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Welcome to OSI's blog section, where experts share medical, legal, media, business transcription, and search engine optimization news and views on industry developments. Readers can add feedback to the posts by clicking the "comments" link under the post you want to comment on. |
Wednesday, December 26, 2007
Avoiding Problems in Medical Billing
What are the problems that can happen with medical billing? As the medical and health care expenses are rising by the day, it is very essential to plan ahead for unexpected health care bills. If the clients are not careful they may end up paying huge medical bills out of their pockets. The very purpose of taking medical insurance is to avoid such burden of unexpected medical expenses which can be devastating and may totally upset all personal / family plans.
Some of the common problems that you may encounter during the healthcare / medical billing are,
- Overdue payments
- Denied claims
- Not good communication within the provider group
- Errors in claims
- Inaccurate coding
Medical bills have to be paid either by the patient, or by a third party payers, which is could be a private insurance company, a private managed care company, or a government insurance program such as Medicare. Whenever a claim is denied by the insurance company the billing company must find out the exact reason why it happened. The claim should be thoroughly checked to determine if any coding or other error has occurred.
Quite often, a portion of the care (co-payment or deductible) is to be paid by the patient, and the remaining amount gets billed to the insurance or managed care company. If the patients cannot pay the amount at one stretch, he or she can request for credit so that payment can be done over a period of time. Is interest charged for this extended credit? Well, it depends on the individual state credit laws.
A statement called the explanation of benefits (EOB) is received from the insurance company from where the payment is received and it has all details of the payment. All received payments must be endorsed with a rubber stamp. The physician or health care provider must be contacted and doubts clarified if there is any doubt about the diagnosis or service performed.
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posted by Outsource Strategies International @ 11:19 PM
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Tuesday, December 25, 2007
National Medical Biller's Day
AMBA (American Medical Biller's Association) has declared March 27, 2008 as the Medical Biller's day. AMBA has the goal to provide medical biller's association members with resources to enhance knowledge and skills, to develop new ideas and technology collectively, increase and realize true industry growth and leadership. See details at,http://www.webcom.com/medical/AMBA.htm
AMBA's Online Compliance and HIPAA Seminar can be taken at http://www.ambanet.net/compliance.htm
This medical billing association offers a totally unique concept and approach in networking, sharing of information and in building an association led by professional medical billers from across the US. Its National Advisory Board provides input, ideas and advice to AMBA leadership for the betterment of the association and the medical billing profession. AMBA also offers the Certified Medical Reimbursement Specialists (CMRS) an exam which is a voluntary, national credential for the medical billing profession.
Contact Outsource Strategies International (OSI) a US based medical transcription company that offers professional outsourcing services in medical billing, medical coding and medical transcription.Labels: medical biller's day 2008, medical billing, Medical Coding, medical transcription
posted by Outsource Strategies International @ 11:40 PM
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Details Required for Medical Billing
In the earlier days medical billing was done on paper. Today this process is being replaced by computers and it has become possible to effectively manage large amounts of insurance claims. Who handles the medical billing process? It may be handled either directly by the doctor or by his staff or by a third party professional medical billing company. Medical billing could also be a team work process and may involve the following people.
- Office manager
- Nurse
- Receptionist
- Medical assistant
- Insurance clerk
- Medical coders
Present day medical claim process begins with proper medical coding. All medical procedures and diagnoses have codes. The Current Procedural Terminology (CPT) was developed in the year 1966 by (AMA) American Medical Association and it lists medical procedures and corresponding codes. Each medical procedure has a unique code that will be listed in a CPT manual. What are the types of details that are required for the medical billing process? They include,
- Name, address, telephone number, and ID number of provider
- Name of insurance company / groupID number of insurance holder
- Patient's name, date of birth/address/phone no
- Insured person's name, date of birth/address/phone
- Relationship between patient and insured person
- Details of provider name, address, telephone number, and ID number
- Details of other health insurances
- Patient's medical history /condition
- Details whether the medical condition is related to accident etc
A document called the explanation of benefits (EOB) often may accompany the payment that is received from the insurance or managed Care Company. This document describes details of services covered and not covered. It also mentions what bills have been sent to the provider and the patient. One can also know if the patient had missed out on his annual payments/deductibles to the insurance company making him ineligible for total claim.
OSI (Outsource Strategies International) is a US based medical transcription company that offers medical transcription, medical billing and medical coding services outsourcing either domestically or from the Philippines and India.Labels: AMA, medical billing, medical transcription company, National Medical Coding
posted by Outsource Strategies International @ 8:58 PM
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Medical Billing Rules
Medical billing procedures are governed by certain laws. Those who work in this field and directly involved in collecting the medical fees have especially got to be aware of these basic rules and regulations. What is the main purpose of medical billing? Well it is just to make sure that the service provider receives fair payment for services provided and also that payment is received in time. What are main laws that govern medical billing? They include,
- Fair debt Collection Act
- The Health Insurance Portability and Accountability Act
- The Privacy Rule
The Fair debt collection Act is a federal law that dictates how and when should a debt is to be collected. This act is for protection of the patients and consumers from unlawful threats.
The Health Insurance Portability and Accountability Act of 1996 which is better known as the HIPAA was enacted by the U.S. Congress in 1996. HIPAA has two titles.
Title I of HIPAA regulates the availability and breadth of group and individual health insurance plans. It amends both the Employee Retirement Income Security Act and the Public Health Service Act. This act also prohibits any group health plan from creating eligibility rules or deciding of insurance premiums for individuals in the plan based on health status, medical history, genetic information, or disability.
The second title of HIPAA contains a portion that increases the efficiency of data exchange for healthcare financial transactions and protects the privacy of electronic data transmission and the confidentiality of patient records. If the HIPPA rules are violated, penalties can be imposed. Title II of HIPAA defines numerous offenses relating to health care and sets civil and criminal penalties for them. It also creates several programs to control fraud and abuse within the health care system.
The privacy rule regulates the use and disclosure of Protected Health Information (PHI). PHI is any information about health status, provision of health care, or payment for health care that can be linked to an individual. Any person who believes that the Privacy Rule is not being upheld can file a complaint with the Department of Health and Human Services Office for Civil Rights (OCR).
Outsource Strategies International (OSI) is a US based medical transcription company that offers highly professional outsourced services in medical coding, medical billing and medical transcription.Labels: HIPAA, medical billing, Medical Coding, medical transcription company, Privacy rule
posted by Outsource Strategies International @ 8:03 PM
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Sunday, December 23, 2007
Medical Classification is Medical Coding
What is medical classification and what is medical coding? Well, both the terms refer to the process of transforming details of medical diagnostic processes and diagnosis into medical code numbers that are universal. From where are the details about the patient's disease and his medical history taken? Some of the sources include,
- Doctor's notes
- Biochemistry/Lab reports
- Radiology reports
What is the use of these medical codes? They are used to track diseases and quite useful for health insurance companies, government hospitals, worker's compensation carriers etc. Some of the other applications of these medical coding/ classification systems include,
- Reimbursements
- Statistical analysis
- Epidemic surveillance
- Knowledge based decision support
Here are the different types of medical classifications
- Reference Classifications
- International Statistical Classification of Diseases and Related Health
- International Classification of Functioning, Disability, and Health
- International Classification of Health Interventions
- International Classification of Primary Care
- International Classification of External Causes of Injury
- Anatomical Therapeutic Chemical Classification System
- Technical aids for persons with disabilities: Classification and terminology
- International Classification of Diseases for Oncology, Third Edition
- ICD-10 for Mental and Behavioural Disorder
- Application of International Classification of Diseases to Dentistry and Stomatology
- Application of the International Classification of Diseases to Neurology
- International Classification of Functioning, Disability and Health for Children and Youth Procedure Coding System
- Diagnostic and Statistical Manual of Mental Disorders
- Systematized Nomenclature of Medicine
- TNM Classification of Malignant Tumours
- Unified Medical Language System
- Mendelian inheritance in Man
- Current Procedural Terminology
- Health Care Procedure Coding System
- North American Nursing Diagnosis Associates
- Logical Observation Identifiers Names and Codes
- International Classification of Headache Disorders 2nd Edition
Outsource Strategies International (OSI) is a US based medical transcription company that is offering professional medical billing, medical coding and medical transcription services.Labels: medical classification, Medical Coding, medical transcription, medical transcription company
posted by Outsource Strategies International @ 10:45 PM
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The CPT Medical Coding Set
CPT or Current Procedural Terminology is a code set with the trademark of the AMA (American Medical Association). It is maintained by the CPT editorial Panel. The current version of CPT is 2007. What does the CPT describe? It accurately describes,
- Medical services
- Surgical services
- Diagnostic services
All the information regarding the different services are communicated in a very uniform way healthcare providers, among doctors, physicians, patients, coders, Accreditation organization, insurance companies etc.
The three categories of CPT codes:
- Category I CPT Code(s)
- Category II CPT Code(s) - Performance Measurement
- Category III CPT Code(s) - Emerging Technology
CPT is currently identified by the Centers for Medicare and Medicaid Services (CMS) as Level 1 of the (HCPCS) Health Care Procedure Coding System.
The upcoming CPT Editorial Panel meeting is scheduled for Feb. 7-10, 2008 at the
Rancho Las Palmas Resort & Spa, Rancho Mirage, CA.
General public registration for the meeting can be done at
http://www.ama-assn.org/ama/noindex/category/16960.html
There is a free search engine that gives users of CPT the opportunity to perform CPT code searches and also obtain information about Medicare's relative value payment amount associated with these codes. To use the services go to https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp
Outsource Strategies International (OSI) is a US based medical transcription company that offers professional services in medical billing, medical coding and medical transcription.Labels: CPT codes, medical billing, Medical Coding, medical transcription company
posted by Outsource Strategies International @ 9:28 PM
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