Category/ Medical Billing

Outsourced Medical Billing offers a Multitude of Benefits

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.


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.


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