As a doctor or physician, you could be anxious about using the services of a medical billing company because you do not know if it can meet your requirements. One way to solve this issue is to use your initial meetings with the company to ask its service representatives questions about the company’s experience. These questions can help you assess if the company is right for you.

Areas of Medical Billing Experience

A reliable medical billing company would have sufficient expertise and experience in the following areas:

• Typing of identified ICD-9 and CPT codes
• Keying in of patient demographics
• Contacting insurance firms on claim payment
• Writing appropriate appeal letters
• Determining the right codes for a particular specialty
• Development of proficient fee slips/superbills
• Providing detailed explanations on the handling of A/R reports
• Awareness about compliance with HIPAA rules
• Comprehension of Workers’ Compensation associated state laws
• Assisting with credentialing

Other Highlights

A reliable medical billing company would be well aware of the current ICD-9 and CPT codes and HCPCS (Healthcare Common Procedure Coding System). It would also work with advanced medical billing software such as Advanced MD NextGen, Practice Admin, Lytec, eClinical Works, Eclipse, Medisoft and IDX. Its professional team would be able work with your software if you prefer that to them using their own. Versatility in specialties covered, flexibility in turnaround time, competency in addressing your specific requirements, cost-benefits, reduced claim denials and increased revenue are other benefits you can expect.

The pressures associated with heavy patient inflow, patient scheduling, medical emergencies, and general administration makes it difficult for healthcare practices to give patient care and back office tasks the level of dedication they demand. Added to this is the need to conform to standards such as the HIPAA 5010, ICD10 and EHR. Many healthcare practices find themselves behind on the implementation part as well as on paperwork, and healthcare suffers as a consequence. The best thing to do in such a situation is to outsource back office tasks. Outsourced physician billing services are much more affordable than in-house medical billing.

Medical Billing Services for Physicians – Other Benefits

• The service provider would be up-to-date on happenings in the medical billing industry and so can help your practice in matters of compliance. It would be difficult for you to keep track of the updates on your own.

• The billers would have wide-ranging domain experience and expertise, would use only current/new technology and have reliable security features in place to maintain data confidentiality.

• They would provide solutions using your software or use their own billing software.

• High accuracy levels are consistently maintained.

• You can avail of physician billing services for all kinds of medical specialties.

• Project completion deadlines are kept.

• Once the burden of billing is the responsibility of the medical billing company, you are relieved of keeping track of headaches such as pending claims, re-billing, follow-up on bills, book-keeping and tracking of healthcare information. All these issues would be managed by the company.

• The service provider would always have technical support professionals on hand to answer your queries and give you any assistance.

• Work reports would be promptly delivered to you in weekly or monthly intervals.

• You can commit more time towards looking after patient treatment needs.

Fewer Claim Denials, More Revenue

Outsourcing your billing tasks would enhance inter-office workflow and communication, and reduce labor time and associated costs as well as time associated with missing records. The greatest advantages are of course the reduction in claim denials, speedy reimbursement, and the increase in ROI that you benefit from. So why think twice about using physician billing services when they can give you that ideal healthcare-back office balance?

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.