Category/ Medical Coding
Medical Billing and Coding Everything You Need to Know- A Quick Guide
Category/ Medical Coding
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!
Contents
Differences between Physician Billing and Hospital Billing
CPT Coding: History, Background and How Does CPT Coding Work?
10 steps to find the Best Medical Billing and Coding Companies
Why is Digital Marketing Becoming the Industry Standard?
What is CPT VS ICD 10 & HCPCS Coding? Future of Medical Coding?
What Does a Medical Coder Do? Starting Your Career as a Medical Coder!
What are CPT Codes? Understanding CPT Codes
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.