Medical Billing

Cardiology billing

Answered: Your Most Burning Questions about Cardiology Billing

Cardiology billing is one of the most complex processes. There are multiple reasons behind the complexity of cardiology billing.

Changing policies and regulations and some of the most complex treatments of cardiology make it more difficult for the health service provider to get their reimbursement easily. Also there are lots of challenges for the billing companies to handle the operations specifically for cardiology.

What is Cardiology Billing?

Like many other medical billing processes, cardiology billing works the same. But it is slightly complex for the physicians and for the billing services providers.

The system works in which the patient came for the services and after the pre-authorization by the staff member the patient acquired treatment and was charged.

In case he has been insured then his insurance service provider is liable to pay for the treatment. And the health service provider can get assistance in a way by forming an in-house team for managing billing activity and they can also outsource their billing to any medical billing services.

What is the Step by Step Process of Cardiology Billing?

Here is a step-by-step process of cardiology billing practice.

  • First, the medical practice needs to acquire the complete information of the patient. It is also called the patient registration process.
  • In the next step verify the insurance eligibility and responsibility of the patient.
  • After the verification process, the medical practice can give them the services according to their coverage.
  • In the next step, you have to generate a claim to get reimbursement from the insurance provider. The claim generation required a lot of proceedings like ensuring the appropriate use of a modifier and error-free coding also following the regulations of HIPAA and other regulators.
  • After the adjudication by the payer, he might release the amount or deny it due to multiple reasons.
  • You have to follow up on denied claims after finding out the proper reason behind the denied claim to get fair reimbursement from the cardiology treatment you rendered to the patient.

That was the brief breakdown of how a standard medical billing system works. On the other side, the working of Cardiology billing is very similar to the standard medical billing process but the addition of multiple medical processes is making it more difficult for the service providers to appropriately record all the procedures and modifiers, enhancing the chances of error in coding as well as record keeping so we will discuss how we can appropriately manage it to get maximum reimbursement.

How To Effectively Manage Cardiology Billing?

It’s important to fully understand the standard procedure to effectively handle the process that revolves around Cardiology billing. Here are some key steps you need to understand before applying for the claim.

Ensure the Accuracy in Records

In the very first step, the accuracy regarding patient information matters a lot. Because any mismanagement at this stage will further cost your practice a lot. There are lots of claims denied due to inaccuracy in the records. So it’s very important to eliminate the chances of error in record-keeping from the very first step.

Your front desk staff member should accurately record all the essential information from the patient. His name, his social security number, his address age, demographic information, and information about his insurance provider should be recorded accurately.

Make sure that you are communicating very well with the patient. It helps to sort out that thing at the very initial stage. Because better communication helps you to better understand the whole scenario.

Checking Insurance Eligibility

The insurance verification or eligibility process is one of the most important steps in the billing process. For the cardiology treatment, there are multiple options that need to be considered while addressing the patient.

These steps involved a proper diagnosis treating conditions, operations, and using multiple types of equipment. So as we can see there are multiple steps involved in treating a patient suffering from cardiovascular disease.

On the other hand, there are multiple services that are usually excluded from the general agreement of the insurance company.

In short, the Insurance company usually refuses to pay for the services just because they are not part of their agreement. And patients are usually ignorant of these conditions.

So it’s the responsibility of the healthcare service provider to check the insurance eligibility and coverage before rendering any kind of treatment.

Using Appropriate Modifiers/Codes

Cardiology billing is relatively difficult compared to other forms of medical services. It requires a team of professionals who actually knows the use of appropriate modifiers and accurate coding procedures.

Medical codes are sometimes very confusing especially when you are dealing with a cardiology medical procedure. This somehow can increase the chances of inefficiency so to make it efficient you need to double-check all the codes before the submission.

Many of the health service providers are aware of how many denied claims they receive from the insurance payer due to the use of inappropriate modifiers. So for an accurate billing process, the use of accurate modifiers is also very important.

Keep your Practice Up-to-date

It’s important for every practice that is providing cardiology facilities to keep themselves updated about the latest regulations. Follow the latest updated ICD-10, CPT, HCPCS codes.

You can also follow the latest trends and regulations by visiting the website of CMS and also following organizations like the American heart association and the office of the inspector general (OIG) to keep your practice up-to-date.

Should You Outsource Your Cardiology Billing?

Cardiovascular complications are one of the leading causes of death in the USA. And it is a need of the hour to maintain excellent facilities for the heart patient but for many service providers, the main concern is about the increasing financial burden and not effectively managing the revenue cycle management.

While it’s tough to cope with the new medical reforms and hire professionals at the same time for the cardiology billing services. There are chances that with all this management, patient care can be compromised.

Outsourcing is the best way for cardiology services to not only manage their expenses but provide excellent patient care. The medical service providers are experts in handling the billing services effectively.

Med-Miles can help you in your cardiology billing. We have the best billing solution with an excellent track record. Our goal is to make revenue cycle management more efficient for our clients. To get more information you can call us at 888-5989-181.

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Hipaa Compliant

Tips That Will Help Your Practice Become HIPAA Compliant

Every healthcare service provider and insurance company needs to ensure HIPAA compliance.

It will help them to secure the sensitive medical information of the patient. Making your practice compliant with HIPAA will save the practice from common breaches in the system and also save them from any penalties. 

These complaints are based on some set rules under the health insurance portability and accountability act. In this article we will discuss some tips which will make your practice compliant with HIPAA.

What Is HIPAA Compliant?

It refers to the health insurance portability and accountability act. This act is responsible to set a standard for the protection of the sensitive data of the patients. This act is applicable to any entity which is responsible for holding the sensitive information of the patient. 

The covered entities include health care service providers and insurance service providers and anyone who has access to the sensitive information. All these entities are bound to comply with HIPAA.

What Is Protected Health Information (PHI)?

It is defined as any kind of information that is used to get the identification of the patient and this is the information that is protected under HIPAA rules and regulations.

This information includes the name of the patient, his address, social security number, contact information, medical history, and financial information.

What are Covered Entities?

Under HIPAA regulations the covered entities are one which is responsible for maintaining the PHI. These entities are usually involved in collecting, creating, transmitting and accessing sensitive information. The health care service providers, insurance companies, clearinghouses are all included in this category.

What are Business Associates?

Under HIPAA the business associate is any entity that links with PHI in anyways.

When you find out the business associate you will see that there is a wide range of business associates involved in this process because this sensitive information is transferred from one entity to another and many service providers handle and process this information.

This business associate includes lawyers, Information Technology specialists, accountants, administrators, third-party consultants, cloud service providers, and email service providers.

HIPAA Rules and Regulations

These rules and regulations were first introduced way back in 1996. The essential HIPAA rules and regulations are:

HIPAA Privacy Rules

HIPAA  privacy rule is exclusively for the covered entities. These privacy rules are responsible for protecting the sensitive information of the patient.

As sensitive information is under the covered entities which are responsible for handling this PHI data. They’re also responsible for reporting the violation of HIPAA rules and regulations. The HIPAA set some privacy rules which includes:

  • A patient’s right to access protected health information.
  • A healthcare service provider also denied Access to protected health information.
  • They’ll also advise for the proper training of their staff they are pretty much aware of the handling of the sensitive information.
  • They also have to ensure written permission from the patient before using his sensitive information for any kind of purpose.

HIPAA Breach Notification Rule

Under this regulation, the covered entities and business regulations are required to notify the breach in the protected health information.

All the covered entities and business associates are bound to report any kind of breach whether it is external, internal, smaller, or larger.

This breach notification includes:

  • The kind of protected health information involved in the process.
  • The person who accesses the PHI whether it is authorized or unauthorized.
  • A Confirmation that the sensitive information is actually acquired or not.

HIPAA Omnibus Rules

These sets of rules are designed to expand the HIPAA scope towards business associates. The Omnibus rules are introduced to cover the gaps which are ignored in the previous updates.

The Omnibus rules cover these key areas of HIPAA regulation.

  • This includes the introduction of the final amendments under the requirements of health information technology for the economic and clinical health act which is a part of the American recovery and reinvestment act.
  • This includes the incorporation of the penalty structure, the final rule on breach notification, and some modifications that are required by the genetic information nondiscrimination act.
  • Last but not least it also includes the restriction on using the PHI for marketing incentives.

Tips To Become HIPAA Compliant

Following are some tips to make your practice HIPAA compliant.

Identifying Common Breaches

One of the first steps to becoming HIPAA compliant is to identify some of the most common breaches which are happening in the system. These common breaches include:

  • Theft of those machines that are required to store the protected health information.
  • Any hacking attempt.
  • Transferring the protected health information to any wrong entity or any wrong Business administration.
  • Disclosing sensitive information on any public platform.

By avoiding all these breaches you can make your practice fully Hipaa Compliant.

Complete Awareness about Fines and Penalties

Service providers who are responsible for the patient-sensitive data should be aware of any kind of breach which can lead to heavy fines and penalties. It should be your first priority to avoid all these penalties and fines to maintain your financial cycle.

To effectively manage it, you have to be aware of all the existing violations that lead to heavy fines. These violations include Tier 1,2,3,4. Having a complete awareness of this will make your practice fully compliant with HIPAA.

Fulfill Transaction Standards

The majority of the health service providers handled the protected health information on a daily basis. The health care service provider has the intention to get the claim from the insurance providers. 

To protect that sensitive data HIPAA sets some transaction standards which include the eligibility, premium claim payments claims and encounter information,  claim status, and advice in maintaining the remittances and payment method, full coordination of benefits, and a secure authorization and referral process.

Keep Yourself Updated

After fulfilling all the safety rules and maintaining all the standard procedures. You must update yourself on a daily basis about the new developments of HIPAA.

In order to keep yourself fully compliant with the latest regulations, your practice needs to work with your compliance partner to ensure the fulfillment of all the requirements.

Med-Miles can help you to keep your practice updated about all the latest regulations. We are serving the healthcare industry in managing their revenue cycle management for more than 8 years. Call us at (888) 598-9181 to get more information.

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Charge Entry In Medical Billing

How to Do Charge Entry In Medical Billing?

In the revenue cycle management system, charge entry is a vital step in the whole process. This process gives us a clear indication of the amount of reimbursement the health service provider will receive from the insurance payer.

As said earlier, this process is vital in the revenue cycle management system because n the medical billing management system the chances of error are also very high and it can lead to increasing denial rates. 

This article will help you to effectively manage your charge entry. We assure you of a well-structured and effective process that will eventually increase your revenues. Let’s find out!

What is Charge Entry in Medical Billing?

A charge entry process is a complete and well-structured process in which the charges for the medical services rendered to the patient and other treatments details are submitted to the insurance payer to claim a reimbursement.

Step By Step Process of Charge Entry In Medical Billing 

 The charge entry is a complex process and it took time for an effective charge entry process. Following is the step-by-step process for charge entry in medical billing.

  • Receipt of Documents

The first step in charge entry is to get a patient registration and some details about the financial responsibility for the particular treatment. We will also collect all the essential forms and documents termed as an explanation of benefits (EOBs).

Other financial statements like checks, card payments, and relevant payment options are also added from the client in a secure way through the FTP server.

  • Entry of Necessary Details

The second step consists of patient referencing and billing Referencing. We will collect details like demographic information which includes the name, age, address, and a brief medical history of the patient. On the other side, the billing referencing includes the time and date in which the services are rendered to the patient.

Complete details about the insurance service provider and the amount paid for that particular service. These are essential steps for the proper coding practice which will eventually be used in the submission of the claim. 

  • Follow up on Explanation of Benefits (EOB)

The third step is pretty much important for the service provider. It will help the service provider to get all the proper share for the services rendered to the patient.

In case of a partial payment like some dues are pending on the patient. These pending dues are surely not part of insurance coverage and the patient is liable to pay for it.

To get all the remaining payments the provider can initiate an investigation through EOB to acquire all the essential details of the patient coverage to take some necessary legal actions.

  • Proper Denial Analysis and Recovery

In many cases, health service provider faces denial rates after submitting the claim. In addition to the case when patients refuse to pay the remaining amount considering it a responsibility of their insurance payer.

A very similar conflict occurs with the insurance companies. When they refuse to pay for the services by indicating that these are not part of their coverage.

A billing team in that phase needs a detailed and in-depth analysis of all the processes. Reviewing the coding and other documentation can help to get the remaining payments.

  • Customer Feedback

It is considered an optional step. While customer feedback is also essential if you want to establish long-lasting contact with your customers. It also helps you to improve the overall charge entry process.

Like if you are getting negative reviews regarding the data collection process then you have to figure out the gaps in the process and immediately resolve them.

Many service providers consider it an important part of their operations.

Outsourcing 

In medical Billing, the charge entries are complicated procedures and the chances of errors are also very high especially when you are dealing with coding.

While many health service providers facing the problem of low reimbursement due to mismanagement and lack of resources to have an expert in-house billing team to control the RCM, In this case, It’s reasonable to hire a billing expert for your health care system.

Med-Miles is the leading medical billing solution company with an experience more than 8 years. We are serving the health service provider in effectively managing their revenue cycle management at reasonable pricing.

Here are some of the features of our billing services.

  • We are strictly compliant with HIPPA. We are well aware of the standard rules and regulations set by the American medical association.
  • A non-disclosure agreement will assure you of the safety of the confidential data of the patient. We maintain a strict security framework for our clients which will save your essential data from a third party.
  • As an outsource medical billing service provider we adopt the latest innovation and billing software solution to keep ourselves updated and minimize the time taken for the charge entry.
  • We ensure a proper analysis of denials and a swift recovery Process.
  • An expert team of coding will assure that there would be no coding error in the claim.
  • A dedicated follow-up team will help you to get timely payment for your services without any conflicts.

Our services will help you to get maximum reimbursement with lower denial rates in affordable pricing. Call us at  (888) 598-9181 for details. 

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Outsourced Medical Billing

A Future for Outsourced Medical Billing

Many medical practices are now seriously considering managing their financial activities through medical billing experts. Outsourcing has become a need for every health service provider, because of consistently higher denial rates and low reimbursement from the insurance provider.

On the other hand, it is not easy for every health service provider to hire staff exclusively for billing activities. The hiring process and lack of resources also put in-depth stress on them to have assistance from a medical billing expert and most probably we will see this trend growing in coming years. 

While there are lots of speculations about the future of Outsourced Medical billing. We will show you why its future is bright but first, we look at the difference between outsourced medical billing and in-house medical billing. 

Difference Between In-house & Outsource Medical Billing 

If you will start figuring out the differences between in-house and outsource medical billing then you will see that there are some pros and cons associated with in-house medical billing and there are some pros and cons associated with outsourcing medical billing. Here is the difference between both these processes.

In-house Medical Billing

The in-house medical billing activity is conducted by the health service provider within the healthcare system. The staff members are responsible for all the revenue cycle management.

In this system, the health care staff is supposed to enter all the required details in the medical billing software when a patient comes for the services.

This documentation has essential details about the patient’s medical history and his insurance coverage which will later define whether he is eligible for the services or not.

Before submitting the claim to the insurance company the claim is forwarded to the clearinghouse whose job is to review the claim before submission. 

After submitting the claim to the insurance company they will let you know about the acceptance and denial of that particular claim.

Outsource Medical  Billing

When health care service providers choose to have assistance from a third party known as medical billing services to manage their revenue cycle management.

In this activity, your practice loses control over their financial management and all the related tasks will now be managed by an outsource billing team. 

An outsourced medical billing service will manage all the activities like submitting a claim, data entry and even they will follow up on the denied claim. 

They will also send invoices to the patient and strictly monitor your outstanding account receivable. 

Most of the billing services charge a percentage off collection or they may charge on a monthly basis for their services.

Challenges in Medical Billing 

Right now the health service providers are facing multiple problems in the revenue cycle management system. These challenges are crucial for every health care system in order to maximize their revenue to operate at their full potential. Here are the challenges in medical billing.

Higher Ratio of Denied Claims

In recent times it has been seen that the ratio of claim denials increased significantly. Many health practices lose a significant amount of revenues due to denied claims.

We can say that the inexperience in handling the billing activity and lack of effective resources to handle the RCM is one of the top reasons behind this. While many of the denied claims are avoidable and can be resubmitted after the correction.

Incomplete Data

There are many health practices that are still using the manual way of documentation of essential details. Which eventually will increase the chances of errors in any documentation that might be the reason for low reimbursement and higher denial rates.

Insurance Eligibility

Patient eligibility for certain treatment is one of the reasons behind the denial rates. It is the responsibility of health service providers to take a proper assessment of the insurance scope before rendering the treatment.

The Rise of Telehealth

Recent events like the covid-19 pandemic have completely changed the behavior of the general population. During the pandemic, people prefer to have a general check-up through online video conferencing so they can avoid going to the health centers due to the high risk of the virus.

New technology comes with new challenges same case applied to telehealth services in which the risk of getting lower revenues is still high and many of the health service providers are consistently focusing on it.

Why Outsourcing Is The  Future?

All the health care service providers need an efficient setup to manage their RCM. On the other hand, they also have a responsibility to give their patients better health facilities.

Managing both activities at the same time is not easy for every practice. Changing regulations and mass adaptation to telehealth services also raise challenges for the healthcare service provider. In that scenario outsourcing is the best option right now and here are some of the reasons behind it.

Cost-Efficient

The cost related to billing activity is much lower when you opt for outsourcing. It is cost-efficient in a way that when you opt for an in-house building then you have to spend a lot of your money in the hiring process and sometimes on the training process. Your practice also requires the latest software solution for the proper assessment of your document which is very costly.

Reducing Billing Error

Outsourcing assured you the minimum error in your billing as they have an experienced team. They are well aware of the insurance companies and common occurring coding errors in the claim. So, they can better manage all these activities compared to the in-house building team.

Following up

Many billing service providers have an active team for following up the denied or unpaid claims. which will eventually enhance the chance of getting maximum reimbursement for the services.

Higher Transparency

A high transparency rate is one of the prominent features which makes it more valuable for the medical service provider. Teams are bound to provide the services and a comprehensive performance report which will allow them to evaluate the present scenario of their financial system and they can also forecast this activity.

Need Help?

Now you have seen that outsourcing can give you an edge in better management of your RCM. If you are looking for medical billing solution for your practice then Med-Miles can help you in managing your financial affairs as we are well aware of the regulations by the financial system and we are also well aware of the common errors in the claim. You can call us at 8885 989 181 for more details.

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Dental Insurance Denials

How To Properly Appeal Dental Insurance Denials?

Dental Insurance denials are very common in the medical billing process. For the health service provider, it becomes so frustrating and they try their best to avoid denial rate as much as possible. 

Similarly, the dental service provider faces equivalent kinds of issues. In some cases, the insurance company decided to deny the coverage to the patient.

At that point, the dental care handled this situation in a different manner by submitting an appeal. But first, we need to have a quick look at the reasons behind the dental denial rates.

Top Reasons Behind the Dental Insurance Denials

Getting a full reimbursement for the services you rendered is sometimes very frustrating but if we know the exact reason behind the lower reimbursement rate then we can better manage our revenue cycle management. 

There might be many reasons behind the insurance denial rates but if we closely observe in the perspective of dental denial then there are various other reasons behind it.

In this article, we will try to explain some of the main reasons behind the denials in dental insurance.

Eligibility Issue

For any dental service provider, the verification eligibility of the patient for the insurance should be the topmost priority. In many cases, patients are not aware of the insurance coverage of their plans and they might take the services and treatment that might not be part of their insurance coverage.

On the other hand, the insurance regulation plans are not constant throughout the year. So when a patient came for the services you need to take the essential documentation on the first interaction. 

Your front desk staff can note the following information carefully the patient’s name a brief detail of his primary insurance, social security number, insurance carrier details, identification number, etc. It will help you to verify all the necessary details first hand and it will also minimize the chances of error later.

Root Planning or Periodontal Scaling Coverage

In Dental Practices, Root Planning and Periodontal scaling are supposed to get higher denial rates compared to any other treatments. For insurance purposes, they required a special documentation list that includes some clinical indicators and evidence.

The periodontal chart required a pocket depth and full mouth radiographs and digital images.

This documentation should be embedded with the patient record first hand.

On the other side, the correct use of CPT and CDT codes is also essential in this stage. Many a time Insurance companies fail to present guidelines for the relevant purpose and codes.

In SRP claims you can make your case even stronger by giving them additional documentation of periodontal charting description of the procedures that are used during the treatment and some radiographic evidence of bone loss.

Core Build-up Procedure

The core build-up procedure is applied to maintain the crown retention in the internal anatomy of the tooth. The purpose of this procedure is to completely replace the missing tooth structure and make a proper symmetry to protect the integrity of the tooth. Usually, this procedure is denied with the statement of no benefits or low benefits.

There are multiple complexities in this procedure like when the dentist conducts this treatment then they have to further remove the irregularity and all the existing filling from the tooth and use the material to fill these irregularities. 

This procedure is pretty much similar to the D2950 build-up. It is the same procedure but for different purposes so it might create some mess.

Let it be very clear with your patient about the lack of benefit in doing this procedure. Use radiographic evidence to get reimbursement from the insurance company while performing this kind of treatment.

How To Deal With Dental Insurance Denials?

Dental insurance denials can be managed in various ways. Here are some of the ways in which you can minimize your insurance denials. 

Prepare an Appeal Letter

An appeal letter is an essential step for getting reimbursement for your dental services from the insurance payer. In this letter you need to fulfill all the essential details required by the insurance provider this information consists of;

  • Complete details of the patient like his name, policy number, contact information, and information about the policyholder.
  • In this letter, you should also mention the complete details about the denial rate.
  • Like you have to mention that what was the reason behind the denials, the date of the denial and also specified some main reason which leads to this.
  • Lastly, mention the details of the dentist who performed the whole treatment for the patient.

The purpose of this detailed appeal letter is to tell the insurance company to have a look at the case as soon as possible and your practice is strongly eligible for reimbursement.

Make a Template of Appeal Letter

For your convenience, you can also prepare a template appeal letter in case you are filling multiple appeal letters. In this template, you can add a similar process and treatment and you just need to switch the name and claim number and relevant information associated with each patient.

This template will eventually not only save you time but also increase the efficiency and productivity of your practice.

Proper Coding 

To get a maximum reimbursement the proper coding is an essential part to be done.

Make sure that your practice has a team of professional coding experts who are aware of the proper CPT coding or dental terminologies coding CDT by the American dental association.

Now you are pretty much aware of how you can effectively make an appeal for your dental insurance claims and what is the real reason behind the increasing denial rates and how you can manage it by following steps like appropriate coding practices, understanding the agreement of different insurance companies creating awareness about lack of benefits among the patient and preparing proper documentation of all the required procedures. To avoid hassles you can also take assistance from a medical billing service provider.

Med-Miles is one of the most prominent names in medical billing services. We have been serving our clients for more than 8 years and our professional team is pretty much aware of the challenges dental health service providers face. We have the best billing solution for your practice call us at 8885 989 181 for the services.

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Dental Surgeries

How to Bill Dental Surgeries to Medical Insurance?

Oral health plays a key role in the overall well-being of a human. Good oral health leads to a healthy lifestyle. So dental hygiene plays an important role in our life.

Dental billing Is more complicated compared to other medical billing activities. One of the most difficult tasks a dental surgeon faces is to guide their patient about how they are paying for the services. 

The majority of the time patients are clueless about the consequences of their dental health which if not treated earlier can lead to serious health conditions. Dental surgeries are relatively more expensive and it has a very low benefit cap.

Meanwhile, medical billing for dental surgery is more suitable for patients who can’t afford the expenses of dental treatment. Not only for the patient but a dental practice can get maximum reimbursement from the insurance company.

Tips to Get Medical Insurance For Dental Surgeries

To get medical insurance for dental surgeries you need to make a very strong case that the patient’s dental health is associated with his overall health condition. For this purpose, you will require proper documentation like;

  • The initial condition of the patient represents the complications.
  • A secondary note with supportive diagnosis 
  • An appropriate diagnostic code as these codes are used to get reimbursement so the appropriate diagnostic code is essential for the treatment you plan for the patient.
  • A surgical preauthorization is also essential for the treatment.
  • A letter termed as a medical necessity this letter recognizes that the surgery is necessary to treat the patient for his underlying health condition.
  • A support letter from the patient’s primary care physician has also required. A support letter to make sure that the patient needs dental surgery to avoid a serious health condition.
  • Lastly, the documentation of the procedure that is performed at each surgery location should be given as this documentation is critical for the coding purpose which eventually gives your dental practice reimbursement from the insurance company.

This will give a clear picture to the insurance service provider that the dental treatment or surgery is performed to treat a medical condition.

Dental Procedures That Are Covered By Medical Insurance Payers

Below are some of the dental treatments and procedures that will be covered by the health insurance provider. This coverage is according to the plan of the patient and the coverage of the procedure and treatment by the insurance payer. Let’s have a look!

  • Any accidental injury which required dental restorations.
  • Any kind of oral infection can impact the body function of the patient.
  • The treatment that is related to cancer complications.
  • The cone-beam computed tomography (CBCT) is used to get the data by using a cone shape X-ray that is used to create a 3D image of the teeth.
  • Frenectomy, a procedure that is used to remove the connective tissue from the upper and the lower side of the mouth or specifically under the tongue and it is usually recommended for newborns suffering from speech eating or other oral disorders.
  • Treating sleep apnea which is a serious sleep disorder in which a patient suffers from interrupted breathing during sleep, dental appliances are used to treat sleep apnea for patients who suffers from moderate to obstructive sleep apnea these instruments will prevent the tongue to block the throat and lower jaw region and that eventually leads to help in passing the air during the sleep.
  • Gentle biopsies are usually used to get tissue from the patient’s oral cavity.
  • The treatment that is used to treat congenital malformation.

These were some of the treatments that are covered by the insurance service provider.

Step By Step Guide To Get The Reimbursement

There are some steps that you need to consider to get reimbursement from the medical insurance payer for the dental surgery.

A pre-authorization Process:

A pre-authorization is an initial step to getting a reimbursement. As you are providing dental services to the patient or treating any other underlying health complication. When a patient visits to get treatment the first step you do is to verify the insurance eligibility and insurance coverage.

Many times patients are not familiar with their insurance coverage. Complete information related to copays and deductibles helps you to guide the patient to pay their liability so a pre-authorization can save your practice revenues.

Medical Necessity:

The letter for medical necessity is a type of statement which is written by a doctor that clarifies the services or instruments which are used to treat the patient from a medical condition. 

Through the letter of medical necessity, a dental service provider can get reimbursement from the insurance company by highlighting the case for surgery.

You can get the reimbursement by giving appropriate reasoning for the surgery. In that case, you need to use the proper ICD-10 coding procedure; an insurance company only approves those claims that are properly managed under ICD-10 coding.

For the claim approval, list down the most essential part of the procedure to the least essential part.   

The appropriate cording is the key to getting reimbursement your dental practice has to explain to the insurance provider about the need to have the dental surgery like if a patient loses his tooth and has other medical complications like cancer or diabetes then it becomes essential to get a tooth surgery to prevent the further complication.

Filling and submitting the claim:

The last step is to properly check, fill and submit the claim. In the earlier section, we have discussed that we should list the procedure and treatment for the surgery from the most appropriate or most expensive to the least appropriate or the least expensive procedure.

Before submitting the claim make sure that your claim is appropriate, all the essential information is embedded and there is no coding error in your claim.

To make your case stronger always include some supporting documentation with your claim like you can add Lab reports for dog diagnostic imaging.

If you are facing any denied claim due to some kind of error in your claim then your practice should find out those errors and resubmit the claim and consistently follow up with the insurance companies to get reimbursement.

Need Help?

Get desired results and maximize your revenues with Med miles. Med-Miles LLC provides the best solutions to get maximum reimbursement. Call us at (888) 598-9181 for more information. 

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Medical Billing Errors

Resolving Medical Billing Errors Can Save You Money

As a medical service provider, your practice can lose a significant amount of money due to medical billing errors. It’s not possible to fully eliminate the chances of errors. 

The billing activity revolves around the measures when patients visit for the services and the service providers record all the essential details for the coding purpose to get a claim from the respective insurance company. 

Between these measures, the chances of errors are extremely high, and due to these errors service providers lose an enormous amount of revenues each year.

In this article, we will discuss the common billing errors faced by medical service providers and how we can reduce them to save money. 

Common Medical Billing Errors & Solutions

The medical billing process seems to be very complex, but if done efficiently you can overcome it and save your practice a substantial portion of remuneration.

Here are some of the errors in medical billing and their solutions.

  • Inaccurate Record Keeping

A complete and error-free record is essential for further proceedings. When the patient comes for the services your front desk staff needs to record all the essential details accurately like Name, Address, Contact number, and Insurance provider details.

It will save you from billing errors. Many a time claims are denied due to missing and inaccurate information. So make sure that the details must be accurate.

  • Insurance Verification

It’s very important to verify the coverage given by the insurance providers. The majority of the patients don’t know about the coverage by the insurance companies.

So your practice needs to check the eligibility as well as the service range. Tell the patient that these services are excluded from your insurance scope and you have to pay for these services. 

  • Medical Coding Errors

In the medical billing process. Coding errors lead to claim denials, late reimbursement, and view as fraudulent activity if done intentionally.

Your RCM suffered a lot due to coding errors if not addressed timely. Below are some common coding mistakes to look at for saving your revenues.

Unbundling

Using multiple codes for a single medical procedure. The American Medical Association claims that using multiple CPT codes is one of the most common coding errors.

Upcoding

In this type of coding error, the Patient is charged for the services that are relatively much higher than the actual treatment performed. It’s considered a clear violation of the False Claim Act. 

Under coding

When a patient is not charged fully for the services he availed during his stay in the health center then it is termed as under coding. Your practice can lose revenues due to under coding.

Inaccurate Reporting of Data

As said earlier the accurate data holds significant importance in the billing process.

Missing or errors in any essential information lead to the wrong coding and these claims are denied by the insurance companies.

Coding errors are very common in medical billing, Your practice can lose remunerations if it is not resolved earlier, make sure to use the American Medical Association-approved coding procedure. 

  • In-Experienced Staff

It has been estimated that some common errors occur due to the negligence of the staff member. Like missing information and not checking the insurance coverage and errors in coding.

Due to these mistakes, your medical practice bears the loss of revenues Make sure that your In-house staff is trained enough to handle the administrative as well as billing activity or you can hire professionals who are experts in managing the medical billing. 

  • Higher Claim Denial Rates

Tracking denial rates is essential for the smooth flow of your revenue cycle. If your practice is unaware of the rising ratio of denial rates then you lose revenues.

The common reason behind the higher denial rates is due to the coding error, late claim submission, and mistakes in the verification process. 

  • Late Claim Submission

Insurance companies only process those claims that are submitted on time. If your practice failed to submit the claim on time then you will lose payments. 

  • Aging Accounts:

Aging accounts are the leading cause of an outstanding account receivable. If you are not tracking your aging accounts then you need to put some extra effort to get dues from those accounts.

By tracking the aging accounts you also came to know about the patients who hold secondary insurance.

Your In-house team should frequently track the aging accounts in order to get maximum reimbursement. 

  • Not Following-Up Frequently:

If your team is not following up on the overdue accounts then your account receivable will expand surely, A timely follow-up is key in increasing the revenues.

Your account receivable follow-up team should closely monitor those claims that are not paid within the 30 days period and actively follow up on those accounts to collect revenues. 

Patient follow-up is also important. For the services that are not part of insurance coverage and patients have to pay for them, usually, patients forget to pay their dues.

Your account receivable team is responsible for actively following the patient by sending them Emails and calls to make sure that they pay their dues on time.

How Do Medical Billing Services Help To Save You money?

Outsourcing your billing services is a great way to save money. The in-house billing team usually lacks experience so the chances of errors are relatively high. 

Like for coding, your practice needs to make a lot of investment in your In-house staff for their proper training.

Even if you are interested in hiring professional coders for your in-house billing activity then you need to invest a lot of time and energy in the hiring process. 

Medical billing service providers have a team of experts and their primary task is to manage the billing activities of the health service providers. 

They can help you with accurate coding by following all the regulations, tracking denial, and actively follow-up to manage the account receivables. 

Why Med-Miles? 

Med-miles have experience of more than 8 years in providing billing solutions to health service providers.

Our excellent services assure maximum reimbursement and low denial rates. For more information call us at  (888) 598-9181 

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Patient Collections

The Best Ways To Collect Your Patient Collections In 2022

The Pandemic affects the operations of the healthcare system worldwide. Many practices are facing a decline in patient visits. 

Fear is the one component of this low volume. People are afraid so they are delaying their regular health checkups. 

Telehealth system is the new hope in these tough times, patients are now utilizing these options for their regular visits. But the revenue collection management system is still down.

People are experiencing a change in their insurance policies due to the ongoing pandemic. Which is making it more difficult for the health service provider to collect revenues. 

How to Maximize Patient Collections?

The emergence of the new variant is more than worrisome in the coming days. The health care providers can still take some effective steps to raise their revenues in 2022.

Here are some easy ways to maximize patient collections;

Collect Essential Data before Appointment

The first step is to collect all the required data from the patient when he calls to book an appointment.

Your front desk staff member can collect all the data like name, address, phone, and insurance coverage. 

These details will help you to follow up with the patient when the treatment is done.

Moreover, the coding process to get reimbursement from the insurance companies also required a complete detail of the patient. Otherwise the denial ratio and account receivable can expand.

Verify Eligibility

Before starting the treatment, verify the insurance eligibility and insurance coverage.

Patients are usually unaware of their insurance coverage, while some treatments and procedures are excluded from the insurance agreement. 

The insurance verification is a regular process but due to COVID-19, massive regulations and changes in policies that occurred from the insurance providers, while people have undergone many job changes resulting in new insurance coverage.

 All these regulations are urging the importance of strong verification and eligibility measures.

Make a Payment Policy

Setting up a payment policy plan is ideal in this situation. Many people are facing problems in visiting the health care units, due to changes in the policies and the growing fear of pandemics. 

Since most of the appointments are scheduled through Telehealth visits, It’s ideal to make amendments to the policies. 

The billing process of telehealth services should be dealt with by the online system, like sending emails, phone calls. Make a payment plan that will allow the patient to gradually pay their dues.

A reliable payment plan allows the health sector to collect maximum revenues over time. 

Multiple Payment Options

A multiple payment option system can increase the likelihood of getting payments on time. 

It is furthermore effective during this pandemic, as the chances of contact with the virus are also reduced when the transaction can be done remotely. 

There are multiple payment options like payment through credit cards, debit cards and the health sector can also make its online patient portal where payments can be easily transferred. 

There are other options too like payment through mobile phones using QR codes. 

The multiple payment option system can work best for both the patients as well as health service providers. 

Follow-ups

Patient follow-ups are the regular procedure to collect payments. While it is not recommended every time.

But if your patients are not paying their bills on time then it will reduce the revenue of your practice. Your account receivable will jump and you failed to manage your regular services. 

The patient might forget that they have some amount to pay. It could be due to many reasons like they consider that those treatments are covered by their insurance companies but they might be excluded due to non-coverage. So a timely reminder to the patient is essential in that case. 

Use Best Billing Softwares

Medical billing software is helpful in the collection process. Your practice can maximize the revenues by installing proper software in the system.

They effectively track the payment details like past due bills and late payments. A software system is the best tool to maximize revenues in 2022.

Outsource The Services

Many health service providers are associated with billing companies. Medical billing service providers not only help the health sector to get maximum reimbursement from the insurance companies but patient follow-ups and collections are also part of their services. 

Payment Posting

Payment posting is an important aspect of medical billing, It gives you an insight into your regular income stream.

These insights give your practice a clear picture of the ongoing financial condition which can be resolved if identified in a timely manner.

Medical billing services can help you to manage your payment posting. They can easily find the issue and resolve them quickly.

Account Receivable Management

Account receivable is the process of obtaining the payment in the given period of time. An outstanding account receivable is not good for any practice.

Outsourcing can help you to get maximum reimbursement by managing account receivable effectively. 

Patient Following Up

Patient follow-up is a hectic task, not every medical service provider can manage this activity regularly. Billing companies can help your practice for regular patient follow-ups. 

With the above-mentioned ways, you’ll be paid in 2022, if you are still confused about maximizing patient collections, Med-Miles LLC can help you maximize your collections.

We have a team of professionals who are in the healthcare industry for more than eight years.

Our aim is to facilitate our customers by managing their revenue cycle at a reasonable cost. Call us at (888) 598-9181  for more information. 

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RCM in Medical Billing

RCM in Medical Billing: 6 Strategies You Need To Follow

Ensuring effective RCM in Medical Billing and also providing excellent service to your patients is not an easy task.

Medical practices looking to balance these functions often consider installing medical billing software in their systems for efficiently carrying out revenue cycle management of their business. Medical billing software saves time, cuts costs, and minimizes errors. 

Furthermore, it speeds up claim reimbursements, you also stay calm by knowing that your revenue processes are in good and professional hands.

Medical practitioners, on the other hand, can focus better on the reports of patients rather than the statements of your business. 

What Is A Medical Billing Software?

Medical billing software is an application for computers that enables medical businesses to automate their healthcare billing process. Medical practices use this software to effectively improve their optimized revenue, reimbursement rates, to sustain the financial situation of their businesses.

Why RCM Is Needed In Medical Billing?

Every medical billing company needs to have a strategic and planned approach to handle every section of their billing process, starting from the patient registration to follow-ups and also the denial management involved in the process.

Having the right technique and a dedicated and hardworking team that understands the importance of handling each medical claim, equipped with the knowledge that they are the financial aspects of their customers is very necessary to handle medical billing and achieve business goals successfully.

Every claim handled in the process of RCM is associated with the firm’s revenue, therefore an effective RCM can play a crucial role in Medical Billing.

Advantages Of RCM in Medical Billing

Pre-Registrations

This feature of RCM saves a lot of time. When a patient visits you for the first time, the normal thing to do is that they usually share details such as their insurance history and medical history.

However, with the help of technology, in the case of medical billing software, we can now skip this step during the patient’s visit as with the help of the software staff members can verify their insurance even before they arrive, which improves the personalized experience as well.

With medical billing software, details like a change of the patient’s insurer or the terms of their existing policies can also be updated for future reference.

Integrated Scheduling

With the help of medical billing software, people no longer have to stand in long queues or call the desk to book appointments. This has now been made easy due to the applications integrated into the software.

A strong scheduling system in the RCM software displays details about the physicians and the times they are available. In case the patient misses an appointment, they regularly receive automatic reminders. The staff does not have to worry to enhance the process and focus on key tasks.

Automated Processing Of Claims

Automation drastically reduces the cost of the medical billing process from beginning to finish. It helps you to keep an eye out on the status of claims in account receivables as they happen and look at why some claims were processed why the others weren’t.

It also allows you to follow up on troublesome claims by sending reminders, tracking denied claims, and much more. Furthermore, you will also receive detailed analysis and auditing reports on the operations of your medical practice.

Fewer Chances Of Recurring Errors

Medical billing software nowadays uses accurate patient data stored in the system, which creates an efficient and smooth RCM billing process. It is essential to spot errors quickly and fix them in an instance. This reduces the number of rejected claims and speeds up the flow of revenue into the firm’s accounts.

Managing Of Accounts And Finance

Even though your staff is very efficient, when it comes to dealing with accounts, it is always best to take advantage of the technology and install accounting software for your firm. This helps out a lot in managing the collections, creating accurate financial reports, and generating statements.

This results in a reduction in the margin for errors but also speeds up the process.  Advanced systems also allow firms to ease paying for consultations that help patients. This is an additional benefit, especially since the COVID-19 pandemic, social distancing is the way forward.

Security Of Data And HIPAA Compliance

Nowadays, to protect your patients’ medical data, you should consider medical billing software that is compliant with the Health Insurance Portability and Accountability Act or HIPAA. As storing personal data about your patients in your system is quite sensitive, it is a great responsibility to keep this data safeguarded with software that includes the best and up-to-date security features.

This increases the credibility of the firm’s practice and enhances your level of confidentiality. Ensuring patient data security and managing the RCM by complying with HIPAA is something you should always keep in mind if you decide to install medical billing software. 

Credit Card Payment

In today’s era, patients opt to pay using credit cards as it is among the most convenient methods of payment. The latest RCM medical billing software makes it easy for you and your staff to process payments using credit cards, both online and also in person. 

Strategies For An Effective RCM

RCM is a vast and complex process to handle, as there are many areas where the staff need to consciously take care of as it ensures the claims are reimbursed accurately and completely. Any miss-handling of the medical billing claims during any part of the RCM process can cause denials and loss of revenue. Here are a few areas to focus on for best results.

  • Ensure workforce collaboration by making sure all the teams involved in RCM are in perfect coordination. This ensures the claims are processed as per the requirement of HIPAA.
  • Constantly provide training, as this ensures that the staff involved is up to date with the trends and changes.
  • Organize regular audits which help in finding the causes for the decrease in successful claim percentage.
  • Utilize automated software and decrease errors, as a result increasing efficiency
  • Having an evaluation of your process strategies constantly helps you to keep revised on the guidelines and regulations that need to be followed to help stay on top and in control.
  • If you can’t handle the RCM on your own then it’s best to hire RCM billing services to an established and professional medical billing partner like Med-Miles. This helps to provide a quick solution to all your medical billing needs

Looking To Improve Your Medical Billing Process? Give Us A Call!

Having read the benefits of adopting the latest and HIPAA-compliant medical billing software, it is easy to see that adding effective software to your RCM system can be profitable for your business. 

Med-Miles provides the latest medical billing software around, and also allows you to outsource your RCM billing service.  So what are you waiting for? switch to efficient medical billing software ASAP for the betterment of your healthcare business.

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Medical Billing

Mental Health Billing Vs Medical Billing

For any typical medical practice, the process of billing is a time-consuming and frustrating process with plenty of margin for errors. The paperwork required to run a practice requires practice and training, thus, it can quickly become overwhelming without professional help. 

Medical practitioners nowadays, build themselves a separate team to handle the billing concerns or they also have the option of outsourcing the work to medical billing companies.  These issues are there for both standard medical practices and mental health practices.

What Is Mental Health Billing?

The healthcare industry is quite vast and different mental health professionals treat their patients in different ways.  Psychiatrists do whatever they can to help their clients recover, during the therapy sessions.  This situation is different from going for a routine dental check or cleaning.

In another case a hearing test for fitting hearing aids to a patient. Nowadays, with so many people turning towards insurance, Insurance companies have the power to indicate how long each session should be.  The insurance industry also sets how many treatments should occur daily or throughout the week.

All these requirements make the billing process complicated for mental health firms, who need to make sure that they keep their income levels, and profitability high, also ensuring that every patient who visits them gets the best possible care. 

The different office budgets set by the insurance companies determine the complications that make the billing process time-consuming. Private practitioners handle their billing instead of outsourcing as it keeps operating costs low, which is a basic need for all kinds of businesses.

What people need to take care of when carrying out billing is that they need to follow all formats that the insurance company provides, make sure all files are completed on time, and also the right code is entered.  

How Is It Different From Regular Billing?

In most cases, insurance companies dictate how mental health services are to be provided and how often. They set a limit on therapy sessions which creates a financial barrier for mental health professionals or psychiatrists, on the other hand, normal doctors that perform ear exams or x-rays don’t experience this, which severely limits the quality of the mental practice.

According to data found some years ago, pediatricians were able to bill up to 10 different billing codes for medical visits, but when it came to mental health visits only 1 code could be entered.

Mental health practitioners also operate with fewer staff members, which leaves quite a bit more money on the table due to the inability to properly manage all of the billing needs. Some estimates suggest that as much as 80% of the money owed by insurance companies to mental health practitioners goes uncollected.

Judging by those numbers, you get to understand why mental health billing and behavioral billing are being outsourced more often than others these days.

Billing Concerns For Mental Health Providers

Mental health and behavioral claims are only approved around 85% of the time. This is caused due to several reasons, but the majority are:

Changing Methods And Rules

Insurance policies are always under constant change which eventually lapses. If practitioners don’t make an effort to be active in checking up on these trends and issues, they quickly find themselves trying to handle a lot of paperwork.

This is because mental health practitioners are often notified last of these changes in billing methods. Compliance rules, coding changes, and others need to be followed consistently.

Not keeping up with the changes quickly adds up to the problems when they arise. What mental health providers need to ensure is that you double or triple-check all of your patient’s insurance info before their visit.

Costs

Cost is one of the most talked-about issues for mental or behavioral health providers. Higher cost leads to understaffing, which usually takes place in the administrative department.

If you try to cut costs it can cause an overload of work for your staff which can lead to a decreased morale, which makes them less effective. Outsourcing billing to a specialist like Med-Miles drastically reduces the chances of rejected claims and improper coding issues, giving you a feeling of relief and confidence.

Concerns Of Staff

Outsourcing medical billing for behavioral health doesn’t only allow providers to gain access to coding experts who file their claims correctly and professionally for the first time but also opens a window to an entire denial management process that improves payments. With tools like claims scrubbing and real-time tracking, the chances of denied claims are stopped and corrected ASAP.

Tools For Behavioral Medical Billing

With the right and updated software, mental health providers can simplify their billing process. Nowadays there is special software specifically designed for primary care providers which strengthen their mental health practice.

Specialty Coding

Behavioral health billing involves specialty-specific medical billing codes. Mental health specialists do not use normal codes designated for PCPs and are not bothered by them in the billing process.

Many systems slow specialists down, because of crowding in their billing process with irrelevant information and codes which are never used.

Special software designed specifically for behavioral health specialists offers a ready-made list of the most used codes which leaves out codes your practice will never use.

Custom Dashboards

Other than the most used medical billing codes in your specific specialty, software designed with medical billing software for behavioral health offers a special or custom dashboard. Tailored reports reflect the progress of your billing efforts and what the practice needs to work on to improve overall performance.

Claim Enhancing Tools

The quickest way to compensation is a clean and clear claim. Payers nowadays cover more mental health diagnoses for patients than before, leading to behavioral health experts pushing for more providers to accept insurance for their practice.

Quality software for medical billing contains claim-enhancing tools for behavioral health which keep your claims clean, verify the coverage before providing the services, and enable the practice to receive undelayed payments from payers.

Get Help For Your Mental Health Billing Process

The dynamics of medical billing for behavioral health are always at a state of change with each passing year. This has increased the need for mental health providers to have the right software and resources to be successful.

Here at Med-Miles LLC, we keep up to date with the trends of mental health billing. Combining this knowledge with our IT experts we make sure our collection of bills is consistent and contains fewer errors.

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