Insurance Info

A medical billing service is the answer for those looking to make their medical practice more effective. It provides all types of administrative help in managing billing. They are HIPAA approved, manage your entire billing process, track your accounts, submit claims to the claims clearing houses and pursue the rejected claims.

What are the benefits of hiring medical billing services?

Medical Billing Service is an efficient alternative to processing billing in-house. It saves you time and money. Following are some of the reasons you should hire one.

* It saves money by reducing your costs and increasing collections of delinquent account.
* It reduces the time your staff spends on processing claims. You may be able to eliminate most of the staff and thus save expenditure on their health care, salary, insurance and training.
* It usually performs better than the in-house staff. They keep their staff updated on insurance regulations and codes. It lessens number of denied and rejected claims. They are also quick to resubmit the claims returned from clearinghouses.
* Their turnaround from clearinghouses is faster as they process large number of claims with them.
* They have bigger incentives to increase collections as they are paid a percent of the amount they collect. Continue reading ‘Medical Billing Services Provider Can Improve Your Collection and Lower Your Costs’ »

Doctors now-a-days have started taking help from medical billing services which helps the doctor to prepare a document for a patient who has an insurance policy or simply calculate the total amount of money to be paid after the treatment and hand it to the doctor. Doctors have complained that they are facing difficulties in preparing complicated claim forms and insurance policy procedures. These technical hassles are no longer the headache of the doctor as there are a number of companies which will prepare the medical bills on behalf of the doctor or the hospital.

More and more doctors are looking for outside help. There will be representatives of the company, who will advise the doctors, attend the seminars organized by different insurance companies and offer regular financial reports to the doctors. This is popularly known as medical billing outsourcing. And one will find that there are a number of organizations who are helping doctors with the billing process. Most in-house staffs are not willing to prepare the medical bills. At times they are so long and so complicated, that common staffs find it difficult to prepare the perfect document without any errors. A medical billing company will come to the aid of the doctors. Continue reading ‘Medical Billing Services For You!’ »

An acronym for International Classification of Diseases, ICD-9 is a numeric diagnostic code used by insurance companies to determine whether to pay for a medical test, treatment or procedure. The 9th edition is the most recent one, with ICD 10 slated for 2013.

The new ICD-9 codes effective October 1, 2009 are fewer in number than previous years. But with the increasing emphasis on medical necessity and complete documentation and appropriate assignment of ICD-9 codes, these codes bring with it added complexities for the coder.

In June this year, National Center for Health Statistics (NCHS) expanded code category 488 to add two new codes:

- 488.0 (influenza due to identified avian influenza virus)

- 488.1 (Influenza due to identified novel H1N1 influenza virus) Continue reading ‘ICD 9 Codes Effective Oct 1, Fewer in Number Than Previous Years’ »

Effective January 1, 2007, the Centers for Medicare and Medicaid Services (CMS) implemented Medically Unlikely Edits (MUEs) to reduce the Paid Claims Error Rate for Part B claims. These edits are designed to minimize errors that occur due to clerical entries and incorrect coding based on anatomic considerations, CPT/HCPCS code descriptors, among others.

Previously called Medically Unbelievable Edits or MUEs, these apply only to the services specifically listed in the table of MUEs, as such, all services do not have MUEs associated with them. Continue reading ‘Do Away With Unfair MUE Denials by Attending Audio Conferences’ »

We have had a very hot topic on our forum lately regarding how medical billing services charge their providers. Most billers charge either a flat monthly fee, a per claim fee, or a percentage of the billing. But did you know that some states have laws on the books that prohibit physicians from entering into certain types of “fee splitting” arrangements?

It is very common for a medical billing service to charge a percentage of the money collected as a result of their efforts in billing the insurance claims but many billing services don’t realize that this practice is considered fee splitting and may be illegal. Several states have laws banning this practice and some have prosecuted doctors for paying this way. Continue reading ‘Are You and Your Providers Breaking the Law?’ »

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) signed by George Bush as part of the financial rescue package in October 2008 will take effect 1/1/2010. This law greatly affects all mental health professionals and billers.

The Paul Wellstone and Pete Domenici Act of 2008 made changes to the Mental Health Parity Act (MHPA) of 1996 which allowed for too many restrictions to benefits. The problem with the 1996 act was that it allowed for too many loopholes and still encouraged discrimination against benefits for those seeking treatment with psychotherapists.

The 2008 Act closed up some of those loopholes. For example, the 1996 MHPA allowed employers to limit the number of visits for treatment whereas the 2008 Act states that mental health benefits can be no more restrictive than medical benefits. Continue reading ‘New Mental Health Law Affects Benefits’ »

Insurance carriers often deny claims for not being coded to the highest level of specificity. As many billers are not coders they often don’t understand what has gone wrong or how to fix it.

If a service line is denied for this reason they are saying that the diagnosis code needs to be more specific. Some diagnosis codes are only three or four digits but many are five digits. The diagnosis must be coded to the absolute highest level for that code, meaning the most number of digits for the code being used.

For example, the diagnosis for hypertension begins with 401. However if you submit a cliam with the diagnosis 401 it will be denied. The code 401 requires a 4th digit. 401.0 is malignant essential hypertension. 401.1 is benign essential hypertension. 401.9 is unspecified essential hypertension. So to bill a claim with a diagnosis of hypertension it must be either 401.0, 401.1, or 401.9. Continue reading ‘Coding to the Highest Level of Specificity’ »

Everyone knows denials and documentation requests reduce the value of your chiropractic claim and frustrate your billing department. To get paid on time and in full, be sure you avoid the following common errors in your chiropractic coding and billing:

1. Modifier Failures. Depending on which procedure code you use, a modifier may be appropriate. In Medicare, for example, you need to indicate whether the service represents Active Treatment (using the modifier -AT) or it will not be paid. Similarly, performing Manual Therapy (97140) on the same visit as an adjustment will also require a modifier to be present to signify that it was a separate and distinct service (Modifier -59).

2. Stagnant Adjustment Codes. Billing for a 5 region adjustment (98942) on every visit just because you are a full spine doctor will not sit well with most insurance companies. From the viewpoint of the insurance company, it is statistically improbable that every one of your patients needs an adjustment from top to bottom every visit. Continue reading ‘5 Common Chiropractic Coding & Billing Mistakes to Avoid’ »

Spinal instrumentation is a method of keeping the spine stiff after spinal fusion surgery. It is used to treat the deformities of the spine owing to birth defects, fractures, scoliosis, spine diseases, and other injuries. When the spine no longer maintains its normal shape, and nerve damage occurs, different kinds of instrumentation (made of metal/titanium) are inserted into the spine. The instrumentation is typically comprised of pedicle screws, rods, plates, intervertebral cages, hooks and rods.

Guidelines in spinal instrumental coding: New techniques and technologies for spinal instrumentation are moving faster than codes can keep up. What’s more, procedures come in a variety of configurations, which are often puzzling. While coding, these procedures could prove to be tricky. In a nutshell, unique coding guidelines and billing requirements for spinal instrumentation test the knowledge of even the most experienced neurosurgery coders. Continue reading ‘Give More Bones to Your Spinal Instrumentation Coding’ »

Current Procedural Terminology (CPT) is a useful tool for streamlining the medical information technology. These CPT codes are continually reviewed, revised and updated to reflect changes in health care. There are three types of CPT code — Level I, II and III.

Understanding the CPT coding is particularly important for employees of records, billing and insurance firms, who do not possess any medical training but depend on their knowledge of the CPT code for their work. Continue reading ‘CPT Code List – Get Acquainted With It’ »