Category/ Medical Billing
What is Medical Practice Management? Managing a Medical Practice successfully
Category/ Medical Billing
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:
1. Processing claims for your practice
2. Securing payments from payers
3. 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
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.