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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. |
Friday, February 01, 2008
Medical Billing Process
Medical billing was done on paper for many decades. Today our world is computerized and also networked, thereby making medical billing and claims process a very efficient process. It also allows for a lot of claims to be managed in much lesser time.
Many companies have developed medical billing software with the intention of selling them to potential users. A newer development in this area is the availability of online medical billing interfaces that can be accessed on the Internet. Thus one need not even invest or purchase on individual medical billing software to use it.
The process of medical billing involves an interaction between a healthcare provider and the insurance company that finally pays the bill. A record of all the event of the patient's visits to the doctor is summarized that will contain the following details:
- Demographic details
- Nature of illness
- Details of examinations
- Medication details
- DiagnosisTreatment
For the purpose of medical billing, now the level of service has to be determined. This is done by evaluating the extent of different tests and examinations, and other data collected. The level of service is now converted into a five digit procedure code from the Current Procedural Terminology (CPT). Also the verbal diagnosis (disease details etc) has to be numerically coded using the ICD-9 (International Classification of Diseases, Ninth Edition).
The next step after diagnosis and medical coding is the process of transmission of the claim to the insurance company. This is done electronically as an ANSI 837 file using Electronic Data Interchange via a clearing house. In the early days (and sometimes even now) this process was done using the paper CMS form-1500.
Now it is the insurance companies' job to process the claim by testing its validity, eligibility after looking at the credentials etc. The claim can be rejected if the claim fails the test and a rejection message will be sent to the claim submitting source. After receiving the rejection message, the client has to make the necessary action / correction, and resubmit the claim. This resubmission process may be repeated many times. Today it is seen that almost 50% of the claims are being rejected mainly due to different errors and the complex character of claims. Further there are also false and fraud claims that have become a big challenge to the medical billing /insurance industry.
Outsource Strategies International (OSI) is an Oklahoma based medical transcription company that offers professional outsourcing in medical coding, medical billing and medical transcription services.Labels: medfical transcription company, medical billing, medical billing company, medical billing process, Medical Coding
posted by Outsource Strategies International @ 10:06 PM
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Medical Coding and Out Patient Reimbursement
Quite often we find radiologists, hematologists and other consultants having a confused state of mind with regards to taking decisions on medical coding. This is because on one end there is the risk of being penalized for over charging the patient and at the other end is the risk of getting insufficient reimbursement. So what is the solution to this problem?
The obvious solution is to be careful while billing and coding. Essential skills include,
- Detailed awareness of Coding
- Medical terminologies
- Ability to get into details
- Basic coding principles
- Proper documentation
- Understanding all codes
- Regulations of Medicaid/ Medicare/ Blue Cross etc
HOPPS is the payment system, implemented August 1, 2000, and is used by CMS to reimburse for hospital outpatient services. The Centers for Medicare and Medicaid (CMS) issued a final rule on the 2008 Hospital Outpatient Prospective Payment System (OPPS) on November, 1, 2007. This final rule affects outpatient services furnished by general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and long-term acute care hospitals. To download or take a look at 2008 OPPS proposed rule, go to the CMS Web site,
http://www.cms.hhs.gov/HospitalOutpatientPPS/downloads/cms1392p.pdf
Outsource Strategies International (OSI) is a US based medical transcription company that offers outsourced services in medical billing, medical coding and medical transcription services to clients world wide and in all the US States.Labels: medical billing, Medical Coding, medical coding and Outpatient reimbursement, medical coding company
posted by Outsource Strategies International @ 6:04 PM
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Thursday, January 31, 2008
Emergency Medicine 2008 Medical Coding in Denver
The Coding Institute is to conduct the 2008 Emergency Medicine Coding & Reimbursement Conference, from April10-12, 2008, in Denver, CO Here is a list of topics/presenters for the conference.
Pre-Conference Workshops (Thursday, April 10)
ED Coding Nuts & Bolts: Making Sure The Things You Do Every Day Get Paid
Presenter: Jeffrey Linzer Sr., MD, FAAP, FACEP and Dennis Beck MD FACEP
Conference Day 1: (Friday, April 11)
PQRI: Are You In or Out?
Presenter: Dennis Beck MD FACEP
How to Draw the Observation Line so You Don't Step Over It
Presenter: Carol Edelberg, CPC, CCS-P, CHC
What's included? The Answer May Surprise You
New 2008 Critical Care Rules: What You Need to Know Now
Presenter: Carol Edelberg, CPC, CCS-P, CHC
Trauma Team to the ED - Stat!
Presenter: Carol Edelberg, CPC, CCS-P, CHC
FBR vs. I&D - They're More Alike Than You Think
Presenter: Jeffrey Linzer Sr., MD, FAAP, FACEP
ED Services for the Crayola Set: How to Keep the Red Off Your Pediatric Claims
Presenter: Jeffrey Linzer Sr., MD, FAAP, FACEP
Conference Day 2: (Saturday, April 12th)
NPPs in the ED: How to Do the Mid-Level Provider Mambo
Presenter: Kenneth Engel, CPC, CHC, ACS-EM, CCP
9 Keys to Reporting Fracture Care - ED Rules You Can't Code Without
Presenter: Kenneth Engel, CPC, CHC, ACS-EM, CCP
Should You Follow CPT or Medicare? Making the Wrong Call Could Hurt You
Presenter: Kenneth Engel, CPC, CHC, ACS-EM, CCP
Post-Conference Workshop (Saturday, April 12th)
Practice Makes Perfect - And Here's Your Chance
Outsource Strategies International (OSI) is a US based medical transcription company that offers professional outsourcing solutions in medical coding, medical billing and medical transcription services for clients in all the US States and worldwide.Labels: 2008 coding, coding conference Denver, Emergency Codingand Reimbursement conference 2008, Emergency Medicine Coding
posted by Outsource Strategies International @ 9:44 PM
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The Different Parts of Medicare Health Insurance
Medicare, in the US is a social insurance program provided by the federal government to provide health insurance coverage to the following group of people.
- Elderly workers and their dependents,
- Individuals who become totally and permanently disabled
- End stage renal disease (ESRD) patients.
Thus Medicare is a critically important source of health insurance for over 44 million Americans. Those on Medicare also have the additional choices associated with the Medicare prescription drug benefit. So what are the different basic parts of Medicare? These are the four basic parts. Medicare Part A is about Hospital Insurance and helps cover your inpatient care in hospitals. It can also help to cover skilled nursing facility, hospice, and home health care under certain conditions. Medicare Part B is concerned with Medical Insurance and helps cover medically-necessary services like doctors' services and outpatient care. It also helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse. Medicare Part C (Medicare Advantage Plans) is another way to get your Medicare benefits. It combines Part A, Part B, and, sometimes, Part D coverage. Medicare Advantage Plans are managed by private insurance companies approved by Medicare. These plans must cover medically-necessary services. However, plans can charge different co-payments, co-insurance, or deductibles for these services. Medicare Part D (Medicare Prescription Drug Coverage) helps cover prescription drugs. This coverage may help lower one's prescription drug costs and help protect against higher costs in the future. Detailed information from official Medicare site is at http://www.cms.hhs.gov/home/medicare.aspIf you already have Medicare go to http://www.medicare.gov/To keep up with the latest changes in America's health insurance coverage system, go to the link, http://usgovinfo.about.com/od/medicarehealthinsurance/Medicare_and_Health_Insurance.htmOutsource Strategies International (OSI ) is a US based medical transcription company that offers professional outsourcing solutions in medical billing, medical coding and medical transcription to clients in the US, Canada the UK and Australia. Labels: Health insurance, medical billing, Medical Coding, medical transcription, medicare, Medicare Insurance, Social insurance
posted by Outsource Strategies International @ 6:59 PM
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Wednesday, January 30, 2008
Choosing the Medical Coding Certification Exam
Do you wish to be a certified medical coder? Are you confused about which coding certification exam is to be taken? It is true that the CMS (Centers for Medicare and Medicaid services) has recommended the physician offices and other healthcare facilities to employ certified coders. Only AAPC's certifications are nationally recognized by employers seeking ethical, accurate and experienced coders.
Remember that today various employers, payers and government agencies including the Department of Labor, currently only recognize AAPC's CPC for physician and outpatient coding, and AHIMA's CCS for inpatient coding. Thus there are the following choices,
- Certified Procedural Coder - Hospital (CPC-H)
- Certified Procedural Coder (CPC)
- Certified Procedural Coder - Payer (CPC-P)
- Specialty Credentials
The CPC exam addresses physician billing and is suited for those working in any physician office, hospital associated physician's office, health agency, physician billing service, auditor of physician claims, consultant or an educator.
Take the CPC (H) exam if you are working in areas of billing of Ambulatory Patient Categories (APC), hospital APC departments, ambulatory surgery centers, outpatient billing coding service, consultants, and educators.
The (CPC-P) exam concentrates on coding and billing after it has been submitted to the payer. So take this exam if you are a claims manager/auditor for a payer, a post-billing auditor for a physician group or in related facility billing service, an consultant, educator or a physician. Specialty credentials are to enable CPCs, CPC-Hs, CPC-Ps, CCSs, CCS-Ps, RHIT and MDs to demonstrate their superior levels of expertise in selected specialty disciplines.
Contact OSI (Outsource Strategies International) is a US based medical transcription company that offers outsourcing solutions in medical coding, medical billing, and medical transcription services to clients globally.Labels: AAPC certification, coding certification, CPC, Medical Coding, medical coding exam
posted by Outsource Strategies International @ 8:01 PM
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The Origin of Medical Coding
What is medical coding and who are medical coders? Well, everyone does know about the importance of medical data while providing quality healthcare service. The professional medical coders is one of the main person involved in the capturing of this critical and accurate medical data that needs to be delivered it in time.
During medical coding all verbal descriptions of diseases, injuries, and procedures are converted into numeric or alphanumeric designations. How did the medical coding originate? It was originally performed to classify mortality (cause of death) data on death certificates besides being used to classify morbidity and procedural data. Such type of coding is very useful especially as it helps us today to get easy access to medical records by diagnoses and procedures so that in can be used in,
- Hospitals/clinics etc
- Research work
- Education
The federal government introduced The Medicare Prospective Payment System (PPS) in October, 1983, for better management of medical care. Each patient was classified into a DRG (Diagnosis Related Group) depending on the information from the Medical Record that appears on the bill. Under PPS, hospitals are paid a pre-determined rate for each Medicare admission. Since then there has been a great deal more emphasis placed on medical coding.
At present assigning of medical codes is the backbone for reimbursement of claims for Medicare patients. Codes are given for diagnoses, services, and procedures provided. Thus healthcare providers today have to comply with different medical coding guidelines.
OSI (Outsource Strategies International) is a US based medical transcription company that offers outsourced services in medical coding, billing and medical transcription services to clients globally and also across USA.Labels: DGR, Diagnosis Related Group, Health insurance, medical billing, Medical Coding, medical coding services, medical transcription
posted by Outsource Strategies International @ 6:53 PM
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Tuesday, January 29, 2008
Radiology Coding 2008 Conference in Denver
The 2008 Radiology Coding & Reimbursement Conferenceconducted by the Coding Institute will be held from April 13-15, 2008 at Denver, Colorado. The list of topics for the conference is given below.
Pre-Conference Workshops (Sunday, April 13th)
Expert Strategies To Make You A Vascular IR Coding Superstar
Conference Day 1: Main Sessions (Monday, April 14th)
- Non-Vascular IR Coding: Stumble-Free Expert Tips To Get The Revenue You Deserve
- Expert Tactics To Get Every Penny In The Door
- Get Up To Speed On Computed Tomographic Angiography (CTA) and increase your bottom-line
- Get The Inside Scoop On Nuclear Medicine Revisions And Maximize Your Practice's revenue
- Become A Mammogram Coding Guru With These Comprehensive, Expert Tips
- OIG Workplan: Is Your Practice Protected?
- Ace Your Radiological Guidance Coding With Fail-Safe Expert Tips
Conference Day 2: Main Sessions (Tuesday, April 15th)
- 5 Most common mistakes in Diagnostic Radiology and How to avoid them.
- Diagnostic Radiology Definitions: Are You Getting Every Dollar You Deserve?
- Proven techniques for ensuring complete Radiology Documentation
Post-Conference Workshop (Tuesday, April 15th)
- New STARK Rule: An In-Depth Look At Exactly What It Means For Radiology
Registration details are at http://www.codingconferences.com/radiology08r.htm Hotel reservations are available at http://www.codingconferences.com/radiology08h.htm
For outsourcing solutions in medical coding, medical billing and medical transcription services do call up the Oklahoma based premier medical transcription company OSI (Outsource Strategies International)Labels: 2008 coding conference, medfical transcription company, radiology coding, Radiology Coding Reimbursement Conference 2008, radiology conference
posted by Outsource Strategies International @ 10:15 PM
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HIPAA Privacy Law and Medical Billing
The Health Insurance Portability and Accountability Act (HIPAA) were enacted by the U.S. Congress in 1996. It consists of two different titles. These are,
Title I: Health Care Access, Portability, and Renewability
Title II: Preventing Health Care Fraud and Abuse
What is the HIPAA privacy law? Well, The (HIPAA) Privacy Rule is the first comprehensive Federal protection for the privacy of personal health information. This Rule that comes under Title II took effect on April 14, 2003, with a one-year extension for certain "small plans." It is about regulations for the use and disclosure of Protected Health Information (PHI) that is about an individual's information about his health status, provision of health care, payment for health care etc. (Take a look at the privacy rules after final modifications at http://www.hhs.gov/ocr/hipaa/privrulepd.pdf ) It forms a patient's medical record or payment history. The other laws for preventing of health care fraud are,
- The Transactions and Code Sets Rule
- The Security Rule
- The Unique Identifiers Rule (National Provider Identifier)
- The Enforcement Rule
Besides the Fair Debt Collection Act and the HIPAA acts, one of the major laws that govern medical billing is the privacy law. The Privacy Rule allows individuals the right to request that a covered entity correct any inaccurate PHI. If a covered person feels that the Privacy Rule is not being upheld he 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 professional medical billing, medical coding and medical transcription service to clients in all the US States.Labels: Health insurance law, HIPAA Privacy Law and Medical Billing, Medical Coding, medical transcriptionist, privacy law
posted by Outsource Strategies International @ 8:52 PM
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Monday, January 28, 2008
Optometry Coding Conference 2008 in Las Vegas
The Coding Institute will conduct the Optometry Coding and Reimbursement Conference from February 24-26, 2008 in Las Vegas, NV. The conference is meant for practice managers, optometrists, coding and billing professionals, non-physician practitioners, billing companies, compliance professionals, coding consultants and anyone involved in optometry coding.
Here is a list of the topics:
Pre-Conference Workshop Topics (Sunday, February 24th)
Documentation Best-Practices
Presenter: Nina Watson, CMA (AAMA), CPC
2008 Modifier Essentials
Presenter: Raequell Duran, CPC
Conference Day 1: (Monday, February 25th)
Unlock the Reimbursement Secrets of Special Testing Services
Presenter: Raequell Duran, CPC
PQRI from A to Z: Making the Most of the Program
Presenter: David R. Gibson, O.D.
Narrow Your Focus: Eye Codes vs. E/M codes
Presenter: Jeffrey Restuccio, CPC, CPC-H
Get Post-Op Cataract Care Claims Paid the Very First Time
Presenter: Raequell Duran, CPC
Visual Fields: Spot the Differences and Avoid Losing Audits
Presenter: David R. Gibson, O.D.
Successfully Code Your Patients' Conditions with Guaranteed Expert Tactics
Presenter: Mark Michael, MD
Billing Frames, Contact Lenses So Your Bottom line looks pretty
Conference Day 2: (Tuesday, February 26th)
Navigating Glaucoma Guidelines - Screenings and Beyond
Pitfalls in Optometry Coding and How to Avoid Them
Presenter: Alice Marie Reybitz, RN, BA, CPC, CPC-H
Master Optometry Documentation Essentials to Make Sure You Get Every Penny in the Door
Post-Conference Workshop (Tuesday, February 26th)
The Future of Eye Care: Making the System Generate More $ For You
Presenter: Mark Michael, MD
Registration for the conference is available at http://www.codingconferences.com/optometry08r.htm
Outsource Strategies International (OSI) is a US based company that offers outsourced solutions in medical coding, medical billing and medical transcription to clients globally and in all the US States.Labels: 2008 coding conference, medical billing company, Medical coding conference, optometry coding, Optometry Coding and Reimbursement Conference
posted by Outsource Strategies International @ 8:12 PM
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Pediatric Coding Newsletter
Are you looking for easy online practical and accurate solutions and answers to your most urgent pediatric coding questions? Then here is a monthly newsletter that can be of great help. The American Academy of Pediatric has developed a pediatric coding newsletter which is very useful to the pediatric communities. This peer-reviewed newsletter has been developed with a careful review done by the AAP committee on coding and nomenclature. Here one can expect a wide coverage of both,
- Pediatric primary care
- Subspecialty services
Labels: coding newsletter, Medical Coding, pediatric coding, pediatric news letter
posted by Outsource Strategies International @ 6:31 PM
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Sunday, January 27, 2008
Medical Coding Process
The process of Medical Coding is today become a necessity for claiming of medical reimbursements. Also called by the name of insurance coding, the medical coding process involves assigning of codes to medical diagnoses and various other related procedures. Thus the medical coders convert the entire physicians note into medical codes that is used by the insurance companies to pay the health care provider. This type of coding actually helps in attaining quick judgment with just a glance. One can see the accurate display of the entire history and services performed on the patient.
So what are the different steps in this process of medical coding?
From the hospital, the patient chart is first sent to the medical coding service provider. These medical records usually include nursing documentation, physicians' documentations, and the patient demographic sheets. Medical coding service providers thoroughly check all these records and within the next 48 hours have to assign appropriate numerical and diagnostic codes to each of the records. These can include,
- E/M level
- CPT codes
- HCPCS
- ICD-9 codes
- Modifiers
After assigning the codes it will have to be rechecked to see if the right codes have been assigned or if there is any thing has been overlooked. The coding team thus rechecks the entire documentation and makes sure that all the codes assigned are correct.
These coded records are then returned to the client. Transfer can be by postal mail, e-mail or electronic down load or air shipping. These coded files are now ready for the next step of medical billing.
Outsource Strategies International (OSI) is a US based company that offers highly professional services in medical transcription, medical coding and medical billing services to clients in all the US states.Labels: CPT codes, ICD-9 codes, medical billing, Medical Coding, medical coding process
posted by Outsource Strategies International @ 9:25 PM
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Podiatry and Medical Billing
According to The American Podiatric Medical Association (APMA) not all preventative foot care visits to a podiatrist, including patients with diabetes, are covered by insurance providers.
The word Podiatry (known earlier as Chiropody) has originated from the two Greek words "podis" and "iatria". Podis means the foot, and iatria refers to healing. Thus podiatry is a medical specialty that is concerned with the diagnosis treatment and prevention of diseases, deformities and disorders affecting the lower extremity parts of the body. The American Society of Podiatric Medical Assistants awards the Podiatric Medical Assistant Certified credential to medical assistants.
Medical billing with regards to podiatry has long been a sensitive area. Last month a national union of podiatrists, met with Senator Hillary Clinton to discuss podiatry's role in the healthcare delivery system.
The differences in podiatric medical and surgical practice are determined by state law. The United States is one of the few countries, which allows invasive surgical privileges to podiatric physicians. Even though Podiatrists are often defined as physicians in most States, it can involve surgery above the ankle and leg in 44 US States. There are some podiatrists who are not in the hospital environment and limit their work to the non hospital surgical treatments. Most of the podiatric procedures involve the works like,
- Removing of corns
- Cutting of nails
- Diabetic footcare
- Arthritis foot problems
Even though the common man would not consider all these above related procedures as surgery, the insurance companies consider most of them as equivalent to surgery. Thus Podiatry claim and billing can be done from,
- Individual Podiatry physicians
- Podiatry/physician groups
- Multi specialty groups
- Clinics
- Free standing diagnostic facilities
- Acute care facilities Hospitals
- Long term care centers
There are many medical billing software that can be used for the execution of medical billing process such as Medisoft, Inception, NextGen, IDX, Lytec, Medic, Misys, Eclipse, Medical Manager, e-clinical and more. Contact OSI (Outsource Strategies International) for outsourced professional services in medical billing, medical coding and medical transcription.Labels: APMA, Podiatry, Podiatry Billing, Podiatry coding, Podiatry insurance claims, Podiatry services
posted by Outsource Strategies International @ 7:33 PM
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