. Still, it has evolved in the sense that they now have more responsibility for submitting claims, collecting payments, and resolving errors. They must navigate a complex and ever-evolving regulatory environment that requires them to collect more information from providers and patients, adhere to new billing laws, and comply with government audits, among other things.

Many physicians will move from in-house medical billing to outsourced billing in the next decade. Here’s why it makes sense for you too.

Factors that contribute to an increase in demand

There have been many changes in the healthcare industry over the past few years. The Affordable Care Act and ICD-10 have made the task of billing and coding for physicians extremely difficult, especially since the introduction of the Affordable Care Act.

Medical billing outsourcing is becoming increasingly popular due to the following reasons:

Lack of in-house expertise; Revenue cycle management (RCM) has become more complex in recent years, requiring a higher level of expertise to achieve maximum reimbursement and optimal cash flow. A billing company’s staff likely processes thousands of claims across multiple specialties per month instead of in-house billers and coders handling hundreds. Taking advantage of this greater level of expertise can benefit medical practices.

Software that is no longer supported: To meet the latest industry demands, billing software has undergone a series of evolutions. Software upgrades can cost tens of thousands of dollars to stay compliant and maintain billing efficiency. If physicians don’t upgrade their software, they may find that their billing process is complex and inefficient due to outdated software.

Care for patients should take precedence: Physicians are under pressure to refocus on quality metrics due to changes like MACRA and a shift to value-based care to avoid penalties that may affect insurance reimbursements. Outsourced billing allows physicians to focus on patient care without having to worry about their billing as well. The billing company will be responsible for handling all incoming billing questions, so front office staff will also benefit from fewer calls.

Revenues increased as overhead costs declined: It is common for medical practices to have a fixed cost associated with in-house medical billing. Independent practices need to pay their staffing, and IT costs regardless of how much revenue comes in. It is possible to eliminate a portion of these expenses if you outsource your billing, shifting them to variable costs that depend on the number of accepted claims and reimbursements. Outsourcing provides significant revenue growth to medical practices with large claim volumes, partly because 20% of claims are not processed correctly by payers, resulting in underpayments and no payments. When practices outsource, they can enjoy significant cash flow and revenue improvements.

Why outsourcing is a good idea

It can be challenging to determine whether to outsource your practice’s medical billing. Yet, there is a point when it becomes too lucrative not to pursue it.

Switching to a third-party billing system can be intimidating and daunting, especially for physicians who have done billing in-house. Outsourcing billing can be a smooth transition – far from as intimidating as most people think.

However, not all billing companies are the same. Don’t settle if you have had an unpleasant billing experience. Consider working with a billing company that understands your needs, responds quickly, and has a track record of maximizing reimbursements.

As for pricing and budgets, they should be discussed, but the most important thing is considering the long-term. It’s not a good deal to pay less to a company whose collections are lower.

Choose one that charges a higher fee and has proven recovery rates when choosing a recovery company. As a result, you will not only cover the higher fees, but you’ll also have more money in your pocket.

Physicians can now hire staff to do follow-up work and pursue even more of their practice’s revenue with improved cash flow.

Think about Scribe Align Medical Billing

We can assist you if you are interested in outsourcing your practice’s medical billing. Our billing specialists understand the complexities of revenue cycle management and the critical role of accurate billing processes in ensuring practice profitability. Offering a full range of medical billing services fit for any practice size, we have a proven track record of reliability and effectiveness.

Medical practice management encompasses many roles and responsibilities and is not limited to the medical sector alone. In addition to the medical field, such as doctors and nurses, other fields, including law firms, accounting firms, etc., also benefit from competent and efficient back-office support. While every profession has its specific requirements and demands, there are several common goals that most professions share.

The main goals of medical practice management are ensuring client satisfaction, regulatory compliance, organizational management, financial planning, fiscal accountability, medical staff relations, and service delivery.

Achieving these goals requires an understanding of the business side of medicine and the clinical side. To succeed, medical practice managers must have a solid foundation in both areas. In addition, they must effectively communicate with and manage staff, clients, and other stakeholders.

There are many different software programs available to help with medical practice management. These programs can automate various tasks and help keep track of essential data. They can also provide reports and analytics that can help improve efficiency and effectiveness. Ultimately, choosing the right software program depends on the specific needs of the medical practice.

It’s more complicated than ever for a physician to manage and grow a practice today. One challenge leads to another for practice managers, including:

Mandates for new regulations: In light of new regulations like the No Surprises Act, physicians must be ready to respond quickly.

Staffing shortages: Many healthcare facilities are experiencing a 50% or more increase in labor costs. Approximately 76% of medical practices have changed operational models because of staffing shortages. EMSI has shown that healthcare workers will have a critical shortage by 2026.

Revenues are down: Many practices still struggling to recover from the lingering effects of COVID-19. In 2021, 40% of medical practices did not achieve revenue goals.

In terms of cash flow: Almost half of all medical practices say that the amount of time spent in A/R has increased.

A more competitive environment: With CVS, Walgreens, Walmart, and others entering the healthcare field, consumerization is accelerating rapidly.

Medical practice management is a complex process, but it is essential for ensuring quality care and efficient operations. By understanding the various roles and responsibilities involved, medical practice managers can develop strategies for success.

To effectively manage a medical practice today, you must have the right processes, systems, and resources in place. Medical groups must be able to adapt to a complex healthcare environment in order to remain resilient over time.

Three important success characteristics are required for effective medical practice management

In today’s healthcare environment, many medical groups are working with disparate systems; revenue leakages and cost overages cause havoc on the bottom line due to processes that make it challenging to locate and solve. With operating margins being cut across the board, standardizing best practices is critical in reducing wasteful expenditures.

Adopting a fully integrated platform into current systems can enable physician groups to lower overall cycle times and improve financial margins through uniformity across the revenue cycle. Healthcare is changing rapidly, so physician practices can benefit from a state-of-the-art, highly innovative platform that helps them stay ahead instead of just keeping up. Instead of creating the infrastructure from scratch, partnering with an automated platform is the better solution.

If organizations do not have access to critical operational metrics, they tend to be reactive instead of proactive, which can lead to significant problems (many of which are preventable).

Healthcare leaders must regularly be aware of their organization’s revenue cycle operations and performance metrics.

Scribe Align LLC is a medical billing service that specializes in communicating with insurance companies on your behalf to ensure you receive payment for your services. We prioritize your workflow and ensure you get paid efficiently and accurately, saving you the time and money to do it yourself. As a medical practice management company, our services are tailored specifically to physicians’ needs. We can create a cost-saving strategy just for you, including your effort with the following:

·        Processing claims for your practice

·        Securing payments from payers

·        Audit assistance

For more information about Scribe Align and how we can save you time and money through medical billing, contact us today at 888-503-7888

Medical billing companies are a helpful resource that can help you streamline your practice and get paid faster. But how do you choose the right one?

There are a few things to consider when looking for a medical billing company. First, decide if you need full-service or do-it-yourself billing. A full-service firm may take over your RCM processes completely, handling the day-to-day and reporting to you regularly. Or you can hire an independent biller—someone who will find potential errors and reconcile bills for you on a monthly or quarterly basis. Either way, you’ll want to make sure your prospective firm has experience with your type of practice.

A medical billing company can help healthcare providers adjudicate claims and provide many other services. Claim-related tasks include entering data, checking a claim’s details, and filing it electronically or on paper. Many companies also provide RCM support, including claims patient billing, follow-up and appeals, and cash posting.

A medical billing company specializing in this area is likely to provide software and services to help with all of the above and more comprehensive solutions. These might include credentialing software, schedule management, and electronic health records.

Medical Billing companies offer services in a variety of ways at different levels. In some cases, full-service firms handle your RCM needs completely and provide regular reports to you. You may also find companies that offer software and solutions to help with the billing process. Other companies provide hybrid solutions that employ solutions that enhance your workflows and engage professionals to help with overflow.

Benefits of Medical Billing Companies

There are several benefits available to medical billing companies. With a medical billing company, you can focus on your clients, which is the most important part of your business. You can give them the best service possible by handing off the billing and collections process to the medical billing companies. This allows you to grow your business in several ways.

Medical billing companies offer two primary services. The first is to help doctors and physicians save time and money by managing their practice, including the mechanics of submitting claims to insurance companies. The second service is the creation of invoices and statements that show a patient how much they owe. This can be useful for helping a patient budget their expenses, or it can be helpful for patients who are paying their bills over time. The following are some options:

Expertise at your fingertips: Medical billing companies help medical offices with the more labor-intensive aspects of running a medical practice, from electronic claims filing to payment collections. Whether your office is a single provider or you have thousands of medical professionals on-site, medical billing companies can lighten the load.

A scalable capability: Most medical practices are small enough that the doctor and staff can handle the paperwork themselves. There are many advantages to working with a medical billing service, especially in a busy practice like yours. They’re much better at filing claims than you are because they have more workforce and years of experience under their belts.

Your office will be more efficient: Many small medical offices don’t have the time to track medical billing but also to check and verify the accuracy of bills received, determine insurance coverage, and follow up on underpayments or late payments. A medical billing company can provide all these services, freeing up your staff to focus on patient care. 

Medical billing companies are in high demand. If you run a medical practice, this is your opportunity to provide a convenient and affordable billing service to your patients without investing in a large set of resources.

What to Look for in a Medical Billing Company

Medical billing services are something that professionals in both the medical and for-profit arenas need. Medical billing services providers can vary greatly; however, choosing the right one for you is crucial to both your health and your business’s success. To feel comfortable trusting the provider with your patients’ data and revenue, you should make sure you get satisfactory answers to the questions listed below.

Medical billing companies house a wide range of pricing models. Understand whether you’re getting charged per claim or hour, a flat rate for services, or a percentage of revenue collected. While the terms can vary from company to company, the most important thing to know is that healthcare professionals are typically charged per claim, not on an hourly basis.

If you’re looking to hire a medical billing company, consider two things: their skills and their experience.

The best medical billing companies will have a staff that includes Medical Billing Coders and Certified Medical Assistants. They’re trained to properly document all of your patient visits, emphasizing coding and insurance reimbursement.

Medical billing companies should always have these experts available 24/7 to get help with an insurance claim, especially if your patient is about to be discharged from the hospital or in the office for a regular visit.

While you can train your personnel to do medical billing, it’s not always feasible. Many medical billing companies can provide you with emergency help if you need to care for a patient coming in after-hours or being admitted as an emergency case.

Do your staff do some of the work before the billing partner takes over, and how is the data translated between the two parties?

Medical billing companies need to be HIPAA-compliant as a part of medical billing compliance. HIPAA compliance is necessary for the medical industry, but what do you know about HIPAA and its effect on your business?

To ensure patient confidentiality, your medical billing company needs to be HIPAA-compliant.

“Finding the right medical billing company can be a challenge.” Your business is unique. When it comes to medical billing, you need to find a company that understands how your workflow works and how to file claims in your specialty.

The Cost of Medical Billing Company

Fees for medical billing and coding companies vary widely. Flat fees, hourly rates, and contingency are the most common means of billing for medical billing and coding companies. Flat fees have no relation to the time spent on a specific case. The flat fee may be charged on a per-transaction or per-claim basis. Some companies may charge a set amount for work done by an individual scribe, while others may charge a set amount per total claim processed, regardless of how many hours or transactions it took to process the claims. Not all companies charge the same fees, which is something to look into before selecting one.

Why Choose Us

Our medical billing experts provide billing and coding services for your practice. We take care of every aspect of your account to ensure claims are filed timely and accurately. With a proven track record of reliability and effectiveness, we offer a full range of medical billing services to support any practice size.

What is Medical Billing and Coding Service, Cost, and what Reason to Outsource Medical Billing?

The busy medical practices must maintain a high standard of patient care while completing the necessary administrative tasks to keep doors open.

Medical billing can consume lots of time. It’s also challenging to locate and train staff to perform this important job. Additionally, if claims are not processed properly or on time, they could negatively affect your practice revenues.

Many practices use third-party medical billing firms to manage their claims.

WHAT IS MEDICAL BILLING SERVICE?

The independent medical billing service is utilized to submit, process, and monitor health insurance claims to reduce the amount of time spent by your staff.

These companies employ highly trained employees that understand specific customers to get a better payment rate in a short amount of time.

In addition, any medical billing service you choose can follow up with denied claims and seek to recover delinquent accounts.

WHAT IS MEDICAL CODING SERVICE?

The primary responsibility of medical coders is to examine clinical claims and assign codes standard by using CPT (r), ICD-10-CM, and HCPCS Level II classification systems. On the other hand, medical billers manage claims made to health insurance companies to ensure reimbursement of services.

Medical coders and billers could be the same person or work together to ensure that invoices are properly paid. To understand what the coding process looks like, check out this article, ” What Does a Medical Coder Do?“

MEDICAL BILLING VS MEDICAL CODING SERVICES

Medical billing refers to a specific service that is different from medical coding. Coding is assigning a standard code to particular services before submitting claims. Medical billing involves the process of submitting and following up on claims.

Most medical billing companies require you to write your code; however, some offer both.

If you have questions about billing or coding, our certified coders can assist you. They also help with medical codes for your clinic.

WHY DO MEDICAL PRACTICES OUTSOURCE MEDICAL BILLING SERVICES?

The advantages of working with companies that outsource medical billing are:

·        Improvements in workflow for practices Office staff

·        Eliminating any confusion regarding the specific payment policies of each payer

·        Reduction in submission errors

·        More rapid claims processing

·        Improved Healthcare Revenue Cycle Management

·        Access to skilled industry specialists

·        Lower costs per patient

·        Profitability increases

·        Patient satisfaction is improved as claims are processed promptly

The main reason third-party medical billing companies are important is that they reduce stress for practitioners concerning billing issues.

Scribe Align LLC clients enjoy the following benefits as a result of our services:

·        100% HIPAA complaint process

·        98% claims payment on the first submission

·        Increased efficiency owing to the certified coding team

·        Shortest turnaround time and faster reimbursements Cycle management by billing specialists

·        Reduced staffing issues and operating costs

·        Denial follow-up and resolution by industry experts

·        You will save almost 70% on operating costs

·        No headache with staff training or update

·        Quick response and answers to any billing query

·        Dedicated practice manager for every practice to ensure streamlined communication

·        Continuous and rigorous follow-ups on denied and pending claims

We also provide providers with current information about local, state, and national local fee trends so that you can adjust your fees on time to ensure your practice is on the same page as other practices.

HOW MUCH DO MEDICAL BILLING SERVICES COST?

Costs for medical billing services are determined by the number of claim submissions, a setup fee, a percentage of collection, or a monthly service fee. The costs vary widely between businesses.

Contact the prospective service provider to learn more about their specific pricing structure.

The best choice for you will be based on your company. For example, if you’re a small-sized practice with fewer claims to be processed, the cost per claim might be cost-effective. Many methods, however, prefer the model of a collection percentage, which means that to allow the billing firm to be paid, the practice has to be paid first.

Are you unsure about the medical billing service we offer? Feel Free to Contact Us at any time!

We at Scribe Align LLC are experts in medical billing and coding enrollment management services, including credentialing for your staff to ensure they have the right credentials necessary when it comes time for care coordination or insurance verification. We also provide claim denial/ acceptance processes as well as business intelligence reporting across various departments within our practice so that you can stay up-to-date on all aspects of running a successful clinic!

History

The first version of CPT Coding was printed in 1966 and is primarily concerned with surgery. There was little prominent coding in neuroradiology. Four-digit codes were utilized at the time. When the second edition came out in 1970, each code had five digits instead of four. The 70000–79999 code range means radiology.

The third and fourth editions of CPT were published in the mid-to-late 1970s. Not unexpectedly, each version became increasingly complicated, reflecting the increasingly complex healthcare system.

Since then, this transformation has persisted. In 1983, the predecessor of the Centers for Medicare and Medicaid Services (CMS) combined CPT with the Healthcare Common Procedure Coding System, which had always done something similar to CPT.

Just as the World Health Organization’s International Classification of Diseases keeps an updated taxonomy of medical conditions, CPT keeps an updated categorization of surgical treatments.

The Kennedy Kassebaum Act, commonly referred to as the Health Insurance Portability and Accountability Act of 1996, was adopted thirty years after the CPT system was introduced. This law says that the Department of Health and Human Services has to make rules for digital transactions of health care information, such as code sets.

As a result of the Health Insurance Portability and Accountability Act, the American Medical Association decided to examine the CPT system in depth to see if the then-30-year-old system was still helpful.

As a result of this study, the CPT-5 project was founded. CPT was expanded with new nomenclature to monitor new operations and services. CPT also includes particular reporting measures that could be utilized in performance-based remuneration.

The CMS chose to formally adopt CPT codes in Medicare claims processing as a result of the Health Insurance Portability and Accountability Act’s expansion. CPT was adopted as the national coding standard for reporting medical services and procedures in 2000.

The AMA persists in recognizing the importance of preserving an up-to-date and relevant CPT coding system, which it does through House of Delegates resolutions, active physician participation in a standardized evaluation of current codes, the discontinuation of outdated codes, and authorship of new codes to reflect changes and innovations in medical practice.

The CPT codebook is a living document that is updated annually. For instance, the 2016 edition includes over 350 code changes, 140 of which are new, 134 of which are modified, and 93 of which are discarded. So, CPT is essential to providing health care in 2016 and beyond.

Background

Qualified healthcare professionals (QHPs) must disclose their professional services in a way that institutes, corporate and state consumers, scholars, and other stakeholders can understand.

The data from QHPs is used to track healthcare utilization, determine services for reimbursement, and collect quantitative healthcare statistics on people. Healthcare insurers in the United States process about 5 billion claims for payment each year.

A uniform coding system for medical services and operations is required to ensure that healthcare data is captured precisely and consistently and that health claims for Medicare, Medicaid, and other health programs are handled correctly.

The American Medical Association (AMA) developed the Current Procedural Terminology (CPT) standard for these purposes. The AMA model creates a standard lexicon and numerical coding system to promote proper communication across various stakeholders, including patients and the medical, surgical, diagnostic, and treatments provided by QHPs.

The CPT descriptive terminology and related code codes are the most widely accepted way to describe healthcare solutions and procedures for claims, research, figuring out how much healthcare is used, making clinical recommendations, and other types of healthcare documentation.

Introduction

CPT is the terminology providers, and buyers use when billing healthcare services and procedures for remuneration.

CPT, or Current Procedural Terminology, is a collection of medical codes used to define the procedures and services conducted by physicians, nonphysician practitioners, outpatient facilities, hospitals, allied health professionals, and laboratories.

CPT codes, in particular, are used to report procedures and services to federal and commercial payers for compensation for given healthcare services. CPT codes were developed by the American Medical Association (AMA) in 1966 for standardized reporting of diagnostic services, surgical, medical, and procedures conducted in hospital and community settings.

Each CPT code represents a written description of a process or service, removing the need for subjective assessment of what was provided to the patient.

The AMA updates the CPT code set annually, issuing new, amended, and deleted codes, as well as revisions to CPT coding guidelines, to reflect the expanding world of healthcare, along with the availability of new services and the deletion of outdated codes, among other factors. The AMA also issues minor modifications to specific portions of the CPT code set throughout the year.

Furthermore, the AMA changes CPT nomenclature, or medical terminology, to reflect medical breakthroughs. Even though the AMA owns the rights to CPT, it encourages providers and organizations to help keep the code set up to date by suggesting changes to the codes and how they are described.

CPT Committee Construct

What is usually referred to as “CPT” comprises two key committees: the CPT Editorial Panel and the CPT Advisory Committee.

The CPT Editorial Panel oversees the development of new and amended codes and the maintenance of code sets. This panel comprises physicians, CMS representatives, and other stakeholders.

The CPT Editorial Panel convenes three times a year. On the other hand, the CPT Advisory Committee comprises representatives from constituent societies in the AMA House of Delegates. This arrangement shows the American Society of Neuroradiology (ASNR).

The Advisory Committee helps the CPT Editorial Panel by suggesting changes to the code set and, more importantly, by giving feedback on coding proposals from other interested parties, such as industry vendors, other societies, and insurance carriers.

Categories of CPT Codes

The CPT Codes have been divided into three categories.

Category I: Category I CPT codes are the most commonly utilized in clinical practice. Medication and devices must be approved by the US Food and Drug Administration, have peer-reviewed literature showing clinical efficacy, and be routinely used by doctors in the US.

Category II: Various quality performance initiatives are reported in Category II codes and are intended to reduce administrative burdens such as medical record review to simplify involvement in quality measurements.

Category II codes are not used after Category I codes. They are intended to aid in data gathering, tracking performance, and complying with state or federal legislation but are not to be utilized for billing services or procedures. Metrics from the Physician Quality Reporting System have grown a lot, and so have the number of category II codes.

Category III: To track breakthroughs or experimental technology, Category III codes were developed in 2001. An alphanumeric descriptor differentiates these temporary codes (e.g., 3456T). The information gathered by these surveillance tags can help with the US Food and Drug Administration approval process.

Category III codes don’t need to provide the same level of evidence as Category I codes. Category III codes do not have a professional work value ascribed to them, and reimbursement for these services is at the discretion of Medicare and private payers.

Category III codes are, by definition, temporary and are only valid for five years, which can be extended once. If experimental data supports it, a Category III code can be changed to a Category I designation before the primary or renewal term ends.

The code is permitted to expire if the treatment has not yet proved efficient. The advisors and committee members use common, rigorous standards to determine medical evidence. A modern Category III code would be CT perfusion imaging.

Proprietary Laboratory Analyses (PLA) codes: These codes were recently introduced to the CPT code system and reflect unique clinical laboratory findings that can be delivered by a sole (“the exclusive”) laboratory or licensed or sold to numerous provider laboratories that are certified or approved by the Food and Drug Administration (FDA).

This category comprises Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as specified by the Protecting Access to Medicare Act of 2014 (PAMA).

Coding that Moves Medicine:

As medical advances like genetic testing and remote patient monitoring become more common, doctors, business owners, and others in the healthcare industry will have to decide if a new or updated CPT code is needed to reflect these changes.

As they create new goods, services, and platforms that employ CPT content, technology developers will have to comprehend how and when CPT codes are updated. Our health-care system is driven by data, which is combined with medical advancement to improve patient care. With feedback from stakeholders across the health care landscape, the CPT code set is primed and ready to develop and evolve.

How Does CPT Coding Work? An Illustration:

CPT codes are made up of five digits. Most codes are digital, but some include an alpha character as a fifth, such as A, F, T, or U. Some examples are given below:

Coders provide a code for each service or treatment performed by a provider. CPT even contains unlisted codes for services and operations that are not precisely identified under any other defined CPT code. Given the massive number of services and procedures, the AMA has classified CPT codes logically, starting with three types:

CPT Category I:

The most extensive set of codes comprises those routinely used by providers to describe their services and processes. The six critical sections of CPT Category I codes are:

• Evaluation & Management (99202–99499)
• Anesthesia (00100–01999)
• Surgery (10021–69990)
• Radiology Procedures (70010–79999)
• Pathology and Laboratory Procedures (80047–89398)
• Medicine Services and Procedures (90281–99607)

CPT Category II:

Additional tracking codes for performance management. Category II codes are arranged in the order:

• Composite Measures (0001F–0015F)
• Patient Management (0500F–0584F)
• Patient History (1000F–1505F)
• Physical Examination (2000F–2060F)
• Diagnostic/Screening Processes or Results (3006F–3776F)
• Therapeutic, Preventive, or other involvements (4000F–4563F)
• Follow-up or other conclusions (5005F–5250F)
• Patient Safety (6005F–6150F)
• Structural Measures (7010F–7025F)
• Nonmeasure Code Listing (9001F–9007F)

CPT Category III:

Temporary codes are used to describe new and experimental services and practices. Category III codes are commonly shown in the code book with four numbers and a letter. They can be issued for up to five years. Suppose the services and treatments they represent meet Category I criteria, including FDA approval, proof that many practitioners perform the procedures, and evidence that the procedures have proven effective. In that case, they will be allocated as Category I codes. Category III codes, on the other hand, maybe phased out if practitioners do not use them.

10 steps to find the Best Medical Billing and Coding Companies

Outsourcing revenue cycle management to medical billing and coding companies can be a beneficial experience for healthcare organizations. Over the last few years, the outsourcing market has grown in this area. The Healthcare Business Process Outsourcing Market report for 2022–2025 predicts that the market size for these services is expected to increase by USD 7.43 billion between 2022 and 2025. As a result of the scarcity of staff, With the growing needs of healthcare organizations during the pandemic, RCM companies have become increasingly important.

Although there are many options available on the market, it can be pretty challenging to choose the right partner. For the best results, you need to take into consideration the various pros and cons and then balance them with the financial budget. As the RCM company is going to handle sensitive data for your organization, you should also check out its credibility. This article walks you through 10 easy steps to evaluate and choose the correct medical billing and coding company.

Determine the size of your account:

Despite the fact that there are numerous medical billing and coding companies in the market, few are capable of handling all account sizes. Identify the scale of your practice and your accounts in order to know what revenue cycle management company to hire. A conclusion can be drawn by evaluating aspects like the estimated budget, the number of physicians, and the accepted insurance companies. The following steps will help you decide whether to hire a small-scale billing service, narrow down specific steps of billing, or hire an end-to-end revenue cycle management service.

Taking stock of past experience:

A revenue cycle management company with many years of experience has managed the changing healthcare billing ecosystem. Partnering with a company with strong credentials and proven experience dealing with accounts for another healthcare system can be useful. Make sure the company has been in business for a long time. Be sure to ask for testimonials from their clients. Consider reading reviews of real healthcare providers instead of generic ones to get a better sense of how their customers have been successful.

Professional Experience: 

Medical billing poses a unique set of challenges for every medical specialty. It is important to find companies that have demonstrated their ability to provide services for the specialties you are looking for. In the case of an organization with multiple specialties, ask the company if it is up-to-date with the latest practices. Even if you have a general practice right now, it may be a good idea to expand into specialties. It is important for your outsourcing partner to be able to grow with you.

Number of employees: 

Staff members in the billing department are ultimately responsible for doing the groundwork. It is important that your medical billing provider has enough staff to handle your account. The sheer number of bills you may receive at non-peak times might overwhelm you without the support of enough trained professionals. Determine the number of people who will manage your account and provide emergency support.

Estimated costs: 

One of the most important factors to consider when selecting a medical billing and coding company is the budget. You can choose between different types of costs. There are two types of fees: a flat fee and a percentage of the revenues collected. When it comes to getting a reasonable price, it is vital to compare multiple quotes from a few vendors. However, you should also consider the quality of the services being offered.

Measures to ensure compliance and security:

RCM companies’ credibility is based on compliance and security. Account billing professionals will have access to sensitive medical information about patients when dealing with your account. Verify that the IT systems are secure multiple times to ensure the safety of PHI. Medical billing and coding companies must maintain HIPAA compliance as a security building block.

Management of Claim Denials: 

Despite taking all the necessary steps, some insurance companies may reject your claim. Get an idea of the denial rate from the companies. A survey reported that more than 60% of billing professionals never edit or submit a denied claim within the given deadline. Thus, it is very important to know how your outsourcing provider plans to deal with these issues.

Advancements in technology:

Errors in medical billing can be a result of typographical mistakes or incorrect or outdated insurance information, among other things. In order to maintain revenue integrity, these issues must be handled with proper software solutions. Make sure your medical billing company is using the right tools to make sure there aren’t any mistakes with your bills.

Services and Support:

Medical billing and coding companies can benefit from maintaining a good customer service record. Companies that lead the way in RCM ensure that their internal counterparts are kept in the loop so that information does not lag. Discuss the different modes of communication you can expect from the billing team, including chat, email, and phone calls. The organization will become more effective if you have a responsive staff.

Additional Services Offered:

Many RCM companies offer more than just billing and coding. They can also provide EHR companies with additional services, such as provider credentialing and customer service. You can also ask them if they offer any additional services in these fields if you’re suffering from any other back-office issues. An RCM company that is well-known will help you run your business better when you work with them full-time.

A business may find it overwhelming to select a vendor from several options. If you follow the above steps, you will be able to narrow down your options to one that matches your needs.

The article above explains how you can choose a medical billing and coding company among a number of options. Please feel free to contact us if you have any queries.