Tag - Medical Billing Company

Revenue Cycle Management

The Ultimate Guide To Benefits of Revenue Cycle Management

Revenue cycle management permits healthcare providers to spot, track, collect and manage incoming payments for services provided.

The RCM method plays a vital role in maintaining money viability and providing exceptional service.

In addition to easily streamlining secure requests and payments, RCM will promote national, patient, and student engagement by strengthening relationships that build an improved sense of community and commitment.

Revenue cycle management can increase provider revenue whereas decreasing the time spent on body and clinical functions. which results in extra money and time dedicated to the patient and their treatment.

Preregistration is the 1st and most important step of  the revenue cycle method. Pre-registration allows practice to capture demographic data, insurance data and eligibility in period through a clearinghouse, typically whereas the patient continues to be on the phone.

Revenue Cycle Management Benefits:

Saves time: A good RCM ought to be designed to save lots of the time taken between the supply of service and receipt of payment.

Saves money:  Revenue cycle management systems offer insights into denied claims.

The Purpose of Revenue Management, specifically speaking, the aim of revenue management is to:

  • Connect systems and knowledge.
  • Manage assortment, revenue, and reconciliation.
  • Communicate with and interact with customers.

When these CORE solutions close in one system, they type a comprehensive image of AN institution’s revenue and money status—which is the final purpose of revenue management.

 Revenue Cycle Management Advantages

Revenue cycle management brings several advantages to organizations: quick and error-free payments/reconciliations, deep insights into discourse information, and higher service to users.

Integrating multiple systems:

  • Consolidates information into one accessible, period read
  • Eases multi-departmental revenue collections
  • Gives insights on payment experiences
  • Automating processes like causing invoices, process payments, electronic messaging users, playacting reconciliations, and generating reports:
  • Eliminates frustrating and expensive entry errors.
  • Significantly reduces the time departments pay playacting manual tasks
  • Knowing the standard and accuracy of finances, whether or not merchandiser services are presently operating well.
  • Collect revenue faster.
  • Give period, comprehensive, and significant understanding of knowledge.
  • Allow you to administer higher service to your customers.
  • Keeping your organization compliant with the very best security and PCI standards and privacy requirements.
  • Protects personal and monetary info from unauthorized access.
  • Maintains your smart complete name.

4 Steps within the Revenue Cycle Management Process:

The exact steps within the revenue cycle management method vary betting on the business (government, healthcare, or higher education), however the final steps are as follows:

Step 1: info Capture

This opening includes gathering info that’s needed before an Associate in Nursing invoice is issued. this could embody personal information like name, address, or checking account range. It conjointly includes forms for state verification, insurance eligibility standing, and authorization.

Step 2: Charge Capture and asking

Once services are rendered, they’re coded and calculated against any amount of money or different written agreement obligations. For instance, in an exceedingly health care situation, a claim is distributed to Associate in Nursing non depository financial institutions to be accepted or denied.

The right charge is announced, Associate in Nursing an invoice and clarification of charges are sent to the accountable party for payment, at the side of any notifications.

Step 3: assets Management

Next, claim standing is edited/updated (if necessary), bills are submitted, and payments are announced. Reminders and collections notices are sent, and late fees (if applicable) are more to the charge total.

Step 4: levy

The final step enhances revenue by gathering information into readable reports for driving data-backed selections that move Associate in Nursing enterprise nearer to its monetary goals.

Since the results of improper revenue cycle management are dire, having a sensible, structured, corroborated revenue management strategy is important. Here are the 3 commonest ways that to travel concerning it.

This can be the normal manner of managing revenue, however of late, it’s nearly not possible to try and do it on your own. Managing a whole revenue cycle with none skilled solutions, particularly as you start or still scale, is currently too difficult for many businesses to try and do on their own.

Organizations WHO do attempt to have it all themselves place in large amounts of your time and energy, just for this strategy to fail. Inevitably, that’s after they conceive of a decision within the professionals.

  1. Source RCM: 

Having Associate in Nursing other companies are available and taking over an organization’s revenue cycle management is helpful. There are some downsides, though, like:

  1. Ending up with a fragmented body method
  2. Hold up on misaligned goals
  3. Having a slim read of your own information

Use a Revenue Cycle Management System:

This can be the revenue management strategy CORE suggests. Having Associate in Nursing panoptic software system resolution that you simply manage and that we support provides your organization the simplest of each worlds. You’ll get the advantages of:

  1. Total management
  2. Seamless integration
  3. A simplified method
  4. machine-controlled tasks (invoicing, messaging, reconciliation)
  5. merchandiser services
  6. Resource management (ticketing, events, etc.)
  7. a whole read into decision-driving information
  8. PCI compliance and security that exceeds the industry’s highest standards
  9. 24/7 support from extremely trained analysts and solutions engineers

Who Advantages From Revenue Cycle Management?

Among several others, government, healthcare, and better education are 3 major industries that profit greatly from revenue cycle management.

The answer may be a one-stop, resistance, secure receipt-to-reconciliation payment and engagement platform that resolves the various challenges throughout the revenue cycle.

Local, state, and national agencies have constituents that need fashionable, convenient interactions, particularly as municipalities still evolve. Government agencies want revenue cycle management to alter payments and boost arriving revenue collections, up their constituent’s overall welfare and satisfaction.

Health care suppliers have patients WHO want positive engagements and personal interactions as they create medical asking payments. Suppliers ought to use revenue cycle management to alter payment collections and result in improved patient and workers outcomes.

Education establishments have progressive students WHO expect technologically advanced payment solutions and additional connected fields. establishments will use revenue cycle management to optimize arriving financial gain by understanding and appealing to student and family desires.

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Patient Experience

5 Amazing Tricks To Enhance Patient Experience

Giving your patient an amazing experience is the goal of every healthcare service provider. It is also one of the most critical components because your ability to provide your patient a healthy experience will not only distinguish your practice from other service providers but is also a key component for the attraction and retention of your patient.

What is Patient Experience?

The patient experience is a kind of interaction that a patient built with their healthcare service provider and their staff. When a patient comes to the hospital they want you to provide high-quality health care which includes a timely appointment and easy access to information and good communication with the physician.

Friendly behavior from the staff member is the key. All these attributes are working to create a positive patient experience. If you are not giving them enough attention or not building a  positive interaction then it will work in the opposite way and turn into a negative patient experience.

Why Improving Patient Experience is Important?

When you are working to improve the patient experience then you will find out that you are not only working for a better health facility for the patient but you will also see strong financial stability in your healthcare system.

Here are some of the positive outcomes which tell you how important it is to improve the patient experience.

A positive Health Outcome for the Patient

Every patient comes to the health care center to get relief from the complications they have to some kind of disease. At that period of time, the patient expects excellent care and behavior from the health care unit. If you are trying to give your patient an excellent experience by maintaining a positive interaction.

Give them excellent care and provide all the feedback related to health then he will definitely show trust in you. This will not only give a strong impression to the patient about your services but also solve a greater problem which is Patient compliance which is a very important aspect of the healthcare system.

The patient will try to comply with the treatment and medications which will eventually give him a positive outcome regarding their health.

Improves Hospital Management

If you are trying to give a positive experience to your patient then it will eventually work in improving your hospital management system.

Your medical team is now giving their best to improve the patient experience and they are interacting very well with the patient. It will eventually give a boost to the performance of your employees when the patient feels comfortable around them.

Every time the patient comes for a checkup he may remember that nurse or those staff members due to their good behavior.

This appreciation will further enhance their confidence and it has been seen that when the staff members work diligently then it will not only help them to increase their productivity but also help in enhancing the healthcare unit overall productivity.

Financial Benefits

If we look at a financial point of view then it also helps many healthcare sectors to improve their finances and get financial stability. While you are working in enhancing the patient experience then the positive outcome will give you customer loyalty.

You will have a good reputation among the patients and they will surely recommend your services to you, their relatives and other close contacts.

It will increase the chances of generating more revenues for health care service providers. That’s a good reward if you maintain a good experience for your patients.

Tricks To Enhance Patient Experience 

Now we are done with the explanation about how giving an excellent patient experience is important for any health care service provider. Now we will share some tricks for you to enhance the patient experience. Here are those tricks

  • Ensure a Complete Guidance

When it comes to treating, many health professionals focus on eliminating the symptoms of the patient. But rarely do they discuss the lifestyle of the patient.

This is sometimes a major concern because you might succeed in addressing the current symptoms of the patient but due to their poor lifestyle standards, the chances are bright that the symptoms will prevail in the future again.

So you should ensure complete guidance from financial to nutritional and the proper counseling to overcome their bad habits. It will surely give them an excellent experience.

  • Listen To your Patient

You must listen to your patient if you want to establish a healthy bond with your patient. Promoting a patient-centric culture will boost their confidence in participation and decision-making. Your practice will get the confidence from the patient that you can better understand their condition which leads to a better recovery.

  • Share Your Knowledge

Share your knowledge with your patient. It is one of the biggest issues right now that many of the patients don’t have enough health literacy to comply with the treatment and procedure recommended by the doctor. Not having enough information about their health condition is the greater hindrance towards a Swift recovery.

Patients lose confidence by not getting the desired result so if you give them enough knowledge about their health complications then they will surely be able to see the bigger picture and try to make themselves complaints about the treatment.

  • Use Technology Wisely

If you are giving the services of telemedicine then you must be very careful when interacting with the patient. At that point in time, you must ensure that this interaction will be managed by some highly qualified staff members of your team. With that intent, you can improve your services with a better patient experience.

  • Improve The Wait Time

It’s very frustrating for the patient to wait for a longer period of time. They feel like you are not giving respect to their time. It’s your responsibility as a service provider to manage their schedule effectively so that your patient doesn’t have to wait that long for their turn.

Your staff members can explain to them the reason behind that extended schedule and they will surely appreciate your clarity.

There are many other ways from which you can enhance your patient experience. Just because every health Care unit has its own sets of regulations and challenges. You must find a way to give a better patient experience.

This will not only ensure you a positive outcome regarding the patient’s health but you can also achieve patient compliance and patient satisfaction. Moreover, it will also boost your productivity and improve your revenue cycle.

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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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Covid-19 Vaccine

 New Updates For Pediatric COVID-19 Vaccine

Health experts believe that the recent covid variant stands as one of the leading hazards to World health right now. It tremendously raises the hurry of acquiring vaccinations for every individual.

While the covid-19 vaccines are always proven to be very useful in lowering the chance of viruses. On the other hand, the health professionals are suggesting that in order to tackle the omicron variant masses should think of a booster dose of covid vaccine.

Meanwhile, It has presently become very important for children to get the first dose of the covid vaccine. If you are searching for new updates regarding the pediatric covid-19 vaccine then you are at the right place. Here in this article, we will thoroughly update you about the pediatric COVID-19 vaccine.

Is there a COVID-19 Vaccine For Children?

Yes, the Covid-19 vaccine can be inoculated to children and it is very important for every child to get vaccinated. The children under the age of 18 are covering a portion of 32% globally and 24% only in the United States.

It should be mandatory that every person in this field should be vaccinated if we want to effectively control the reach of this infection.

Is the Covid-19 Vaccine Secure For My Child?

The center for Disease Control and Prevention advised that every child from age 5 to older should get their first dose of covid vaccine. For protection matters, the vaccines go through the clinical process and it clearly suggests that these vaccines are safe to use now.

The FDA approved the Pfizer-BioNTech covid vaccine to be used by children age 5 and above.

After the FDI approval, the American Medical Association updated their CPT code for the pediatric covid-19 vaccine for Pfizer.

Moreover, the safety parameters are fully observed by the center for disease control and prevention (CDC). So we can say that the vaccines are safe to use.

Eligibility

In their recent update, John Hopkins Medicine is encouraging people to get their children vaccinated with a booster dose. This suggests that children aged 12 to 17 should get the Pfizer-BioNTech vaccine with a minimum amount of 30 mcg.

They also suggest that children can also receive their booster dose after the course of 5 months of their initial dose.

On the other hand, the children who have a compromised immune system and they may suffer from certain conditions like immunosuppression then they can receive this extra dose after 28 days of their second dose.

Similarly, children aged 5 to 11 can also acquire the Pfizer-BionNTech vaccine. With the percentage of 10 mcg doses.

And children with medical needs like immunosuppression can also get the extra dose 28 days after acquiring the second dose. It’s critical to note that the children at this age are not qualified for a booster dose at that time.

Why Is Vaccination Important For Your Kid?

Some recent data indicate that the age group of 5 to 12 is heavily affected from a covid-19, in the United State only there have been 2 million cases reported during this pandemic which puts an additional burden on the health sector because some of the cases are very severe.

This severity can be estimated with hundreds of deaths from Covid. It has become the leading reason for death among children aged 5 to 11.

There are also some long-term complications of this virus which can affect the heart, lungs, kidneys, brain, eyes and skin, and other organs of the body.

Are there any side effects of using COVID-19 vaccines?

The side effects and severe health complications are extremely occasional in the covid-19 vaccine. There have been cases of myocarditis and pericarditis (Heart muscle complication) after the dose of Pfizer-BioNTech vaccination. The children aged 12 to 17 are affected by that.

While it is medically admitted that children aged 12 to 17 are more likely to develop the symptoms of myocarditis. On the other hand, the children ages 5 to 11 who received the Pfizer biotech vaccination are not showing any symptoms of myocarditis. So we can say that it is very rare.

There are some possible side effects which possess the pain and swelling of the side of the arm from which the children got the shot of the vaccine. There are chances of fever, nausea, muscle pain and headache, and fatigue but these are some temporary symptoms.

While it has been seen that some people do not even develop the symptoms. You can get the assistance of the doctor in managing the side effects.

There are some other types of reactions including Anaphylaxis which is an allergic reaction but it is also very rare. There are multiple myths about the covid-19 vaccination that it affects fertility. But still, there is no proof that the covid-19 vaccines affect the fertility of human beings.

What is the difference between the vaccine dosage given to the younger kids compared to the teens and adults?

Yes, there is a difference between the vaccine dose given to the younger kids compared to the teen and adults. It is suggested that children aged 5 to 11 should get an amount of 10 mcg of dose. For the teens and adults, they can receive a dosage of up to 30 mcg.

Can a Child Get a Vaccine if he has an Active Covid-19?

No, it is not recommended by the health professionals to give a vaccine to your child if they have an active covid-19. You can wait to get them vaccinated until they recover from the present condition.

The new updates for the pediatric Covid-19 vaccine indicate that CDC gave the green signal to the use of the Pfizer-BioNTech for the younger children and they can also obtain the booster dose.

The new variant of coronavirus is very contagious and continues to circulate, particularly in the places where the vaccination rate is too low.

So it’s very essential that if you are not done with the vaccination of your child then you should seriously consider getting a shot. You can reach your child’s pediatrician for the vaccination appointment.

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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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Medical Claim Denials

Most common Medical Claim Denials

Medical claim denials are very common for Health care service providers. For every practice, the higher denials rates can be very harmful to their operations and can damage their revenue cycle management system.

In order to get all the revenues from the insurance payer, your practice needs to reduce all the common errors which can lead to claim denials. 

In this article, we will discuss some of the most common reasons behind a claim denial and some tips which can help you to reduce them effectively in order to increase your revenue stream.

Common Billing Mistakes That Lead To Medical Claim Denials 

To successfully avoid the medical claim denial we need to figure out some of the most common mistakes that occur in the medical billing process. Following are the Common billing errors that can lead to claim denials.

Missing Information

The health care service provider submits the claim to the insurance company to get the reimbursement. In this process, they are required to submit all the essential information of the patient so that they can easily get the payment from the Payer. 

Any missing or false information can mislead the insurance company and you may suffer from a claim denied. It is the responsibility of the health care service provided that they provide all the essential information correctly to the payer.

When a patient came for the services the hospital front desk officer should carefully note all the essential details of the patient which include his name, address, social security number, contact information, and his insurance service provider.

Verification of Insurance Coverage

It has been seen that many times the patient is unaware of their insurance coverage plans.

Insurance companies cover some specific treatment plans for the patients and there are multiple treatments and procedures that were excluded from the insurance coverage plan and many of the claims are denied due to those reasons.

It is the responsibility of the healthcare system to check and verify the insurance coverage of the patient. And initially tell them that there are some treatment plans which are not in the coverage of your insurance plan so you need to pay for them by yourself. So a prior Authorization is essential for effective RCM.

Duplicate Billing

Duplicate billing is another Common reason behind higher medical claim denial.

It happens when your practice resubmits the claim instead of following up.

Late Claim Submission

Late claim submission is also associated with a higher claim denial ratio. Many health insurances approved only those claims that are submitted on time. If somehow your health care practice failed to submit the claim in the required time slot then you can lose your revenues.

Having In-Experienced Staff Members

The chances of errors have significantly increased when you are working with an inexperienced staff member. Many of the health care service providers particularly those who are operating their Billing activity with an in-house team usually face this kind of problem. 

Many Healthcare service providers have lack of resources to hire experienced team members so they somehow rely on their in-house team members.

On the other hand, if any medical practice is utilizing their in-house staff then they are required to give them proper training to handle all the Billing activity. Because an inexperienced team can’t handle the billing operation as effectively as the experienced staff members.

Coding Errors

In-Experienced staff members enhance the chances of having high medical claim denial. Coding errors are supposed to link with an inexperienced worker while it could have occurred with an experienced worker too because it is one of the most complex activities in the whole medical billing process. Some of the most common coding errors which will lead to a higher claim denial are;

Unbundling:

This type of coding error occurs when we use multiple codes for a single medical process or activity. While this Medical procedure can be covered by utilizing a single procedure code. It is considered one of the most common coding errors. It can also be considered a fraudulent activity if someone did that intentionally.

Upcoding:

It is also considered a clear violation of a false claim act if someone did that intentionally. In this type of coding, the health care service provider uses inaccurate billing codes to get higher reimbursement.

Under coding:

Under coding is exactly the opposite of upcoding; many health care service providers can get rid of auditing if they are doing this intentionally. As it is considered an activity to get rid of auditing but in many cases, it happens due to not knowing the exact use of appropriate codes.

This coding can lead to a medical claim denial in which a health care practice can lose a significant amount of revenues and some legal actions were also taken against them if somehow they were found to be doing those acts intentionally.

Steps To Reduce Medical Claim Denials

Many of the health care service providers rarely focused on the exact reason behind the higher medical claim denial ratios. Below are some tips to reduce the medical claim denials.

  • Get existing data to find out what kind of denies your practice is receiving more frequently. 
  • Also, you have to monitor the clean claim ratio. By monitoring the clean claim ratio you can better get feedback. All you need to do is to make a quick comparison between a denied claim and a clean claim and make your Billing team aware of what they are doing right and where is the margin to improve.
  • Build an experienced team of workers for this purpose you have to hire some experienced workers. If your practice has a lack of resources then you can give effective training to your present staff members to ensure a better Billing activity.
  • Use appropriate billing software which will enhance the productivity of your team member and you will surely see better results.
  • You can also outsource your Billing activity from a Billing services providing company. They are experts in giving a better service regarding the management of RCM.

Why Med-Miles?

As outsourcing is one of the best ways to increase the chances of getting a higher reimbursement. Many health care service providers effectively manage their medical claim denials with the help of our services. We have been serving our clients for more than 8 years.

Our expert services assure you maximum reimbursement with a low ratio of claim denials as we are fully aware of some of the most common reasons behind higher medical claim denial rates. You can call us at 8885 989 181 to get more information.

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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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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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