July Is Sarcoma Awareness Month – What You Should Know About the “Forgotten Cancer”

July Is Sarcoma Awareness Month – What You Should Know About the “Forgotten Cancer”

Held each year in the month of July, “Sarcoma Awareness Month” aims to raise awareness about what is considered to be the “forgotten cancer.” Sponsored by the Sarcoma Foundation of America (SFA), the campaign aims to further highlight the extraordinary challenges that sarcoma patients face, and the need for more sarcoma research and better therapies. Sarcoma occurs in various locations of the body; this type of cancer begins in the bones and in the soft (also called connective) tissues (soft tissue sarcoma) including muscles, fat, blood vessels, nerves, tendons and the lining of the joints. Sarcomas can be benign (noncancerous) or malignant (cancerous).

There are more than 70 types of sarcoma. If diagnosed at an early stage, treatments may be more effective. Diagnosis, treatment and billing and coding related to this condition can be challenging. When providing medical billing and coding services for this particular condition, medical coders require a good understanding of the existing codes and documentation/reimbursement guidelines.

Sarcomas are divided into two main groups, bone sarcomas and soft tissue sarcomas. As per reports from the National Cancer Institute’ Surveillance, Epidemiology, and End Results Program (SEER), more than 13,000 cases of soft tissue sarcoma and approximately 3,900 cases of bone and joint cancer are expected to be diagnosed in the United States in 2022. The condition is more likely to affect children and young adults rather than older adults, and more than half of those diagnosed with the disease are under 60 years. The five-year survival rate for soft tissue sarcomas is 65.4 percent, while the survival rate is 67.4 percent for bone sarcomas.

The 2022 campaign is the perfect platform to educate people and spread awareness about the causes, warning signs and risk factors of this rare, but potentially deadly form of cancer. The exact causes of sarcomas are not known. Generally, cancer forms when changes (mutations) happen in the DNA within cells. Mutations cause cells to grow and divide uncontrollably and the accumulating abnormal cells tend to form a tumor. In due course, cells can break away and metastasize to other parts of the body.

Signs and symptoms of this condition may vary and depend on the type of sarcoma and the location of the tumor. A painless lump under the skin is one of the initial symptoms of the condition. In certain cases, it can cause long-lasting bone pain or swelling in the arm or leg that worsens at night, that may limit your movement. Other related symptoms include – bone pain; broken bone (that occurs unexpectedly, such as with a minor injury or no injury at all); abdominal pain; blood in the stool or vomit; black, tarry stools; and weight loss. Several factors can increase the risk of sarcoma and these include – radiation therapy, inherited syndromes, chronic swelling (lymphedema) and exposure to harmful chemicals and viruses.

Often, sarcomas are difficult to distinguish from other cancers. Their occurrence is probably underestimated when they are found within organs. Therefore, people with lumps and bumps, should have them get inspected by an oncologist at an early stage in case it is sarcoma.

Diagnosis of this condition involves physical examination and detailed medical history evaluation of the symptoms. Imaging tests like – X-rays, MRI. Ultrasound, CT scan, bone scans and positron emission tomography (PET) scans may be performed to identify connective tissue problems. If a soft tissue sarcoma is suspected based the diagnosis tests, a biopsy would be performed to confirm whether it’ a sarcoma and not another type of cancer or a benign disease. If any cancerous cells are found to be present (as part of the biopsy), physicians may recommend additional tests to identify the particular stage of cancer, its severity and to determine the future course of treatment.

Treatment for sarcoma may include -surgery (to remove the cancerous cells), radiation therapy, chemotherapy, targeted therapy, ablation therapy and immunotherapy. The Sarcoma Foundation of America (SFA) estimates that about 20 percent of sarcoma cases are curable by surgery, while another 30 percent may be effectively treated by surgery with chemotherapy and/or radiation.

The screening and diagnostic tests performed as part of the treatment procedures must be correctly documented using the right medical codes. Medical billing companies can assist physicians with their medical coding and claims submission.

ICD-10 Codes for Different Types of Sarcomas

  • C49 Malignant neoplasm of other connective and soft tissue
  • C49.0 Malignant neoplasm of connective and soft tissue of head, face and neck
  • C49.1 Malignant neoplasm of connective and soft tissue of upper limb, including shoulder
  • C49.2 Malignant neoplasm of connective and soft tissue of lower limb, including hip
  • C49.3 Malignant neoplasm of connective and soft tissue of thorax
  • C49.4 Malignant neoplasm of connective and soft tissue of abdomen
  • C49.5 Malignant neoplasm of connective and soft tissue of pelvis
  • C49.6 Malignant neoplasm of connective and soft tissue of trunk, unspecified
  • C49.8 Malignant neoplasm of overlapping sites of connective and soft tissue
  • C49.9 Malignant neoplasm of connective and soft tissue, unspecified
  • C41.9 Malignant neoplasm of bone and articular cartilage, unspecified
  • C46 Kaposi’ sarcoma
  • C46.1 Kaposi’ sarcoma of soft tissue
  • C46.2 Kaposi’ sarcoma of palate
  • C46.3 Kaposi’ sarcoma of lymph nodes
  • C46.4 Kaposi’ sarcoma of gastrointestinal sites
  • C46.5 Kaposi’ sarcoma of lung
  • C46.7 Kaposi’ sarcoma of other sites
  • C46.9 Kaposi’ sarcoma, unspecified

The history of Sarcoma Awareness Month dates back to the year 2007. It was in November 2007 that a group of advocates joined together in Seattle to gather all the sarcoma non-profits under a single united effort. Together, they decided to dedicate a separate month for sarcoma awareness. As part of this effort, a petition was sent to the White House with the intent of gathering 100,000 signatures to officially declare July as “Sarcoma Awareness Month”.

As part of the 2022 campaign, a wide range of activities and programs are conducted through the United States. The main idea is to spread awareness about sarcoma. The key awareness activities include – making donations in honor of Sarcoma Foundation, and sharing posts or stories on social media platforms by using hashtags – #curesarcoma #sarcomaawarenessmonth. As part of the campaign, the Sarcoma Foundation of America (SFA) organizes – the Race to Cure Sarcoma™ run/walk series (5K run/walks held in cities across the nation) – that focuses on raising awareness and research funds for sarcoma.

Coding Different Types of Vascular Disease – A Look at the Related ICD-10 Codes

Coding Different Types of Vascular Disease – A Look at the Related ICD-10 Codes

Peripheral vascular diseases are conditions affecting the circulatory system, or system of blood vessels. These range from diseases of the arteries, veins and lymph vessels to blood disorders that affect circulation. These disorders affect blood flow through the arteries and/or the veins, most commonly the legs. However, the location of the pain will depend on the site of the narrowed or clogged artery. Vascular surgeons treating patients with health concerns ranging from life-threatening conditions like abdominal aortic aneurism to minor conditions like varicose veins, have to document all the diagnostic test results and any clinical findings that support the treatments provided. Vascular medical coding involves reporting the condition and treatments provided using the right diagnosis and procedure codes on the medical claims.

Peripheral vascular diseases are caused by blockage of arteries. Key factors that can increase the risk of getting a vascular disease include high blood pressure, gender, family history, genetics, poor physical activity, overweight or obesity, smoking and stress.

Symptoms can vary depending on the type of vascular disease. Common symptoms include leg pain or cramps with activity, high blood pressure, congestive heart failure and abnormal kidney function, leg and foot cramps, numbness, tingling, discoloration, pain in the arms, hands, legs and feet, shortness of breath, chest pain, and dizziness.

ICD-10 Codes for Vascular Diseases

Abdominal Aortic Aneurysm

  • I71 Aortic aneurysm and dissection
    • I71.3 Abdominal aortic aneurysm, ruptured
    • I71.4 Abdominal aortic aneurysm, without rupture
    • I71.5 Thoracoabdominal aortic aneurysm, ruptured
    • I71.6 Thoracoabdominal aortic aneurysm, without rupture
    • I71.8 Aortic aneurysm of unspecified site, ruptured
    • I71.9 Aortic aneurysm of unspecified site, without rupture
  • I72 Other aneurysm
    • I72.8 Aneurysm of other specified arteries

Atherosclerosis

  • I70 Atherosclerosis
    • I70.0 Atherosclerosis of aorta
    • I70.1 Atherosclerosis of renal artery
    • I70.2 Atherosclerosis of native arteries of the extremities
    • I70.3 Atherosclerosis of unspecified type of bypass graft(s) of the extremities
    • I70.4 Atherosclerosis of autologous vein bypass graft(s) of the extremities
    • I70.5 Atherosclerosis of nonautologous biological bypass graft(s) of the extremities
    • I70.6 Atherosclerosis of nonbiological bypass graft(s) of the extremities
    • I70.7 Atherosclerosis of other type of bypass graft(s) of the extremities
    • I70.8 Atherosclerosis of other arteries
    • I70.9 Other and unspecified atherosclerosis
      • I70.90 Unspecified atherosclerosis
      • I70.91 Generalized atherosclerosis
      • I70.92 Chronic total occlusion of artery of the extremities

    Peripheral artery disease

    • I73.89 Other specified peripheral vascular diseases
    • I73.9 Peripheral vascular disease, unspecified

    Blood clots in veins

    • I82.9 Embolism and thrombosis of unspecified vein
      • I82.90 Acute embolism and thrombosis of unspecified vein
      • I82.91 Chronic embolism and thrombosis of unspecified vein

    Blood clotting disorders

    • D68.8 Other specified coagulation defects
    • D68.9 Coagulation defect, unspecified

    Buerger’s disease

    • I73.1 Thromboangiitis obliterans [Buerger’s disease]

    Lymphedema

    • I89 Other noninfective disorders of lymphatic vessels and lymph nodes
    • I89.0 Lymphedema, not elsewhere classified

    Carotid Artery Disease/Carotid Artery Stenosis

    • G45.1 Carotid artery syndrome (hemispheric)

    Chronic Venous Insufficiency

    • I87.2 Venous insufficiency (chronic) (peripheral)

    Intestinal Ischemic Syndrome

    • K55.05 Acute (reversible) ischemia of intestine, part unspecified
      • K55.051 Focal (segmental) acute (reversible) ischemia of intestine, part unspecified
      • K55.052 Diffuse acute (reversible) ischemia of intestine, part unspecified
      • K55.059 Acute (reversible) ischemia of intestine, part and extent unspecified

    Deep Vein Thrombosis

    • I82.40 Acute embolism and thrombosis of unspecified deep veins of lower extremity
      • I82.401 Acute embolism and thrombosis of unspecified deep veins of right lower extremity
      • I82.402 Acute embolism and thrombosis of unspecified deep veins of left lower extremity
      • I82.403 …. bilateral
      • I82.409 Acute embolism and thrombosis of unspecified deep veins of unspecified lower extremity

    Varicose Veins

    • I83 Varicose veins of lower extremities
      • I83.0 Varicose veins of lower extremities with ulcer
      • I83.1 Varicose veins of lower extremities with inflammation
      • I83.2 Varicose veins of lower extremities with both ulcer and inflammation
      • I83.8 Varicose veins of lower extremities with other complications
      • I83.9 Asymptomatic varicose veins of lower extremities

    Pulmonary Embolism

    • I26 Pulmonary embolism
      • I26.0 Pulmonary embolism with acute cor pulmonale
        • I26.01 Septic pulmonary embolism with acute cor pulmonale
        • I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
        • I26.09 Other pulmonary embolism with acute cor pulmonale
      • I26.9 Pulmonary embolism without acute cor pulmonale
        • I26.90 Septic pulmonary embolism without acute cor pulmonale
        • I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
        • I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
        • I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
        • I26.99 Other pulmonary embolism without acute cor pulmonale

      Raynaud’s Phenomenon

      • I73.0 Raynaud’s syndrome
        • I73.00 …. without gangrene
        • I73.01 …. with gangrene

      Thoracic Aortic Aneurysm

      • I71.1 Thoracic aortic aneurysm, ruptured
      • I71.2 Thoracic aortic aneurysm, without rupture

      Vasculitis

      • L95 Vasculitis limited to skin, not elsewhere classified
        • L95.0 Livedoid vasculitis
        • L95.1 Erythema elevatum diutinum
        • L95.8 Other vasculitis limited to the skin
        • L95.9 Vasculitis limited to the skin, unspecified

      Renovascular Hypertension

      • I15.0 Renovascular hypertension

      Vascular Dementia

      • F01 Vascular dementia
        • F01.5 Vascular dementia
          • F01.50 …. without behavioral disturbance
          • F01.51 …. with behavioral disturbance

      Thrombophilia

      • D68.5 Primary thrombophilia
        • D68.51 Activated protein C resistance
        • D68.52 Prothrombin gene mutation
        • D68.59 Other primary thrombophilia
    • D68.6 Other thrombophilia
      • D68.61 Antiphospholipid syndrome
      • D68.62 Lupus anticoagulant syndrome
      • D68.69 Other thrombophilia

    Klippel-Trenaunay syndrome (KTS)

    • Q87.2 Congenital malformation syndromes predominantly involving limbs

    May-Thurner syndrome (MTS)

    • I87.1 Compression of vein

    Vasospastic disorders

    • I67.84 Cerebral vasospasm and vasoconstriction

    Diagnosis procedures may involve Angiogram, Ankle-brachial index (ABI), Magnetic resonance angiography (MRA), Reactive hyperemia test, Vascular ultrasound, Catheter angiography, CT angiography, and MR angiography. Treatment options include medications to improve blood flow, vascular surgery, angioplasty, atherectomy, stent, catheter embolization, physical therapy and making lifestyle changes. Practices can consider utilizing professional medical billing services provided by experienced companies, to handle their claim submission and coding tasks.

What Is the Correct Code to Report Rheumatic Fever?

What Is the Correct Code to Report Rheumatic Fever?

Rheumatic fever is an autoimmune disease that causes inflammation in the body’s tissues. Also called acute rheumatic fever, this condition causes the body’s immune system to attack its own tissues, causing inflammation (swelling). Rheumatic fever disease develops as a rare complication when the body’s immune system overreacts to a strep throat or scarlet fever infection (caused by an infection with streptococcus bacteria) that goes untreated. If left untreated, rheumatic fever can cause permanent damage to the heart – including damaged heat valves and heart failure.

Assigning the correct medical codes on the medical claims can be challenging as there are several codes and coding guidelines on how to report rheumatic fever. Partnering with a reputable medical coding service provider can ensure correct coding and efficient claims management for optimal reimbursement.

Rheumatic fever may affect the joints, heart, blood vessels, brain and skin. Anyone can get affected by rheumatic fever. But, it most commonly appears in children in the age group of 5 – 15. However, younger children and older adults can contract the illness as well.

Most people who get strep throat or scarlet fever don’t develop rheumatic fever. It only occurs when these conditions don’t get properly treated. When people get rheumatic fever, it usually develops two to three weeks after an untreated strep throat or scarlet fever.

Symptoms of Rheumatic Fever

Rheumatic fever can affect people in different ways. Signs and symptoms of the condition can vary widely, depending on what part of the body the disease impacts. There may be few symptoms or several, and these can change during the course of the disease.

In certain cases, people experience very mild strep symptoms that they don’t realize they had a strep infection until rheumatic fever develops later on. The onset of rheumatic fever generally occurs about 2 to 4 weeks after a strep throat infection. Common symptoms include –

  • Fever
  • Swollen, tender and red joints (particularly in the large joints such as the knees, ankles, wrists and elbows)
  • Unexplained or ongoing headaches
  • Chest pain and abnormal heart beat
  • Fatigue
  • Flat or slightly raised, painless rash with a ragged edge
  • Heart murmur
  • Jerky, uncontrollable body movements (most often in the hands, feet and face)
  • Small, painless bumps beneath the skin

Several factors like – genes, environmental factors, age, and overall health of the patient tend to increase the risk of this condition in the long run.

How to Diagnose Rheumatic Fever

There is no test for diagnosing rheumatic fever. Diagnosis of this condition is based on a detailed medical history evaluation, physical examination and certain test results. Physical examination may be performed to look for a rash or skin nodules, check heart abnormalities and examine the joints for inflammation. Movement tests may also be performed to identify nervous system dysfunction. Blood tests may be performed to check for signs (markers) of inflammation in the blood.Other tests include – electrocardiogram (ECG or EKG) and echocardiogram.

Treatment for rheumatic fever will focus on treating the infections, relieving symptoms and controlling inflammation. Common treatment modalities include – antibiotics, anti-inflammatory medications and anti-seizure drugs. Physicians will also recommend bed rest and restricted activities until the major symptoms like pain and inflammation have passed. In case the fever has caused heart problems, strict bed rest will be recommended for a few weeks or months.

ICD-10 Codes to Report Rheumatic Fever

Physicians treating patients with rheumatic fever need to document the treatment administered using the right medical codes. Partnering with a reputable medical billing and coding company can ensure accurate claim submission. Here are the ICD-10 codes for a rheumatic fever diagnosis –

  • I00 Rheumatic fever without heart involvement
  • I01 Rheumatic fever with heart involvement
    • I01.0 Acute rheumatic pericarditis
    • I01.1 Acute rheumatic endocarditis
    • I01.2 Acute rheumatic myocarditis
    • I01.8 Other acute rheumatic heart disease
    • I01.9 Acute rheumatic heart disease, unspecified

One of the most effective ways to prevent rheumatic fever is to start treating strep throat infections or scarlet fever promptly within several days of contracting the infections. In addition, practicing proper hygiene habits like – covering the mouth (when coughing or sneezing), avoiding contact with sick people and washing hands can help prevent the occurrence of strep throat infections.

Billing and coding for rheumatic fever can be complex. For accurate and timely billing and claims submission, physician practices can rely on the services of reputable medical billing and coding outsourcing companies that provide the services of AAPC-certified coding specialists.

Observing Alzheimer’s and Brain Awareness Month in June

Observing Alzheimer’s and Brain Awareness Month in June

Every year, June is observed as “Alzheimer’s and Brain Awareness Month” in the United States – an opportunity to spread the word about Alzheimer’s disease (AD) and other dementias. Sponsored by the Alzheimer’s Association, the 2022 campaign is a time to recognize caregivers for the unique support they provide to people living with Alzheimer’s and other forms of dementia. A progressive neurologic disorder, AD causes the brain to shrink, resulting in the death of brain cells.

One of the most common causes of dementia, AD results in a continuous decline in thinking, behavioral and social skills that affect a person’s ability to function independently. There is no specific treatment modality that completely cures AD symptoms. However, consuming certain medications may help temporarily improve or reduce the intensity of symptoms. For accurate clinical documentation of this brain disorder, neurologists can utilize the services of a reputable medical billing and coding company.

As per reports from the Alzheimer’s Association, every three seconds someone in the world develops dementia, with nearly 55 million people currently living with the disease worldwide. More alarmingly, this figure is expected to reach 132 million by 2050. The 2022 month-long campaign aims to educate the community about AD and correct common misconceptions about this brain disorder. The exact causes of AD are not known. However, a combination of certain major factors like age, family history and genetics, mild cognitive impairment, down syndrome, head trauma, poor sleep patterns and other related lifestyle and environmental factors tend to increase the risk of this condition in the long run.

The month-long campaign aims to educate people on important facts concerning the progression of the illness and the number of older adults that it affects around the world.AD is an incurable disease that affects the nerve cells and tissues in the brain, affecting an individual’s ability to remember, think and plan. In due course, people with this condition will lose their ability to communicate, recognize family members and friends, and care for themselves.

Dementia is a brain condition that affects parts of the brain that control thought, memory, and language and Alzheimer’s disease is the most common form of dementia. AD accounts for 60-80 percent of dementia cases. While the risk of developing Alzheimer’s disease increases with age, AD is not considered a normal part of aging. The condition tends to affect women more severely than men and the majority of people with Alzheimer’s are 65 and older.

Initially, the signs and symptoms of AD begin slowly. However, in due course, the symptoms become severe enough to interfere with the daily tasks. Memory loss or difficulty to remember recent events or conversations is the key symptom of Alzheimer’s disease. As the disease progresses to advanced stages, other symptoms like – disorientation, mood and behavior changes, deepening confusion about events, time and place, and difficulty speaking, swallowing and walking tend to develop.

There is no exact test that confirms the presence of this brain syndrome. Diagnostic assessment of AD begins with self-reporting of symptoms and imaging tests. Neurologists may recommend brain imaging tests like – Electroencephalogram (EEG), Magnetic resonance imaging (MRI), Computerized tomography (CT), and Positron emission tomography (PET) that help better identify the factors causing symptoms so that treatment can be initiated early.

Neurologists and other specialists providing treatment for AD and related brain disorders have to report the correct diagnostic and procedural codes on their claims to ensure due coverage. Neurology medical billing and coding services provided by experienced medical coding companies focus on ensuring that the right ICD-10 codes are used for billing purposes.

ICD-10 diagnosis codes for Alzheimer’s disease (AD) include –

  • G30 – Alzheimer’s disease
    • G30.0 – Alzheimer’s disease with early onset
    • G30.1 – Alzheimer’s disease with late onset
    • G30.8 – Other Alzheimer’s disease
    • G30.9 – Alzheimer’s disease, unspecified

Under category G30, coders must assign the following additional codes to signify –

  • F05 – Delirium, if applicable
  • F02.81 – Dementia with behavioral disturbance
  • F02.80 – Dementia without behavioral disturbance

As part of the 2022 campaign, the Alzheimer’s Association encourages people around the globe to support the movement by wearing purple, and help fight Alzheimer’s disease. Purple is the official color that represents the fight against Alzheimer’s.

People can share their story about AD by posting or sharing images of them wearing purple, and showing their solidarity in the fight against Alzheimer’s via social media platforms. You can use the hashtag #EndAlz and #AlzheimersAndBrainAwarenessMonth via Twitter, Facebook and Instagram. You can also participate in The Longest Day® on June 21 – a sunrise-to-sunset event conducted to honor patients with Alzheimer’s disease with strength, passion and endurance. Other activities include – making donations to the Alzheimer’s Association and holding public events and seminars to spread awareness about Alzheimer’s.

Participate in Alzheimer’s & Brain Awareness campaign this June. Utilize this opportunity to spread the word about Alzheimer’s disease and other dementias, and the need for proper medical care and attention.

What is the Healthcare Revenue Cycle – Frequently Asked Questions

What is the Healthcare Revenue Cycle – Frequently Asked Questions

Revenue cycle management (RCM) is a step-by-step financial process that healthcare facilities follow to manage the various functions associated with claims processing, payment, and revenue generation. In simple terms, RCM involves identifying, collecting and managing revenue for services provided to patients. Experienced medical billing companies in the U.S. provide comprehensive RCM solutions to ensure providers earn maximum return on investment (ROI).

RCM – Frequently Asked Questions

  • What is the Revenue Cycle in Healthcare?

The revenue cycle makes up all the administrative as well as clinical processes involved in the capture, management, and collection of revenue for patient services. It comprises all the functions from the creation of patient accounts to collection of payment.

  • What is Revenue Cycle Management?

Revenue cycle management is the process of keeping track of billing, coding, accounts receivable and revenue. Patients and their insurance companies must be billed for services in accordance with the terms of their health insurance coverage and using the correct billing code that accurately describes the treatment or service that was performed. Most facilities hire medical billing services to manage the complexity of the billing cycle and maintain cash flow, while delivering optimal patientcare.

  • Why is RCM important in Healthcare?

RCM plays a key role in the day-to-day operations of a healthcare organization and can break or make the business. RCM ensures that providers have proper policies and practices in place to streamline the billing and collection cycles and stay financially fit, and by accurately managing patient registration, appointment scheduling, billing and coding, and claims submission. To ensure maximum reimbursement, providers should integrate best practices in medical billing and collection of payments from insurers and patients. This will bridge the gap between the business and clinical sides of healthcare.

  • What are the Steps in the RCM Process?

Healthcare RCM involves several steps:

    • Patient enrollment/registration: The first step in the RCM process is capture of patient demographic information for medical billing. The billing team reviews all information in patient intake forms enters it into the Electronic Health Records system or Practice Management system. Accurate demographic entry in the provider’s online portal is critical for clean and complete patient information which is critical for a smooth pre-registration and process and for filing compliant claims.
    • Insurance eligibility verification and prior authorization: This step is part of the front-end billing process. It involves confirming the patient’s insurance coverage before the office visit and getting the necessary preapprovals from the payer. It is necessary to submit clean claims.
      • Prompt and accurate determination of the patient’s eligibility provides the provider a clear idea about the patient’s coverage, out-of-network benefits, and payment responsibility before services are provided. During the process, staff will informs patients of any costs they are responsible for and can collect any copayments from the patient at the appointment.
      • Certain medications, imaging studies, etc. require prior authorization or pre-approval from the patient’s health plan before the payer will cover the cost of the service. Experienced insurance verification specialists will verify patient eligibility and obtain preauthorization to reduce delays in providing care and prevent claim denials and payment delays.
    • Medical coding: Submitting claims with the correct ICD-10, CPT and HCPCS codes is essential to obtain reimbursement for services delivered. Expert medical coders will review the physician’s documentation and medical record carefully to extract billable information and assign the correct codes related to a diagnosis, procedure, charge, and professional and/or facility code. They will leverage technology to ensure accurate and complete coding which is essential for optimal reimbursement.
    • Medical billing: Medical billing involves preparing and submitting claims to payers and billing patients for their financial responsibility. Medical billing specialists and coders work together to use patient information and the correct codes for services rendered to prepare a super bill and create a claim. The charge entry process in medical billing involves assigning an appropriate fee based on the fee schedule, based on the medical codes that describe the patient’s visit. Claims are scrubbed to ensure that the procedure, diagnosis, and modifier codes are current and accurate and that necessary patient, provider, and visit information is complete and correct. Claims are submitted on payer-specific forms. The provider’s notes and comments may be included along with the claim to justify medically necessary care.
    • Payment posting: Paid claims must be correctly posted in patient accounts. This step in the RCM process provides an overview of the payment details and the practice’s revenue stream and financial health. Accurate payment posting can promptly identify potential issues so that corrections can be made. For instance, if a claim is denied, the biller can correct and resubmit it, depending on the reason for the rejection/denial. After payments are received, billers will create statements for patients, which inform them of their financial obligation. Patients are usually billed for the difference between the rate on their chargemaster and what the insurance paid.
    • Accounts Receivable (AR) management: This phase of the medical billing process involves identifying accounts that need follow-up with insurance companies and patients. Monitoring AR to understand money owed to the healthcare provider and work with insurance to ensure that these payments are appropriately processed and received.AR management is all about reducing days in AR and improving cash flow by getting money owed as soon as possible.
    • Reporting: Reliable medical billing companies also create various medical billing reports to help their clients track the financial health of their business. These include but are not limited to the AR aging reports, key performance indicators (KPI) reports, payment trend and collection reports, and insurance/payer analysis reports.
  • What is Accounts Receivable (AR) Management?

AR management involves collecting amounts that have been billed. Efficiently monitoring and measuring AR performance or AR follow-up is essential to recover overdue payer or patient payments. The A/R Aging Report that a medical billing company creates will show how long insurance claims and patient balances have been outstanding, expressed both as a dollar amount as well as a percentage. Improving A/R means understanding your current state and conducting a gap analysis to compare your performance with industry peers, competitors and best practices. This will enable you to identify the steps you need to take to close those gaps.

  • What Factors are Critical for RCM Success?

Key factors for RCM success include:

    • Use of automated software can reduce errors and streamline the process
    • Providing web-based services to meet patient demands and improve billing and payment processes
    • Insurance verification services to inform providers and patients as to what procedures and services insurance plans cover. Real-time insurance eligibility verification will save time, reduce risks on denial, and improving patient-provider communication.
    • Staying up-to-date with ever-changing healthcare regulations

A successful RCM process will enable you to better manage transactions with payers and patients, earn profits, maintain financial viability, and provide quality patient care.

  • What are the Benefits of Outsourcing RCM?

With multiple processes, each involving unique challenges, RCM can be complex to handle in-house. Moreover, trends such as aging populations, new, complex treatments and technologies, changing industry policies and public health emergencies like COVID-19 have made RCM more complex than ever. Navigating the field would be much easier with expert support.

The Key Benefits of Outsourcing RCM are:

    • Reduces operational costs
    • Reduces risk of medical billing errors
    • Improved regulatory compliance
    • Streamlines financial processes and improves efficiency
    • Cuts denials/rejections
    • Timely and optimal reimbursement
    • Boosts collections and cash flow
    • More time to focus on patient care

Regardless of whether RCM is done in-house or outsourced to a medical billing company, handling the processes efficiently is essential to improve your bottom line.