Insurance verification services from an outsourcing company can help to curtail write-offs and bring in more collections. The verification process entails getting the patient schedule, examining a patient’s insurance coverage with primary and secondary payers, getting in touch with the patient wherever required, and ensuring that the billing system is up-to-date with eligibility and verification information. Owing to the fact that this is a time-consuming procedure, healthcare providers often don’t have enough time to do it properly. If the process is not done in the proper manner, problems such as write-offs, claim denials, delayed payments, rework and patient dissatisfaction result. Hence the need to outsource, since it helps reverse the situation.

Health Insurance Verification Performed by Specialists

Reliable outsourcing companies have a team of specialists to perform the insurance eligibility verification in the most effective way possible. These specialists would have superior knowledge of healthcare and insurance terminology and of surgical or medical techniques. They would also have considerable customer service/call center experience and computer skills. Using their knowledge and skill and advanced IT technology, they would accurately cross-check details such as co-insurances, co-pays, payable benefits, effective date, plan exclusions, pre-authorizations, referrals, kind of plan, coverage information, claims mailing address, patient policy status, deductibles and life time maximum.

Other Benefits

Healthcare providers can thus expect the following benefits from the insurance verification services provided by experienced outsourcing companies. These benefits are in addition to the benefits of minimal denials and more collections:

• 30 to 40 % reduction in operational costs
• Cleaner claims
• Better staff productivity
• Enhanced patient satisfaction

This article looks at three ophthalmology medical coding myths that could be causing coding errors and affecting payments.

Be Careful When You Code FBRs

First Myth – All Foreign Body Removals (FBRs) within a single eye are clubbed together, which means an FBR code can only be coded once per eye.

The Actuality – It is true that a coder cannot separately report removal of many foreign bodies from the same region of the eye. However, if the ophthalmologist has removed foreign bodies from different regions of the same eye (such as the conjunctiva and cornea) codes can be separately reported for each region. The ophthalmologist should draw a comprehensive figure of the eye that makes clear the specific region and depth of the removed FBRs. If the ophthalmologist has taken out an embedded conjunctival foreign body, you can report a code in 65210 which offers higher reimbursement. This is good news for both coder and physician.

Second Myth – A foreign body diagnosis can be coded even if the examination doesn’t reveal a foreign body.

The Actuality – It is not correct to report a foreign body ICD-9 code (930.0-930.9, Foreign body on external eye) when a foreign body has not come up in the ophthalmologist’s exam. However, coding can be done for the sensation of a foreign body, with an eye pain code (for example 379.91).

Third Myth – The kind of instrument the ophthalmologist uses establishes which FBR code to report.

The Actuality – The FBR series of codes (65205 to 65222) make no mention of a specific instrument to take out the FB. Nevertheless, CPT® code 65222 (Removal of foreign body, external eye; corneal, with slit lamp) does point out the equipment utilized to make viewing the affected area easier. If the ophthalmologist made use of a slit lamp to see the corneal foreign body, the code to be used is 65222. If he didn’t use a slit lamp, the code is 65220.

Outsource to Minimize Errors

To ensure that your medical coding process is not affected by myths or errors that can even cause claim denials, it is best to outsource this process to experts. Do research to find an HIPAA compliant outsourcing company with a good reputation, a superior track record and an extensive client base.

State-of-the-art medical billing software eliminates the need for tedious paperwork. Providers of medical billing services find it easy to use, convenient, HIPAA compliant, customizable and just what is required for the current scenario of a complicated healthcare environment. Some efficient software systems are Medisoft, NextGen, Misys, E-clinical, Medic, IDX, Eclipse, Inception, Practice Admin, Lytec and Medical Manager.

Tasks That Can Be Performed

The software provides invaluable assistance to medical billing companies for the following and other tasks:

• Collection, monitoring and transmission of billing information
• Charges entry
• Checking for previous due balances, delays in payments and extra fees
• Monitoring of patient diagnoses and demographics
• Custom reporting
• Review of documents/scanned images
• Entry of patient appointments and transfer of that information to the billing data section
• Effortless tracking of collections
• Data backup and recovery

Other Benefits

The web-based software does away with all frustrations associated with the medical billing process. It:

• Creates better and quicker claims
• Reduces errors in patient payment files, insurance and billing
• Frees up more time for rectification and resubmission of reports within the least amount of time
• Cuts down operational expenses by 30 to 40 percent
• Improves efficiency

When you entrust your requirements with a professional provider of medical billing services, ask them about the kind of software they use and the benefits it provides. You can even ask your service provider to work with your practice’s billing software instead of theirs because many firms offer this convenience.

Any medical billing company can make an outright claim that it is the best in the industry. How do you know if words do indeed match deeds? Go by some of the following points to ensure that you pick the right service provider.

Experience is Important – Choose a company that has put in many years of service and has extensive experience in the particular specialty for which you want the billing assistance.

Skill of the Medical Billers – A skilled medical biller would have a professional team on the job that is proficient in medical terminology as well as in the application of CPT, HCPCS and ICD-9 codes.

Transparency – The medical billing service provider should be willing to give you access to billing-related information whenever you want it. The kind of information can be payments, user notes, outstanding claims, follow-up information and charge data. This would help you maintain proper control over your practice.

Security – Ensure that the company you are outsourcing to is HIPAA compliant. This is important for the security of your healthcare practice’ as well as to ensure patient privacy. The service provider should have superior measures for data security, and data backup and recovery.

Customer Service – The company should be ready to answer all your queries. It should provide fast and friendly customer service.

Cost Benefits – Find out if outsourcing to them can help you realize cost benefits of between 30 to 40 percent while also boosting your revenue. If not, it is not worth outsourcing to them.

Medical Billing Software and Workflow Changes – If you can find a company that can work utilizing your billing software or theirs as per your requirement, that is a definite plus point. Also, the company should have strategies that flawlessly integrate with your practice’s processes and do not call for considerable realignment or modifications.

Flexible Turnaround – The company’s turnaround should suit your requirements and this should be guaranteed.

No Hidden Charges – The medical billing company should disclose all charges for its services upfront. It is advisable to email or phone the company at the outset to enquire about if there are any hidden charges.

Good Track Record – An easy way to find out if the company has a good track record is to Google its name and look for unbiased reviews. You can even get in touch with the people who have posted testimonials on the company’s services.

Pricing – Different medical billing companies may have different pricing models. See if the pricing model of a particular company is suitable to you.

Any hospital or clinic would want to reduce office expenses, speed up the rate of reimbursement, do away with claim denials, limit aged receivables and improve cash flow and profit. That’s why you’ll find a lot of them considering medical billing outsourcing to make this possible. The information that the reports convey and how promptly they are delivered are definite markers of the capability and expertise of the company. These reports are therefore, important and essential.

Medical Billing Reports – Daily, Weekly, or Monthly

Reports are made available on a daily, weekly or monthly basis as per the client’s requirements. They would include procedure code usage reports, financial reports, and aged summary reports. Reports can be customized to suit customer specifications. Financial reports can take the form of payments/deposits reports, patient account ledger reports, A/R aged comprehensive reports, reports of patient visit history or insurance list reports.

In addition to making it possible to judge the efficiency of the medical billing company, reports would assist the healthcare provider with:

• Knowing what collections are complete and what has and hasn’t been billed
• Payment and procedure code analysis
• Accounts receivable and accounts receivable aging
• Insurance analysis
• Collections ratios
• Having a blueprint of the practice’s financial transactions and accounts

Thus, the healthcare provider would be up-to-date on all billing aspects, the auditing process is helped and there would be improved practice workflow and productivity.

HIPAA Compliance

Please remember that medical billing services and reports should only be handled by an HIPAA compliant company. That way, you can ensure that whatever information you provide to the company is safe and secure in its hands and would not be shared with an outside party.

Healthcare providers and medical coders and billers would surely be familiar with the mandate by the HHS (the U.S. Department of Health and Human Services) to substitute the ICD-9-CM code sets with the ICD-10 ones starting October 1st 2013. This is a challenging transition and one that cannot be overlooked in medical coding and billing procedures.

More about ICD-10

The tenth amendment of the ICD (International Classification of Diseases) was sanctioned by the 43rd World Health Assembly in 1990. The ICD is the global diagnostic classification standard for general epidemiological, clinical and a lot of health management uses. WHO (World Health Organization) member states adopted the amendments in 1994. The categorization is the most recent in a sequence that originated in the 1850s. In contrast to ICD-9-CM which has only over 17, 000 codes, the ICD-10 code set has over 141, 000 codes and contains a number of new procedures and diagnoses. ICD-10 contains in:

Volume 1

• Tabular lists that include codes and titles for cause-of-death (Volume 1)
• Exclusion and inclusion terms for cause-of-death titles

Volume 2

• Guidelines, descriptions and coding resources

Volume 3

• An alphabetical index for table of drugs and chemicals, external causes of injury, and diseases and nature of injury

Choose an Up-to-date and Capable Company to Outsource To

You may read online about a lot of medical coding companies that you can possibly outsource to. However, it would be a smart idea to prefer a company that has the resources to make the changeover to ICD-10 by the deadline set by the HHS. This is in addition to the other requisites of a medical billing and coding company such as AAPC certification, HIPAA compliance, cost-effective solutions, superior quality assurance, ensured faster reimbursement and fewer denials, adherence to specified turnaround, and preferably a free trial option.

Per capita medical spending in the U.S. is much higher than in other countries. It’s no wonder that the medical billing industry is growing by leaps and bounds. As a medical professional, your goal of providing timely and comprehensive patient care is intimately linked to your cash flow, which inevitably slows down if billing procedures are inefficient and irregular. Hiring billing and coding professionals to do the job in-house may not be feasible in these economically trying times. Your best option is to outsource medical billing to a competent service provider. A professional medical billing company is well-equipped to perform the task – both in terms of skilled and experienced billing specialists, coders, and other service personnel as well as advanced billing software.

A reliable outsourcing company would offer claims management and medical billing services for all types of medical specialties. The support you can expect:

• Efficient claims preparation, claims editing and claims submission
• Bills reflecting data accuracy with supporting diagnoses for each service
• Claim submission if the format prescribed by the insurer to minimize refusal
• Accuracy in demographic, policy and coding information to reduce denial

In short, a client-focused provider would provide a full suite of medical billing solutions starting from patient enrollment in the billing system and verification, to coding, billing, accounts reconciliation and AR collections. If the payer makes errors with regard to adjudication, medical billing companies also assist in the appeals process to resolve underpayments or unjustified denial of payment.

When insurance carriers reject claims for reimbursement, it amounts to considerable loss of revenue. A lot of denials result in a cash flow problem. Thus it becomes necessary to have an effective denial management plan to enable you to limit your denials to 4 percent, less or practically nil. This is where medical billing companies come to the fore. Such companies that are established and HIPAA compliant have a lot of experience in denial management and can therefore help you minimize denials.

Error-free Billing for Fewer Denials

A common reason for claim denials is medical billing errors. The errors can be in terms of invalid or wrong CPT and ICD-9 codes, no preauthorization, incorrect identification numbers, wrong patient demographic data and so on. A medical billing company will take note of the claims that were accepted and those that weren’t. The billing experts at the company have great decision making skills. They will put themselves in the position of the insurance carrier, do extensive groundwork and observe denial trends to identify ambiguities responsible for denials. This is so that the error can be corrected and the claim submitted again or an appeal filed.

Knowledgeable, Up-to-date and Good Decision Makers

In addition to the above, the experts at the company keep track of industry updates and give due importance to detail. They will also be geared up to adhere to different deadlines. This just goes to show that the services of a reputable medical billing company are something you wouldn’t want to do without for denial management or any other kind of billing assistance. Benefit from cleaner claims, faster reimbursement and increased revenue with services from a reliable provider.

Medical coding is a job that carries with it a lot of responsibility. Being a physician, you know that the medical coding process involves several duties:

• Completing claim forms
• Signature verification
• Communication with healthcare providers
• Data entry
• Software based analysis of charts or medical data
• Use of correct medical terms to document all activities
• Conforming to the procedures and policies of each insurance carrier
• Bookkeeping
• Administrative work
• Supervision
• Scheduling appointments and more

Benefits of Outsourcing to the Right Medical Coding Company

As such, it is important that when outsourcing, the task can be entrusted only with experts with known efficiency. Some of the benefits of choosing the right medical coding outsourcing service provider:

• Presence of coders with AAPC (American Association of Professional Coders) certification
• ICD-9 coding performed using CMS and AMA guidelines as the basis
• Up-to-date knowledge of procedure changes for bundling and unbundling, payer specific requirements, appropriate coding initiatives and problems associated with federal or state government compliance
• Complete HIPAA compliance
• Medical coding audits
• In-patient or hospital coding
• Fewer denials
• Clean claims

An expert medical coding company provides services in complete compliance with prominent medical insurances such as Oxford, Medicaid, Medicare, Aetna, HIP, EMI, GHI, United, Humana and BCBS.

Physicians are indeed experts at treating their patients. However, when it comes to getting payment for their services, problems arise. Many claims are denied by insurance payers. One of the reasons for this is errors in medical coding and billing. Accuracy in this aspect can be achieved if you outsource to expert providers of physician billing services.

Other Reasons Why You Should Outsource this Process

Here are other credible reasons why you should outsource physician medical billing:

• You Have More Time to Focus on Your Chief Area of Expertise – Your main concern is practicing medicine, and the best interests of your patients. You get more time for that when you entrust the billing process to reliable experts who are willing to handle the complete process of revenue cycle management for you.

• Scalable Solutions for Single or Multiple Locations – The billing solutions made available to you will advance as your business progresses whether you have a single, two, or multiple locations.

• You Can Benefit from More and Better Resources – Whatever be the size of your practice, you may find it difficult to maintain human resources and be up-to-date with systems and billing. Outsourcing companies are up-to-date, use more powerful systems, and have more experienced staff.

• Cost-effectiveness – You’re spending a lot when you carry out medical billing in-house. There are expenses for training, maintenance, support fees and software. When you outsource, you can experience savings of up to 40 percent.

• Superior Performance – Outsourcing companies can help to limit denial rates, misadjudicated and unadjudicated claims.

• Reliable Reports – Reports would be provided to you in daily, weekly, or monthly intervals as per your convenience.

So make optimum use of physician billing services and ensure enhanced workflow and improved productivity of your practice.