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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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Medical Credentialing Process

The Medical Credentialing Process: How Can It Be Simplified? Tips To Follow

In the healthcare system, the medical credentialing process has become an essential part since many patients get insured by the insurance companies for their medical treatment. 

The health service provider needs to get reimbursed for the services rendered to the patient. In that case, they need to submit all the required documentation to the payers.

Sometimes the medical credentialing process becomes too lengthy and time-consuming so it is very important for the service provider to understand all the working backgrounds of the credential process.

What Is The Medical Credentialing Process?

A medical billing process revolves around a system in which the health service provider gets reimbursed for the services rendered to the patient by their insurance company.

For this purpose, the insurance company demands some documentation that will approve the credentials of the physician who render the services to the patient.

The credentialing process consists of the verification of the physician’s education, practice, his license, clinical judgment, specialty, and other certifications. All this information will approve that the service provider is credentialed to provide the services.

This information will help the insurance payer to figure out the need for the treatment verified by the physician for the patient.

What Is The Need For Medical Credentialing?

The medical credentialing process fulfills various aspects like verifying that a certain medical practice has a professional physician who is doing their duty with professional certification and expertise.

This will ensure the quality treatment for the patient and this process allows the best and qualified health professionals to operate. On the other hand, medical credentialing also allows the medical practices to get maximum reimbursement for the services they are providing to the patient.

Steps For Medical Credentialing 

Medical credentialing is a lengthy process and here are the steps included in the credentialing. 

Documentation Process

The medical credentialing process begins with the proper documentation process. As a medical service provider, you need to make sure that you will provide them with full documentation without any error just because vague or incomplete documentation can delay your credentialing process. Also, make sure about the requirement of insurance providers because each insurance provider demands different documentation and form to match the criteria. Here are some details that are usually required for the process.

  • Name
  • License proof
  • Proof of insurance demographic
  •  information social security number 
  • specialties 
  • complete information about the facility which is provided in the hospital and career history.

Prioritizing

Following a medical billing process, you need to make multiple claims because the patient is registered with different insurance companies. In this step, you need to make some rational decisions that will eventually help you out in getting your reimbursement from all the insurance companies.

First, we have to figure out that if your medical billing goes through a single insurance company then make that company your priority and fill their application first.

Also, you have to be familiar with different insurance rules and regulations. Some insurance companies give you an abbreviated application for providers who are already credentialed in a particular area. 

Ensure The Accuracy

Make sure that you have entered all the essential details accurately. Here you can ensure the accuracy of your documents by following these steps.

You can verify all the expertise and certification and license detail through various platforms like:

  • The American medical association 
  • American Board of medical specialties 
  • Office of inspector general 
  • The educational commission for foreign medical graduates certification and Review of credentialing privileges and insurance claims

Make sure that you submit the documentation with full accuracy without any doubt of error. Because this information is essential for the credential process.

Credentialing Through Automation

Some health service providers gather information for credentialing processes through traditional ways. Such practices will consume a lot of your time and it will further delay the whole process. Now there are many software solutions available in the market which are designed to conduct an efficient credentialing process.

These automation tools will cross-reference resumes and application information through different platforms and verify the credentialing of the physician.

Complete CAQH

One of the prominent insurance companies required The council for affordable quality healthcare conjunction in their application process.

  • Whenever any health service provider submits an application to the relevant insurance company then they will give them a CAQH number followed by an invitation to apply.
  • You can complete the CAQH form in both ways through an online platform or manual writing in paper form.
  • Make sure that you give them inaccurate information because any error can delay the whole process.
  • In the last step, you have to prepare a re-attestation. It is an essential step that ensures the continuous eligibility of insurance.

Following Up

When you have done all the required documentation then the last step is to submit your application to the insurance provider. It is considered a lengthy process and it may take from 90 days to 120 days. But you need to follow up on your application timely which Brightens the chances of early approval.

Call each insurance company every week to get the status of their application. In this way, you can get to know the status of your application and if there is additional information or any missing document required so you can give them instantly rather than waiting such a long time.

Recertification

After completing all these steps you will finally get the credential from the insurance company. But you can’t say that this process is finished while credentialing is an ongoing process and credentialing is required every three years. The credentialing software in that way will notify you of the renewal of the documentation.

Need Help?

As we know that the medical credential process is not simple and it can consume a lot of time of your practice and if you get disapproval from the insurance provider then it may take more time of your practice. Outsourcing is the best way to save time. 

Med-Miles can give you an opportunity to get a quick credential of your services. As it is a tricky process and rules and regulations vary throughout the year.

We assured the submission of clean and correct applications and minimize rejections and elimination of your applications with the help of a dedicated follow-up team. Call us at(888) 598-9181 for further information and details.

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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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Telehealth Denials

Avoid Telehealth Denials With These 4 Tips

The healthcare system has suffered a lot due to the ongoing COVID-19 pandemic. However, the pandemic also transformed the current working of the health system and directed towards a way in which they can improve their ability to tackle the upcoming challenges. 

Telehealth services are one of the positive outcomes of this pandemic. The mandatory social distancing during the peak of the covid-19 pandemic makes it difficult for the patient and the physician to plan an interactive session.

At that time telehealth services are the only way to have a safer interaction between the patient and the physician.

Whether it is traditional or telehealth the denial rates have always been a problem for the health care service provider as it significantly reduces the revenues which impact their ongoing operations.

Ways To Reduce Telehealth Denials 

In this article, we will explore some ways in which you can reduce the telehealth denials and get maximum revenues.

Check the Coverage

Before starting the treatment you need to check the insurance coverage of the patient. The private insurance company offers coverage for telehealth services but it also depends on their policies. 

Because it depends on the policy by the insurance companies then it is essential to verify insurance coverage by calling the payer.

Moreover, the requirement to document a visit also varies. So again the best way to check the coverage and documentation of the visit is to call the service provider and ask for the complete details.

Fulfill the Clinical Documentation

Proper clinical documentation is essential to get the reimbursement for that purpose you practice needs to fulfill all the gaps.

If there are some gaps in the clinical documentation like improper information and any error in the coding then it can lead to a claim denial so make sure that you check all the documents before submitting it.

Proper Training of Your Staff

It is essential to give your staff proper training especially on documentation which is the foundation of any billing process. The staff should be aware of the following process:

Like verbal consent before making an appointment.

And to make sure that what kind of communication medium is used for the interaction, like it can be a video call or an audio call.

They should also note the total length of the meeting when it started and when it ended and what was the purpose of the meeting.

Moreover, the location of the patient and the service provider at the time of interaction should also be noted, and which platform they used during communication. All these details will help your staff member to document the whole meeting appropriately.

Use Appropriate Coding

Coding is one of the main reasons behind the higher denial rates not only for traditional medical billing but also for telehealth claims.

The requirements for the telehealth services coding and billing varies and most of the time the billing staff was not aware of the requirements and regulations issued by the insurance companies. And this was one of the biggest reasons behind the higher denial rates.

To minimize the coding errors the health service provider should:

  • Provide proper training to the coding staff to manage the payer requirements and take a deep look at the proper coding of telehealth services and be aware of the latest regulations and trends.
  • Educate your staff members about the coding guidelines specifically related to covid-19.
  • A proper sequence of diagnosis and treatment should also manage as it is part of appropriate coding. 

Clean Claim Submission

Before submitting the claim make sure that all the essential documentation is correct and there is no error in coding. Make sure to submit the claim on time as the insurance companies only process those claims that are submitted timely.

Track Denial Rates

Make sure that your practice is consistently tracking the denial rates. For most health care systems denial rates are normal but frequent denial rates are the indication that something is wrong in the system and a proper investigation is required.

After the proper assessment of the issue, the follow-up team can provide the proper documentation and make the case to get reimbursement. 

Covid-19 is completely changing the operating system of health care industries. While the adoption of telehealth services is not easy at first instance, challenges are part of the advent of any new system. Who knows that in the coming day’s people prefer to get regular check-ups at the comfort of their homes.

Throughout the article, we discussed how higher denial rates can cause serious damages to your revenues and how you can avoid it to get maximum reimbursement.

Apart from these tips, you can also outsource your billing activity to a professional billing solution company as they have a highly skilled team that manages many other health services providers’ RCM.

Med-Miles is one of the top billing solution companies. We have been serving the healthcare industry for almost eight years. We are focused on learning and implementing the latest ideas to achieve the best results for our clients. Call us at (888) 598-9181 for more information. 

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Revenue Cycle Management

Revenue Cycle Management: Get Paid For What You Do

In the medical billing process, Revenue Cycle Management is the key for any practice to smoothly manage its revenue and make the health care center financially stable.

The whole revenue cycle management system revolves around managing, identifying, and collecting revenues.

It has become essential for any health service provider to efficiently manage its revenue otherwise an outstanding account receivable can badly affect the operations of the services.

Steps of Revenue Cycle Management

The revenue cycle management system revolves around multiple steps. Some of them are described below:

  • Patient Details

When the Patient comes for the services, the first step for the revenue management system is to record all the essential details of the patient. It includes his name, age, address, etc.

Your front desk staff can note all these details with accuracy and these details are essential for the billing process.

  • Checking Insurance Coverage

The next step is to verify the insurance eligibility of the patient. In many cases, some services are excluded by the insurance coverage and the patients are unaware of it.

After checking the eligibility the next step is to make them aware of their insurance coverage and tell them that these services and procedures are excluded from your insurance scope and you need to pay for them.

  • Check Code

In the next step, all the documentation is converted in the form of codes by the coding team. Because insurance companies process only those claims that are in the form of coding.

  • Submitting The Claim

When all the documentation has been done in the form of coding then the next step is to submit the claim to the insurance company. Your claim will be processed by the insurance company.

If there is no error found in the claim then it will be approved in case any error is found in the submitted claim then it will be rejected. 

  • Follow-ups

It’s one of the essential parts of revenue cycle management. When your practice faces a denied claim then your billing team must follow up. Check the claim and find the error and resubmit it.

And for the services that are excluded from the insurance coverage and patients are liable to pay for them then it’s the responsibility of a follow-up team to send them reminders to pay their dues.

How To Make Your Revenue Cycle Management Efficient?

It’s essential for every health service provider to manage their revenues at full potential. Here are some ways in which you can maximize your revenues.

Keep The Record With Accuracy

Record keeping is one of the first steps of the medical billing process and it should be accurate. This information is important to get the right coding done. So if your practice is successful in keeping the record then you can easily get the reimbursement.

Highly Skilled Staff

A highly skilled staff minimizes the chances of error in your billing activity. Your practice should spend more resources in the training of the staff or can hire a professional staff to manage the billing activity.

Reducing The Manual Working

There are higher chances of error in the manual form of working. The paper records can be lost and they are very difficult to manage.

On the other hand, you can lessen these errors by using the automation process, utilizing the latest EHR/EMR technologies and administrative tools, and cloud-based systems.

Efficient Coding Practice

An efficient coding practice is necessary to minimize the claim denial rates. While coding use CPT and HCPCS coding approved by the American Medical Association. Follow the set regulations and hire an expert coding team.

Give Your Patients An Alternative Payment Method

These services are exclusively for those patients that are liable to pay their bills. Many times patients can give your practice an instant payment because you don’t give them multiple payment gateways.

Some might prefer to use their credit/debit card or some might be interested in paying through any mobile application. Make sure that you give them maximum options for payment so that you can receive the revenues without any delay.

Timely Submission of The Claim

The insurance companies only approve those claims that are timely submitted. If your practice fails to submit the claim on time then your account receivable can expand at a significant amount. So a timely submission can save you revenues.

Tracking Denial Rates Frequently

Tracking denial rates are essential for any medical service provider. A consistent denial rate in your billing is the indication that there is something wrong that needs to be corrected. It might be due to frequent errors in coding or late claim submission or might be the inexperienced worker.

A team that monitors the denial rates can give you solutions to overcome them is essential for revenue cycle management.

Financial Responsibility

Many times, patients are unaware of their insurance coverage. So after verifying the insurance eligibility it is the responsibility of your practice to make them aware of their insurance coverage and tell them that they are liable to pay the uncovered bills.

Outsourcing

Outsourcing is one of the best ways to manage your Billing activity. The majority of the time your practice lacks resources to effectively manage the revenue cycle management. Either you have a lack of staff, improper infrastructure, or inexperienced staff or ineffective management.

A Billing service possesses a team of experts who can manage the revenue cycle of your practice. At the same time, they are managing the billing of many other practices so they better understand the regulations and latest trends and nature of different insurance providers.

Revenue cycle management is an essential part of any medical service provider. If you fail to get the desired results after all the hard work then you can outsource your billing activity. 

Med-Miles can help you to achieve your goals. Our vision is to provide a smooth billing process with better solutions. We assure low denials rates with a maximum profitability ratio. 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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EMR Software

Five Reasons You Should Use Urology EMR Software

Urology EMR software is a system that allows urology practitioners to maintain and utilize electronically generated data of patients. EMR authorizes urology practitioners to save and document patient data electronically rather than using the traditional model of record-keeping.

These electronically generated records are accessible and easy to handle. It enhanced the ability of practitioners to provide patients with better care. It is also very essential for handling the billing activity.

Here are 8  reasons for using EMR Software:

 1. Saves From Manual Documentation

An electronic medical record system can save your time from manual paperwork. Record keeping and utilizing is a big challenge nowadays.

An EMR software system is valuable compared to paper documentation Because it allows the service providers to track the data on time. Ensures better accessibility of patient records and maintains overall patient care. Moreover, Patient data is also used to claim reimbursement from insurance companies.

A missing and false record results in a claim denial, Which will eventually lower your revenue. EMR software systems helped many urology practices to protect and utilize the data of the patient effectively.

2. Features In Software 

There are numerous software solution companies that are delivering multiple features specifically for urology practices, some of the popular features include:

  • Online Patient Portal

One of the main features is the patient portal. It will help in accessing and sharing patient information electronically. The patient portal feature allows the patient to get easy access to their physician, which reduces the communication gap.

  • Online Payment Options

Patients now can easily pay through their credit/debit cards through the online payment system. Many of the advanced systems also accept payment through mobile phone apps. 

  • Other Features

Some software systems permit your practice to upload pictures in the same format. For urology practitioners, they can easily edit and crop the images of bladder X Rays and Kidney Biopsies. 

Another feature includes the fastest delivery of lab records to the patient through EMR interfaces with labs and a health screening questionnaire feature which allows you to ask predetermined questions to your patients. 

3. Integration With The Third Party

Taking full advantage of EMR software requires proper integration of EMR with the third-party solution system. It will not only enrich your productivity but also enhance the patient experience. Below are some of the potential EMR integrated options: 

  • Integration With Telehealth System 

Integration with a telehealth system would allow your urology practice to remotely interact with your patient. It further allows practitioners to edit and maintain patient data accurately. 

  • Integration With Lab

Your Urology EMR software should be capable of integrating with your lab system. It will let practitioners access the lab results in a quick time and a timely diagnosis can be ensured. Having quick access will also enhance billing activity.

  • Integration With Medical Devices

It involves the integration of EMR with medical devices at the point when the devices are operated for medical care. EMR assists in recording the reading and utilizing it through medical devices. 

4. Streamline Billing Activity

An EMR provides an auditing trail when needed, which makes it essential for billing activity. 

From patient authorization to referral approval and record release all things can be done by utilizing EMR software. With all records in hand and easily accessible the chances of coding error are also limited to some extent. Resulting in better revenue generation and a low claim denial rate. 

5. Compliance Factor

All the health care systems under HIPAA are instructed to make their present system compliant with ICD-10 coding. Luckily, there are multiple software solutions companies that are providing ICD-10 compliant EMR software. It will save your urology practices from any possible error of data breaching and coding error. 

6. Covering Specific Coding Terms For Urology

Coding is associated with specific medical procedural activities. There are EMR systems that are highly specified for urology coding. It saves a lot of time for the coding staff as they are free from adjusting or assigning the codes to the relevant procedural activity. 

7. Cloud-Based System

There are cloud-based EMR software solutions. Which gives you an option to save and store your data on remote servers. Instead of maintaining the records on in-house servers. It’s best to save them online.

There are chances of system failure and you can lose all the essential health records and there would be no option left to recover them. A cloud-based system is secure for data and with every passing day the security breaches are also declining. Moreover, a cloud system lets you access patient records from multiple devices like your smartphones, tablets, etc.

8. Improves Patient Experience

EMR software system allows urology practitioners to manage their daily activities electronically. Whether it is record keeping, data management, record handling, or coding. It is not only saving time and lowering the chances of errors. But also improving patient care.

The elimination of manual forms of working allows the physicians to get some extra time for their patients. Which is a sign of a healthy interaction between patient and physician and it will further enhance the patient experience. 

Need EMR Consultancy Services? 

Uncovering the most suitable EMR software, fulfilling all your requirements can be a challenge for your Urology Practices. Med-Miles makes sure that our client is up to date with the best suitable options available for their practices in the markets with changing coding regulations.

We provide consultancy services for new practices and help them in finding the best possible EMR vendors which can meet all desired requirements of your practice. For more information call us at 888 598-9181

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Medical Billing

Coding Guidelines For Podiatry Medical Billing

Podiatry is a medical specialty devoted to studying complications related to the foot. Which involves diagnosis, medication,  and surgical treatment.

Services offered by the podiatry specialist are paid by the insurance companies or in case if some services are excluded from the insurance coverage then the patient is liable to pay for them. 

Podiatry medical billing proves to be complicated as it essentially treats the elderly, which is a large set population covered by Medicare. Which demands additional efforts in the medical billing and coding process.

As there is a higher possibility of a coding error, which results in claims denials and loss of revenues. And an additional effort to make your coding compliant with the recent guidelines by Medicare increased the workload of podiatry practices.

Recently a coding guideline was issued for Podiatry practices. For efficient billing activity, you must be compliant with these guidelines.

Coding Guidelines For Podiatry Medical Billing

Proper coding is imperative for clean claim submission. Codes are applied to describe the treatment and diagnosis provided to the patient to prevent claim denial and increase revenues.

There are varieties of codes, some are considered for one operative procedure, while some are applied in an obscure form of treatment.

Based on the insurer company requirement multiple codes are set with each other. A thorough evaluation of all these codes is important for your practice. In case of any error, you may face claim denials which will eventually increase your account receivable. Moreover, coding experts should keep themselves up to date for the new policy regulation by Medicare. 

For some services modifiers are required, they are used to give additional information to the payers about the treatment and services under certain circumstances. 

The policy guideline for Podiatry practices under healthcare Medicare are given below: 

Excluded Services 

There are multiple services that are not covered by Medicare including general routine foot care, except under the following conditions: 

  • When it is mandatory with other treatment procedures. 
  • During the diagnosis and treatment of ulcer wounds 
  • Trimming nail following a fracture. 
  • Subluxation of the foot, an exception in the case of ankle dislocation.
  • Flat foot and some devices except therapeutic and orthotic shoes. 
  • Metabolic, neurologic, and peripheral vascular disease.
  • Treatment of warts and Mycotic nails. 
  • The treatment of mycotic nails can only be covered when there is clinical evidence of mycosis in toenails and the patient is ambulatory. In the case of non-ambulatory, the extent of secondary infection should be taken into consideration. 

Covered Services 

Under the new policy guideline, the covered services include a diagnosis involving hyperkeratotic lesions,non-dystrophic nails, debridement of nails, and dystrophic nails.

And foot exams for people with diabetic sensory neuropathy.

There are many other chronic diseases that are covered under new policy guidelines

List of Codes

Below are some of the procedural or diagnosis codes, which are given for reference purposes only.

  • CPT Code  11055 is applied for cutting benign hyperkeratotic lesions.
  • CPT Code  11719  is applied for trimming non-dystrophic nails.
  • CPT Code  11720  is applied for the debridement of nails.
  • CPT Code  G0127  is applied  for trimming of dystrophic nails
  • CPT Code  G0245 is applied for Primary administration of a diabetic patient with diabetic sensory neuropathy following a loss of protective sensation.
  • CPT Code  G0247  is applied for Routine foot care by a practitioner of a diabetic patient with diabetic sensory neuropathy following a loss of protective sensation. 

Modifiers

Modifiers are used as additional information to the players in coding. These modifiers are utilized with the codes. The modifiers Q7 for 1 class A findings, Q8 for Two class B findings, Q9 for One class B, and 2 Class C findings. Below is the description of each modifier: 

Q7- One Class A findings

This modifier is specifically used in the case of nontraumatic amputation of the lower extremity (A serious complication of diabetic neuropathy and peripheral vascular disease)  or integral skeletal portion.

Q8- Two Class B findings

This modifier is applied in case of the absence of posterior tibial pulse, advanced trophic changes, and absent Dorsalis Pedis artery pulse.

Q9- One Class B & Two class C findings

This modifier is used in edema, paresthesia, burning, temperature fluctuations, and claudication.

For more information, you can see the updated document of Podiatry Policy guidelines. 

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Medicare

Medicare Physician Fee Schedule for Calendar Year (CY) 2022

By the start of November, the Center for Medicare and Medicaid Services (CMS) published a conclusive rule on the physician payment program. The policy exhibits a significant shift towards a better administrative approach at the time of the global pandemic. 

The payment program for the calendar year 2022 not only improves the reimbursement.But the emphasis on the Telehealth system will promote accessibly and empower the health care system with innovation.

Overview of The Physician Fee Schedule (PFS)

Funded by Part B the center for medicare and Medicaid Services uses a physician fee schedule plan to reimburse the health care experts for the services they render. It covers a variety of contexts that cover physician offices, clinical labs and aids other beneficiaries of the health practice. 

Medicare paid the health professional on a particular valuation based on the resources applied in aiding the patient. While the PFS is based on the division of means that are used in rendering the services.

So, the payment method is based on relative resources.RVU( Relative value unit) 

Works at the fixed dollar rate, geographical characteristics are considerable due to the variation in payments across different geographical localities. 

Payment Terms

PFS ultimate rules strive to promote health equality, assuring accessibility and introducing unorthodox solutions to tackle the upcoming challenges in the health care system.

Here are some of the key requirements in the payment method. 

Telehealth

There are principal policy shifts that occur in this sector. The initial and significant shift was the elimination of geographical restrictions for patients having a psychological disorder through the 2021 Act of consolidated appropriation (CAA).

CMA finalized its terms to the amount that there should be a face-to-face interaction within six months earlier than the virtual interaction. 

The ultimate rule obliges the Secretary to arrange a frequent in-person interaction.

CMS also retained some services due to the COVID-19 public health emergency. It extended the duration till 2023 so that more data can be collected.

CMS is also creating shifts in an interactive telecommunication system. Now the home-based mental health service providers who have the ability to provide the service through two ways, audio as well as video can use only audio technology under beneficiary preference or due to some restrictions. This audio can also be tracked by using modifiers. 

Evaluation and Management Visits (E/M) Visits

Evaluation and management visits are conducted in sections by the physicians and non-physicians providers (NPP). CMS extended the scope of E/M visits by ensuring that only E/M visits were provided in the facility by physicians and NPP in the same group. 

The new measures suggest that physicians or NPP who reach the substantive portion would bill for it. Documentation and modifiers are used for the settlement of existing policy and the indication of split/shared visits. 

CMA also furnished a package of services to critical care settings. These services asked full attention from physicians and NPP, on the same day when more than one physician is needed.

The visit may be considered as split and shared and payment should be issued at the same time.

Practitioners are aimed to document, entire time each practitioner served for the patient care and their role and attest that those services were essential and medically approved.

For the teaching facility services, only the time which is used for qualifying purposes will be counted as E/M visit level.

Rural Health Clinics and Federally Qualified Health Centers

CMS settled multiple provisions to facilitate RHC and FQHCs.Including telehealth services paid at the same rate as the in-house services and allowing mental health telehealth visits using only audio interaction in special cases based on beneficiary preferences and limitations. 

Covid-19 PHE flexibility accommodates a temporary authority to pay RHC & FQHC for a distant telehealth facility. That will expire after the PHE ends. 

Drug Pricing Reporting

CMS defines drugs as a product, service, supply that is payable under Part B. Under some regulations, drug manufacturing companies are asked to submit average sales price data which covers their part B product. These regulatory changes are imposed to implement CAA’s requirements.

Open Payment Program

An open payment program is a public disclosure of medical records to maintain transparency and accountability. It eventually tells the financial relationship between the drug manufacturing, medical service provider, and other medical equipment manufacturers. 

  • CMS settled multiple amendments that will eventually expedite data collection.
  • A mandatory payment context field will be used to collect essential data. 
  • Restricted the elimination of data without giving any proper reason. 
  • In case when no data have been recorded then an option of recertification exists.
  • Making it mandatory to publicize the payment record without any delay. 
  • The eligibility to submit general payment records is removed so that all entities are liable to submit up-to-date reportable data with ownership records. 

For more relevant information, see the fact sheet published by the Centre for Medicare & Medicaid Services.

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