Timely filing Limit of Insurance

Aetna: 120 days.
Amerigroup: 180 days.
Bcbs: 1yr.
Cigna: 180 days.
Humana: 15 months.
Greatwest: 1yr.
Medicare: 1 - 2 Year.
Medicaid: 1yr.
Rail Road Medicare: 1yr.
United Healthcare: 90 days.
Universal Healthcare: Depends upon the provider’s contract.
Polk Healthcare (Community Healthplan): 180 days.
Medicare Complete: 180 days.
Ever care: 180 days.
Quality Health Plan: 180 days.

Medicaid Denials and Action

Denial - 0660 Calculated payment equals zero. Other insurance paid more than Medicaid Allowable.
Action: Adjusted the claim (Medicaid write off)

Denial - 2091 Recipient services covered by HMO plan
Action: Claim would be filed to Medicaid HMO's

Denial - 0142 Claim exceeds 12 month filing limit
Action: Claim appealed with Clearing house acceptance report

Denial - 0312 Referring provider required for this procedure in field 17A/19.
Action: Issue raised to calling team regarding the PCP info after that updated the info with dummy#000000100 and refiled the claim.

Denial - 2346 Referring provider number not on file.
Action: Dummy#000000100 updated in 17A and refiled the claim.

Denial - 4888 NDC Missing/Invalid
Action: NDC# updated in claim note and refiled the claim.

Denial - 0721 Recipient ineligible for date of service
Action: After Medicaid eligibility, if the patient have other active insurance claim filed to other carrier. If patient have no other coverage bill to patient.

Denial - 0720 Medicare coverage is present
Action: After Medicare verification claim filed to Medicare.

Denial - 4257 Invalid procedure code modifier
Action: Removed modifier and refiled the claim.

Denial - 4801 These services cannot be billed on this claim form or the provider type listed for this provider number cannot file this type of claim.
Action: Normally G codes denied for this reason. After Medicare payment claim has been adjusted.

Use CPT Modifier to Get the Reimbursement You Deserve

written by : Nancy Rose

CPT modifier is an additional feature of the CPT to indicate that specific circumstances have changed the performed service. Modifiers play an important role in explaining the insurance companies or payers that the additional procedures that were performed which do not look like to be separately paid are in fact justified.

Here are some examples of commonly used CPT modifiers:

50 : Indicates a procedure that not already defined as bilateral was performed on both sides of the patient's body at the same episode of care.

51 : When multiple surgeries are performed during the same operative session. Most payers pay 100 percent for the first procedure, but reduce the reimbursement on the second, third, and fourth procedures.

59 : This CPT modifier is used to indicate that a procedure was distinct or separate from the other procedures performed on the same date. This modifier tells the payer that the doctor has not submitted a duplicate claim.

62 : A single procedure performed jointly by co-surgeons. Here, each surgeon bills with the same code and the payment to each of them is usually 62.5 percent of the normal amount.

76 : Repeat procedure by the same doctor. Often used with radiological procedures, performed more than once on the same date.

79 : Unrelated procedure or service by the same physician during the post operative period. This modifier is the surgical equivalent of modifier - 24.

91 : Repeat clinical lab. This modifier is used when more than one result are required in the course of treatment on the same day. A word of caution here -do not use this modifier in case of equipment failure.

There are many other CPT modifiers which identify the type of provider and supervision - the key objective is to get the reimbursement you truly deserve.

Anesthesia Modifier List

AA - Anesthesia services personally performed by anesthesiologist

AD - Medical supervision by a physician: More than 4 concurrent anesthesia procedures

AE - Direction of residents in furnishing not more than two concurrent anesthesia services - attending physician relationship met

QK - Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals

QS - Monitored anesthesia care

QX - CRNA service with medical direction by physician

QY - Medical direction of one concurrent anesthesia procedure involving qualified individuals

QZ - CRNA service without medical direction by a physician

23 - Unusual anesthesia - Used to report a procedure which usually
requires either no anesthesia or local anesthesia; however, because of unusual circumstances must be done under general anesthesia

47 - Anesthesia by surgeon - Used to report regional or general anesthesia provided by the surgeon (not for local anesthesia)

DIAGNOSTIC PROCEDURES/PATHOLOGY MODIFIERS

CPT Modifier 26

Professional component only - Use to indicate that the physician component is reported separately from the technical component for the diagnostic procedure performed



CPT Modifier 90

Reference Lab - Used to indicate a lab test sent to an outside lab. e.g., lab procedure performed by a party other than the treating or reporting laboratory. NOTE: Outside lab name, address and UPIN must be included on the claim. Section 20 must be marked "yes" and your actual cost for each test, net any discounts, must be included in the charges section.



CPT Modifier GH

Diagnostic mammogram converted from screening mammogram on the same day.



CPT Modifier QP

Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a CPT
recognized panel other than automated profile codes



CPT Modifier QR

Repeat clinical diagnostic laboratory test performed on the same day to obtain subsequent reportable test value(s) (separate specimens taken in separate encounters)



CPT Modifier QW

CLIA waived test



CPT Modifier TC

Technical component only - Used to indicate that the technical component is reported separately from the professional component for the diagnostic procedure performed

EVALUATION/MANAGEMENT CODE MODIFIERS

EVALUATION/MANAGEMENT CODE MODIFIERS

CPT Modifier 21

Prolonged evaluation and management services - Use only with highest level of care code for the category when the face-to-face or floor/unit service provided is prolonged or otherwise greater than that usually required for the highest level code.

CPT Modifier 24

Unrelated E/M service during a post-op period - Use with E/M codes only to indicate that the E/M performed during a postoperative period for a reason(s) unrelated to the original procedure. Modifier 24 applies to unrelated E/M services for either a MAJOR or MINOR surgical procedure.
- Failure to use modifier when appropriate may result in denial of the E/M service

CPT Modifier 25

Separately identifiable service on same day as procedure - Use with E/M codes only to indicate that the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual pre- and postoperative care for the procedure performed

- Failure to use modifier when appropriate may result in denial of the E/M service

CPT Modifier 57

Decision for surgery - Use with E/M codes billed by the surgeon to indicate that the E/M service resulted in the decision for surgery (E/M visit was NOT usual pre-operative care). For E/M visits prior to MAJOR surgery (90 day post-op period) only.

- Failure to use modifier when appropriate may result in denial of the E/M service

AMBULATORY SURGICAL CENTER MODIFIERS

AMBULATORY SURGICAL CENTER MODIFIERS (ASC modifiers)

73 - Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia.

74 - Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia.

SG - Ambulatory Surgical Center (ASC) Facility service

Senate Democrats passed a landmark health care bill

Source: MSN news

Senate Democrats passed a landmark health care bill Thursday that could define President Barack Obama's legacy and usher in near-universal medical coverage for the first time in the country's history.

The 60-39 vote on a cold Christmas Eve morning capped months of arduous negotiations and 24 days of floor debate. It also followed a succession of failures by past congresses to get to this point. Vice President Joe Biden presided as 58 Democrats and two independents voted "yes." Republicans unanimously voted "no."

The tally far exceeded the simple majority required for passage.

The Senate's bill must still be merged with legislation passed by the House before Obama could sign a final bill in the new year. There are significant differences between the two measures but Democrats say they've come too far now to fail.

Both bills would extend health insurance to more than 30 million more Americans.

Vicki Kennedy, the widow of the late Massachusetts Sen. Edward Kennedy, who made health reform his life's work, watched the vote from the gallery.

"This morning isn't the end of the process, it's merely the beginning. We'll continue to build on this success to improve our health system even more," Majority Leader Harry Reid, D-Nev., said before the vote. "But that process cannot begin unless we start today ... there may not be a next time."

The House passed its own measure in November. The White House and Congress have now come further toward the goal of a comprehensive overhaul of the nation's health care system than any of their predecessors.

The legislation would ban the insurance industry from denying benefits or charging higher premiums on the basis of pre-existing medical conditions. The Congressional Budget Office predicts the bill will reduce deficits by $130 billion over the next 10 years, an estimate that assumes lawmakers carry through on hundreds of billions of dollars in planned cuts to insurance companies and doctors, hospitals and others who treat Medicare patients.

For the first time, the government would require nearly every American to carry insurance, and subsidies would be provided to help low-income people to do so. Employers would be induced to cover their employees through a combination of tax credits and penalties.

Republicans were withering in their criticism of what they deemed a budget-busting government takeover. If the measure were worthwhile, Minority Leader Mitch McConnell, R-Ky., contended before the vote, "they wouldn't be rushing it through Congress on Christmas Eve."

Bill to medicaid patients - how and when

how and when to Bill medicaid patients

Bill patients only in the following situations:

The recipient's Medicaid eligibility status is pending . If you bill the recipient and they are found eligible for Medicaid with a retroactive date that includes the date of service, you must return the entire amount collected from the recipient and then bill Medicaid. For this reason, it is recommended that you hold claims until after eligibility is determined.

Medicaid does not cover the service and the recipient agrees to pay by completing a written, signed agreement that includes the date, type of service, cost, verification that the provider informed the recipient that Medicaid will not pay for the service, and recipient agreement to accept full responsibility for payment. This
agreement must be specific to each incident or arrangement for which the client accepts financial responsibility.

The TPL payment was made directly to the recipient or his/her parent or guardian. You may not bill for more than the TPL paid for services rendered.

The recipient fails to disclose Medicaid eligibility or TPL information. If a recipient does not disclose Medicaid eligibility or TPL information at the time of service or within Medicaid ’ s stale date period, the recipient assumes full responsibility for payment of services.


you cannot bill the patient for:

For co-payment indicated on a private insurance card

For the difference between the amount billed and the amount paid by Medicaid or a TPL

When Medicaid denies the claim because the provider failed to follow Medicaid policy

Medicaid is the payor of last resort and must be billed after all other payment sources.

Medicaid

State Insurace Medicaid – An operations study

Medicaid is a federal and state plan, operated by the states, which is an entitlement program under the Social Security Administration of the federal government for patients whose income and resources are insufficient to pay for healthcare.

Eligibility

The Medicaid program, jointly funded by the State and Federal governments, provides medical benefits to individuals with low income and resources. It is run by the individual States under broad Federal guidelines. Each state

a) Establishes its own eligibility standards
b) Determines the type, amount, duration, and scope of services
c) Sets the rate of payment for services
d) Administers its own program

Consequently, the Medicaid program differs widely from state to state. It even differs from region to region within a State, since local bodies are also involved in the funding and implementation of the program. Coverage, billing and reimbursement rules also change over time.

Though each state has discretionary powers to set its own eligibility standards, States are required to provide Medicaid coverage to most individuals receiving federally assisted income maintenance benefits, and for related groups not receiving such cash assistance.

Aid to Families with Dependent Children (AFDC)

Recipients of AFDC and Supplemental Security Income (SSI) are all eligible for Medicaid. They receive federal cash assistance. Besides, other disadvantaged groups, who satisfy the AFDC and SSI program criteria, but who do not receive cash assistance are also eligible. Poor children and low-income pregnant women, both of whom are some of the largest beneficiaries of Medicaid, are examples. Some states also include non-disabled adults without children in the Medicaid eligible groups.

Medically Needy Eligibility Groups

Some groups may not satisfy the low-income standard. That is, their income may make them ineligible for Medicaid. But they can still become eligible by "spending down". This means that a person may have an income above the poverty level indicated by the state's Medicaid program. But high medical expenses may offset this margin. When the medical expenses are reduced from the person’s income that person may fall below the poverty level. This is called spending down and thus the person become eligible.

Another way a person becomes part of the medically needy group and qualifies for Medicaid is by paying the state an amount equal to the difference between family income and the income eligibility standard.

Suppose a person's income is $100.00 above the income eligibility level. The person does not qualify. But by paying $100.00 to the state, after deducting any medical expenses he/she has incurred, he/she becomes eligible. The amount, which keeps him/her above the poverty level, is surrendered to the state. Only Medically needy individuals resort to this method. Their incomes will not be low enough to qualify for Medicaid, and not high enough to help them meet their medical needs.

Different states apply different income and resources methodologies to decide on the poverty level i.e. the methods they adopt to measure income/resources level and thus decide on Medicaid eligibility differ widely.

Medicaid Benefits for Medicare Beneficiaries

For certain poor Medicare beneficiaries, called "Qualified Medicare Beneficiaries" (QMB) with incomes below the Federal poverty level and with resources below twice the standard allowed under the SSI program, Medicaid will pay the Part A and Part B Medicare premiums and co-insurance.
"Specified Low-Income Medicare Beneficiaries" (SLBM), those that have marginally higher incomes than the QMBs, Medicaid will pay the Medicare Part B premium only.

Claims Submission & Payment

Federal Law requires Medicaid to accept CMS 1500 for claims processing in states where optical scanning facility is not available. Some states like New York and Georgia have special forms developed exclusively for claims processing by their state and which has optical scanning facilities. Though the Health Care Financing Administration (CMS) of the Department of Human Services of the US Government is responsible for administering Medicaid, each State Government has its own requirements and they append to what CMS determines. Hence claims submission in some states may go directly to Department of Human Services, while in some states it goes to county department of welfare and so on.

Medicaid carriers in almost all states have the facility of receiving claims electronically.

Filing Limit – This is the period within which claims need to be submitted failing which claims would be denied for lapse of time. Some Medicaid carriers have this as 1 year from date of service while some have this as 90 days from date of service and so on.

Other insurance plan – It is to be ensured that the patient has no other coverage other than Medicaid. If he has one and it is still valid, then we need to submit it to that coverage first.

Crossover – Crossover is a process wherein claims are automatically being sent to the supplemental carriers by Medicare after Medicare processes the primary claims and makes payment to the providers. The supplemental carriers processes and make payment to the providers. Some Medicaid carriers would have this facility. Here the provider need not have to submit a fresh claim to the secondary carrier.

Medicaid addresses and phone numbers of different states

Medicaid of Arizona

P. O. Box 1700, Phoenix, AZ 85002
1-800-962-6690


Medical of California

P.O. Box 13029
Sacramento, CA 95813-4029
1-800-952-5294


State of Connecticut Medicaid

P.O. Box 2991.
Hartford, CT 06104

Alabama Medicaid

PO Box 5624
Montgomery, AL

Delaware medicaid

P.O. BOX 906
NEW CASTLE DELAWARE 19

Arkansas Medicaid

P.O. Box 8105.
Little Rock, AR 72203-8105
1-800-482-8988


Alaska Medicaid

P.O. Box 240808.
Anchorage, AK 99524-0808
1-800-211-7470


Florida Medicaid

P. O. Box 2525.
Jacksonville, FL 32231-0019



IDAHO Medicaid

P.O. Box 23
Boise, ID 83707


Illinois Medicaid

P.O. Box 19115.
Springfield, Illinois 62794-9115
402-471-9580
1-800-842-1461


Indiana Medicaid

P.O. Box 441423.
Indianapolis, IN 46244-1423


Iowa Medicaid

P. O. Box 150001.
Des Moines, Iowa 50315


Kansas Medicaid

P.O. Box 3571.
Topeka, KS 66601-3571


Kentucky Medicaid

P.O. Box 2016. Frankfort, KY 40602-2016
800-255-1932


Louisiana Medicaid

P.O. Box 80159.
Baton Rouge, LA 70898-0159
1-888-342-6207
1-800-776-6323

medicaid claim submission address list

Maryland Medicaid

P.O. Box 1935. Baltimore, MD 21203


Michigan Medicaid

PO BOX 30238. LANSING MI 48909


Minnesota Medicaid claim

P.O. Box 64166. St. Paul, MN 55164


Mississippi Medicaid claim

P. O. Box 23076. Jackson, MS 39225-3076


Montana Medicaid claim

P. O. Box 5865. Helena, MT 59604


Nebraska Medicaid claim

PO BOX 95026. Lincoln, NE 68509-5026


Nevada Medicaid claim mailing address

P.O. Box 30042. Reno NV 89520-3042


New Hampshire Medicaid claim mailing

PO Box 2001. Concord, NH 03302-2001

Benefits Exhausted Denial and action

Coverage not Valid for DOS/Coverage Terminated/ Benefits Exhausted:

All these are patient related. However if we had effective dates of each coverage established, then the first two kinds of errors can be identified at the front end itself before the claims are generated. As regards the last one i.e. Benefits exhausted, this may be due to the fact that the patient’s policy will pay for a particular procedure only once during a year or once during a life time or the insurance company’s general rule

for a particular procedure may be only once reimbursable. If it is latter setting up a billing rule for that procedure and that insurance company can identify it beforehand. If it is patient policy specific, then this can be known only when we receive the denial. The ultimate solution for all these cases is to bill the patient.

HMO and PPO insurance type - basics for medical billing

Managed Care Plans are operated by private companies, which act as the payer. Examples are Prudential Health Care (an HMO) and Independent Health (a PPO). Physicians sign a contract with a managed care plan to accept the plan’s fee schedule, which is usually lower than the prevailing market rate. The physicians are considered part of a MCO (managed care organization’s panel of providers).

The following are the major managed care plans.

Health Maintenance Organization (HMO):

This is regulated by the State HMO laws. The laws require an HMO to cover benefits for preventive care, which includes routine physician examinations, and other services. Co-ordination of care by a PCP (primary care physician) is required for patients to receive benefits. HMOs also do not provide any benefits for patients unless medical services are provided by contracted physicians. There are two types of payments by HMOs, Capitation and Fee-For-Service. HMOs were the first plan to place the physician’s payment at risk by either Capitation or Withhold. Capitation means HMO’s prepay the doctor for the care of a population assigned to the practice. Withhold means that a certain proportion of the payment due to a physician will be withheld by the HMO (e.g. 10-40%) for a defined period, until the HMO has had time to pay all the claims for that period. If an HMO exceeds its budget for the payment of claims for a period, the withheld money is not paid to the doctor.

Preferred Provider Organization (PPO):

This may or may not be regulated by state insurance laws. It is regulated by State Insurance laws if they are owned by a private insurance plan or the PPO operates within a state, which has an insurance law that regular PPOs. PPOs do not cover preventive benefits unless they are regulated by a state, which requires this. PPOs do not generally require co-ordination of care by a PCP. If a patient seeks services outside the panel of contracted physicians, benefits are reduced and the patient must pay out-of-pocket expenses that usually range from 20-30 % of the total costs. If the PPOs are not owned by a private insurance then they are not the payers. They only act as repricing centers for the payers. They decide the fee-for-service that needs to be paid to the providers and forward them to the insurer for payment.

Third Party Administrators (TPA):

This is an organization which contracts with self-insured employers and other insurance mechanisms to provide administrative methods such as provider contracting, utilization controls, enrollment services and claims processing.

Methods of Payment:

Fee for Service: This is fixed charge for the service performed. Either the doctor or the patient submitted a claim and received payment.

Capitation: This is a fixed pre-paid amount based on the number of patients assigned to a practice for a specified period of time.
Links which are simillar.

E-Prescribing in EMR Software

One of the greatest advantages of Electronic Medical Records (EMR) software is that of the e-prescription feature. Certified EMR programs (or certified HER programs) can integrate with e-prescriptions, which can increase your income while also helping to maintain more accurate records. What is an e-prescription?

This refers to computer-generated prescriptions that you can print out and send directly to your patients or pharmacy. Instead of having to write out prescriptions on a piece of paper you simply enter it into the EMR system. The prescription then travels from your office to the pharmacy's computer. This is done through a private, secure and closed network to ensure that the information is never just sent over the Internet or through email, sources which may be compromised.

The benefits of using EMR software for e-prescriptions include less waiting time by the patient, which will in turn increase the patient's satisfaction and loyalty to your office. You no longer have to worry about legibility, as EMR systems have advanced handwriting and speech recognition features. The pharmacist won't even be dealing with your handwriting, as he will be receiving all prescription information via computerized message. Using EMR medical software is also the more economic choice, as it will help you to streamline your business and pass the savings onto your customers.

Currently, over 75% of all pharmacies in the country accept e-prescriptions. Moreover, in the year 2009 and in the upcoming 2010, practices that use a qualified electronic prescribing system are eligible to earn a bonus payment of 2% of the total allowed charges through Medicare Part B. Using certified EMR medical billing software you will have access to e-prescribing features. You will be able to experience dramatic gains in enhanced productivity, additional income and reduction of time and monetary expenses.

The average physician spends an estimated $15,000 a year on nothing in particular-and it all results from using a paper file system or a basic computer record system. Using an EMR system with e-prescribing capabilities enables to you take advantage of e-prescription programs along with increased bonus payments made possible by PQRI (Physician Quality Reporting Initiative).

EMR practice management software simplifies the prescription process, protecting you legally as well as helping you financially. You will be surprised at how much more efficient your office works thanks to a comprehensive electronic document management system. Remember that you can modify and add customized features for your practice as you need them, and you don't have to be a computer expert to make these changes.

Pediatric EMR

By Russ Tanioka

Why the need for a special Pediatric EMR module or program? The original EMR system was developed primarily for out-patient adult services. Since EMR is the wave of the future as deemed by the Federal Government, there became a necessity to include pediatric information.

The information previously lacking was:

- Newborn Screening records
- Immunization Records
- Wellness Child Exams
- Growth Records
- Pediatric Narrative Templates
- Pediatric Examination Templates (by age)
- Pediatric SOAP Note Templates
- Patient Pictures
- Pediatric Image Management
- Collection of Family Structure
- Birth
- Adoption
- Step-Children
- Child-Abuse
- Foster Children
- Genetic Information Collection
- Newer Family Identification Methods, indexing the family together.

Although every EMR system contains templates, the earlier versions did not include an easy way to accept the additional information relating to pediatric care. Physicians and caregivers simply did not have the time to design their own database structure and care for patients at the same time.
With the newer enhanced systems, Pediatric EMR has become a reality and “paper-less” offices are becoming a standard way of practice. From scanners to hospital networking, the physician can now retrieve 98% of a patient’s information:


- Lab Tests and Results
- Radiology Tests and Results
- Cardiology Tests and Results
- Dictated Reports

And much more…

How is all this possible? Hospitals and medical facilities are storing all this data. As they strive for a consistent Master Patient Index (MPI) repository, this data can be gathered from disparate systems and stored in a central location. Most facilities and medical systems are capable of sending HL7 (Health Level 7) messages. This is a real-time connection between systems that keeps data current across all applications and available immediately to be viewed by an authorized person.

So now, a pediatrician with a Pediatric EMR equipped solution, can have data fed to their “stand-alone” application at their local office. Although, this arrangement needs to be authorized by the medical facility, which brings up another issue – HIPPA!

Medical Billing services are now offering EMR as an add-on to the services they provide along with scheduling, billing, collection, and all the back-office services. Primarily physicians of a medium to large group can benefit from such a service.

There’s multiple solutions depending on the needs of the physician and the amount of staff to support the infrastructure. Favorably, this segment has grown in regards to the quantity of EMR vendors and their capabilities.

Soon will be the day when you walk into a doctor’s office and no longer see rows and rows of manila folders (charts). Instead, you will see them viewing Pediatric EMR information from a touch-screen computer in the patient room.

Don't purchase a Pediatric EMR system until you are fully informed. If you value your time and money, make sure your are well educated on the future government mandates.

Medical coding and EMR

written by Ricci Mathew

What is EMR and what does it have to do with the medical coding process? EMR stands for "Electronic Medical Records" and is a system that is used by doctors and hospitals to electronically store and manage patients' medical histories. Today because of the Government regulations (like HIPAA compliance) all patient records have to be handled with the utmost confidentiality.

The huge and growing database of medical information has given rise to the development and use of the sophisticated electronic medical records systems which is good for the insurance companies, doctors, hospitals and also for the HMO (Health Maintenance Organization). Handling of huge quantities of medical documents efficiently in less time is made possible because of EMR.

Medical coding is about assigning codes to the diagnosis and various procedures used for reimbursement from insurance companies and government agencies, software companies and consulting firms. EMR is a necessary base for medical coding. Physicians and doctors find EMR to be a very powerful tool that allows complete medical documentation in an easy manner. Many payers and other agencies like Medicare have to keep checking up if the medical coding has been done rightly or if there has been a mistake. This process of checking can be done and is supported only because of EMR implementation.

However indiscriminate use of EMR can result in major errors and so caution must be taken to avoid mistakes in the medical billing process. These are,

- Checking the software's default settings and override whenever necessary.
- Personalizing records as much as possible.
- EMR training for all.
- Maximize human intervention in choosing the codes

What are modifiers

What are Modifiers?
Use of Modifiers in medical coding and Billing
What is modifier

Medical codes describe health care procedures performed by doctors in their offices or in hospitals. Codes are most often used to bill insurance companies, and there are rules governing which codes may be used in conjunction with each other. Modifiers are sometimes used in addition to medical codes to allow for billing multiple procedures performed on the same service date. It is important to know which modifiers to use for rules compliance and maximum reimbursement.

provider enrollment process

provider Enrollment process

Provider Enrollment is the crux of a proper billing setup. Before we send claims to insurance companies, we should ensure that all provider (doctors) are enrolled with the respective carriers, all providers are contracted.

The process is as follows:

For Federal carriers such as Medicare and Medicaid, we need the provider # to submit claims. Otherwise they would get denied. In order to get this; we need to act at the inception itself.

When a new provider has joined the group, we need to ensure the following:

1: Does the provider have all the credentials?
2: Does the provider have a State License? Without State License the doctor cannot perform in that State.
3: Does the provider have a contract with major carriers in the State? If so we can just write a letter to the carrier saying that this provider has joined the group and request them to merge the provider with the group.

Where the provider does not have a contract with a carrier, a fresh application for enrollment is required.

A Fresh application in Form 855 is filled and signed by the doctor and sent to the carrier. This form should be filled up with details such as the doctor’s name, his Social Security Number (SSN), his State License Number, the name and address of the facility in which he is or will be providing services, the name and address of the group of which he has become a member, the name of the owner of the group, the pay-to address of the group etc.

The carrier processes it and sends in intimation mentioning the provider #. This provider # becomes the individual provider # for that doctor and needs to be stated in Box 24K and Box 33-PIN # in the CMS.

Box 33 of the CMS also contains the Pay-to address where the checks and EOBs need to be sent by the carriers. But Medicare and Medicaid do not go by what is mentioned in this box with regard to pay-to address. Based on the pay-to address mentioned in Form 855 at the time of enrollment the carrier records it in its system. All checks and EOBs will be sent to this address. If there is a change of address, the carriers need to be notified in Form 855-C. Based on this, the carriers update this information in their system.

In this regard the following terms need to be understood:

Employer Identification Number (EIN): This is a tax identification (tax id) number of the group into which the doctor has joined. This number is allotted by the IRS for the purpose of submitting the tax returns. The group needs to show this number in all claim forms and correspondence with the carrier.

W-9 Form: This is a “Request for tax payer identification number and certification” form. This shows the provider’s individual tax id # (SSN) or the group tax id # (EIN) along with the pay-to address. This can be used for updating the tax id # and the pay-to address with the carriers. This should be signed by the provider.

EDI Enrollment:

EDI is Electronic Data Interchange. Certain carriers have the facility to accept claims electronically. For this purpose we need to enroll the providers with the EDI Department of the insurance carriers. This is mandatory requirement in the case of Federal Carriers such as Medicare and Medicaid. This is a separate process apart from the above Provider Enrollment process. We need to fill in a separate EDI enrollment form for providers and send them to the carrier. The carrier will then add the provider in the EDI database. Only then can we submit claims to that carrier for that provider electronically.

Action on Denial for non-covered services

Denied as non-covered services and Action


Medicare Denial - PR-96: Non-covered charge(s).

Medicare Denial - N115: This decision is based on an LMRP or LCD. An LMRP/LCD
provides a guide to assist in determining whether a particular item or service is covered.

Medicare Denial - PR-204: This service/equipment/drug is not covered under the patient’s current benefit plan.

Medicare Denial - N103: Social Security records indicate this patient was a prisoner when the service was rendered. This payer does not cover items and services furnished to an individual while he is in state or local
custody under a penal authority unless, under state or local law, the individual is personally liable for the cost of his health care while incarcerated and the state or local government pursues such debt in the same way and with the same vigor as any other debt.

Action on Medicare Denial:

The MRA messages above are examples of some that may appear when providers bill/report services that are non-covered under the Medicare program.

Medicare exclusions include, but are not limited to: personal comfort items; self-administered drugs and biologicals (i.e., pills and other medications not administered by injection); cosmetic surgery (unless to repair an accidental injury or improvement of a malformed body member); eye exams (for purpose of prescribing, fitting or changing eyeglasses or contact lenses in absence of disease or injury to eye); and routine immunizations. So we can't bill for these services.

Denial for Lack of information and Action

Action on the Medicare Denial for Lack of information

CO-16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice.

When ever you received this denial , check the additional code for which will descripe what the info was required. It could be some of the belows.

- DENIED-RENDERING PHYSICIAN #INVALID/MISSING. SUBMIT A NEW CLAIM
- REFERRING NAME AND UPIN REQUIRED. RESUBMIT AS A NEW CLAIM
- DENIED-CLIA NUMBER INVALID OR MISSING

benefits of EMR

Author: Valerie Mellema

Benefits of EMR - Electronic Medical Records

1. Elimination of Paper

By eliminating paper with your EMR system, you save on office space, save on employee payroll (since filing is a non-issue) and save a great deal of wasted time. Computerized patient charts also save you time, money and a great deal of headache as you no longer have to worry about illegible writing or lost documents. It's all stored in the system.

2. Increased Revenues and Faster Accounts Receivable Cycle

You streamline your accounts receivable process and ensure that you get all the money that you have coming to you. How many times have you lost money because of errors made by staff in managing daily charges? By reducing missing charges, as well as denied claims (that result because of errors) you are actually increasing your income.

3. The Safety of Patients

Nothing is more important than the safety of your patients. Errors that result from human imperfection can be life-threatening and very costly. E-prescriptions (which are highly accurate compared to calling in a prescription the old fashioned way) are saving practices thousands of dollars, as they literally save thousands of lives in the United States alone. With an EMR system, you can also prevent medication errors and get automated alerts warning about possible drug reactions or unsafe drug combinations. This feature alone could potentially save your practice from a lawsuit.

4. E-Prescription

Did you know that a Physician can save $15,700 per year by using the ePrescribing feature of a good EMR Software? Sound too good to be true? Well it is, and it doesn't cost you any more time or money when you select the right EMR Software with an up to date and fully integrated ePrescribing function that virtually does it all on automatic pilot while you're examining your patients.

5. Improved Reimbursements and Reduced Insurance Premiums

Accuracy of certified EMR and certified EHR programs is so trusted that many malpractice insurance companies are now offering discounts to doctors who use full software systems. In addition, practice management software can also greatly improve your reimbursement rates as they will ensure your office claims are compliant with insurance company drug formularies and other policies.

What is an EMR

what is an EMR - Electronic medical record

What is an EMR?

An EMR, or electronic medical record, is a medical record for a patient in a digital format that is stored on a computer or in a computer server. In health informatics, an EMR is considered by some to be one of the different forms of electronic health records, but usually these two terms mean the same thing. Sometimes EMR's include other information, such as HIT, or health information technology, which are systems that keep track of medical information, like medical practice management systems. These systems support the electronic medical records.

Until 2006, most medical practices still do not use EMR's or other health information technologies, like computer physician order entry systems, or CPOE's. In fact, less than 10% of the American hospitals have begun to use this technology, while only 16% of primary care physicians now use electronic health records. The majority of medical transactions in the US are still done on paper, with a system that was developed in the 1950's and is still in use today. The health care industry actually spends only about 2% of their gross revenues on HIT's, or health information technology, which is way behind other areas like finance.

One of the main problems of most medical facilities implementing EMR's is the interoperability for different medical offices and professionals to use the systems and software to communicate and exchange data accurately. In the US, the development of standards for EMR's is at the front of the agenda for national health care. Without a good interoperable EMR system, physicians, pharmacies, hospitals, and other medical professionals cannot share patient information correctly, which would be necessary for patient-centered care.

Since the EMR's need to be compatible, in 2004, President Bush created the Office of the National Coordinator for Health Information Technology or ONC, to address issues that deal with EMR's and interoperability issues to help establish a national health information network, or NHIN. This organization, along with the Center for Information Technology Leadership, has placed four different categories, or levels, of data that is in the health care data exchange right now. These different levels are:

Non-electronic data - this includes paper, mailed information, or phone calls.

Machine transportable data - this includes faxes and emails.

Machine organizable data - this includes HL7 messages, images, and objects.

Machine interpretable data - this includes automatically transferred lab results to an electronic health record.

Denial management performance improvement process

Author of this artilce: Yuval Lirov

Denials management performance improvement process

Partial denials cause the average medical practice lose as much as 11% of its revenue. Denial management is difficult because of complexity of denial causes, payer variety, and claim volume. Systematic denial management requires measurement, early claim validation, comprehensive monitoring, and custom appeal process tracking.

In a high-volume clinic, the only practical way to manage denials is to use computer technology and follow a four-step procedure:


1: Prevent mistakes during claim submission:

This can be accomplished with a built-in claim validation procedure including payer-specific tests. Such tests ("pre-submission scrubbing") compare every claim with Correct Coding Initiative (CCI) regulations, diligently review modifiers used to differentiate between procedures on the same claim, and compare charged amount with allowed amount according to previous experience or contract to avoid undercharging.

2: Identify underpayments:

Underpayment identification involves comparison of payment with allowed amount, identification of zero-paid items, and evaluation of payment timeliness. The results of this stage should be displayed in a comprehensive underpayment report sorted by payer, provider, claim identification, and the amount of underpayment.

3. Appeal denials:

Appeal management includes appeal prioritization, preparation of arguments and documentation, tracking, and escalation. Note that CCI spells out bundling standards but the number of standard interpretations grows in step with number of payers. Therefore, CCI provides justification basis for an appeal and every appeal must be argued on its own merits, including medical notes. Denial appeal process is typically managed with a custom process tracking system, such as TrackLogix.

4. Measure denial rates:

One cannot manage things that do not measure. By measuring denial rates and observing payment trends, you can see if your process requires modifications.

Denial risk is not uniform across all claims. Certain classes of claims run significantly higher denial risk, depending on claim complexity, temporary constraints, and payer idiosyncrasies:


1: Claim complexity

a) Modifiers
b) Multiple line items


2: Temporary constraints

a) Patient Constraint, e.g., claim submission during global periods
b) Payer Constraint, e.g., claim submission timing proximity to fiscal year start
c) Procedure Constraint, e.g., experimental services


3: Payer idiosyncrasies

a) Bundled services
b) Disputed medical necessity




First, for complex claims, most payers pay full amount for one line item but only a percentage of the remaining items. This payment approach creates two opportunities for underpayment:


a) The order of paid items
b) Payment percentage of remaining items

Next, temporary constraints often cause payment errors because misapplication of constraints. For instance, claims submitted during the global period for services unrelated to global period are often denied. Similar mistakes may occur at the start of the fiscal year because of misapplication of rules for deductibles or outdated fee schedules.

Finally, payers often vary in their interpretations of Correct Coding Initiative (CCI) bundling rules or coverage of certain services. Developing sensitivity to such idiosyncrasies is key for full and timely payments.

Powerful Vericle-like technology helps manage denial appeals nationwide and stay current until complete problem resolution. Every time one billing problem is solved, the newly gained knowledge is encoded for recycling. Sharing billing expertise in a central billing knowledge base expedites future problem resolution.

Action on medicare Denial for provider not eligible

Action on medicare Denial for provider not eligible

Medicare reason code of denial

CO-B7: This provider was not certified/eligible to be paid for this procedure/service on this date of service.

CO-38: Services not provided or authorized by designated (network/primary care) providers.

Action on Denial

Services were denied because the date of service on the claim is prior to the effective date or after the termination date of the provider number submitted on the claim.

1: The provider should verify the correct date of service appears on the remittance advice. If the date of service on the remittance advice is not correct, the procedures for having errors corrected should be followed.

2: If the correct date of service appears on the remittance advice, there may be an issue with the effective date and/or termination date of the provider’s Medicare billing number.

Sometime it is necessary to contact Provider Enrollment.

Action on enrolled Hospice Denial from Medicare

Medicare enrolled Hospice Denial and action

CO B9: Services are not covered because the patient is enrolled in a hospice.


Description in easy words: THESE SERVICES ARE DENIED BECAUSE THE PATIENT IS IN A HOSPICE

Action on Hospice Denial from Medicare

There are specific guidelines pertaining to Medicare hospice benefits. Certain Medicare coverage does not apply to a beneficiary that is enrolled in a hospice program.

To determine if a patient is enrolled in a hospice program, contact the IVR, from which the following data pertaining to the beneficiary can be obtained:

1: Hospice effective date
2: Hospice termination date (if applicable)
3: Servicing contractor number

Certain modifiers apply when the services/providers are not related to hospice:

GW Modifier: Services not related to the hospice patient’s terminal condition

GV Modifer: Attending physician not employed or paid under agreement by the patient’s hospice provider

Action on Medicare Denial for Patient cannot be identified

Denial Reason of Medicare

CO 31 - Claim denied as patient cannot be identified as our insured
Description - (PATIENT'S HIC# NONENTITLED. SUBMIT A NEW CLAIM WITH VALID HIC#.)

Action on Medicare Denial for patient not identified

1: make sure that you have a copy of the patient’s most recently issued Medicare card in order to compare that number with the one you are submitting


2: Verify how the beneficiary’s name is listed on their Medicare card and place it that way on the claim (e.g., no nicknames)

3: Verify the beneficiary’s date of birth (DOB)

4: Ensure the numbers are not being transposed (possibly via software)

5: Verify for which part(s) of Medicare the patient is eligible

6: Check eligibility for beneficiaries using the IVR, Call (877) 847-4992; in the menu of eligibility.

7: Resubmit claim with correct Medicare number and patient name

workers compensation in medical billing

Workers Compensation:

Workers compensation is a form of insurance that provides compensation medical care for employees who are injured or sick during the job.

1. Medical treatment and rehabilitation
2. Loss of wages (disability payments)
3. Permanent disability (payments in one sum or weekly or monthly payments)
4. Vocational rehabilitation
5. Compensation to the dependents of employees who are fatally injured (death benefits)

Claim is submitted on CMS 1500 though certain carrier but few required their own. but the basic information which insurance companies are required is
Employeer Information
Injury Date
and other information (normally used in claims)

and without above information, claim will not get paid.

The amount paid by the workers compensation carrier to the provider is in full and final settlement of the claims. Appeal can also be made if you are not agree with the payments. No account should the patient be billed for the balance after a workers compensation claim has been paid.

Claim status calling process

Calling Insurance for claim status

How to call for claim status

A/R callers either take status from IVR or from Insurnace representative , for both IVR or respresentative, A/r caller need to provide below things in order to verify him.

1. Provider name
2. provider ID
3. provider tax id
4. provider NPI

Then you will be able to take claim status and for that you need

1. Patient id #,
2. Patient Name
3. Date of Birth
4. Date of Service
5. Billed amnount on claim

Then representative will let you know

Claim would either not on file, in process, approved to pay , Paid or Denied

If it is paid, You will come to know

1. Allowed amount
2. Patient Responsibility
3. Paid Amount
4. Check Number
5. Check Date

and if there is any Denial, then it will let you know denial reason.

If its not on file, you need to check wheather the claim is submitted or not, and if yes, do check mailing address.

If its in process, then you can ask process days and wait for the process to complete

If its approve for payment, you can payment details.

Accounts Recievable management Process

Management of Accounts recievable in medical billing is responsible to maximize the collections and brining down the accounts recievable , it monitors all the activity related to accounts recievable in such a way to maximize the collection which is a core objective for any billing company.

For the above responsibilities, medical billing company have A/R analyst.

Responsibility of A/R analyst:

- maximize the collection
- Bringing Down the Acconts Recievable
- Reporting related to Accounts Recievable
- meet the Accounts recievable targets
- Keeping track of Electronic and paper Claims
- keeping track of rejection and denials so that further action can be taken on them.
- Keep himself and other departments updated with latest updates in billing
- Cordinate with call center agents (Follow up department) to get the issues solved

In order to bringing down the recivables, get the outstanding claims to be processed completely and for that , one should know about the outstanding claims.

- Claim not in System
- Claim pending
- Claim is in Process
- Claim denied

Claim not in system:

Claim not in system means that claim is not yet recieved by insurance , it can be because of many reason, either The mailing address or information on claim is not correct or the claim is in transit.

Claim pending:

It means that insurance have recieved claim but it is pending because of the information required from provider or patient.

Claim is in process:

it means insurance have recieved claim but it is in process as it take few days to process and the processing time of insurance is different to each other which we will also discuss in next article

Claim denied:

Claim is denied because of defined rules and regulation are not followed , insurance processed them and send EOB which will explain the denial reason.

Medical Billing Process summary
Charge Entry Process
Payment Posting Process
What is EOB (Explaination of Benefit)

Payment Posting Process

Before Reading this article , it is advised you to read about EOB (Explaination of Benefit) First.

Once the claims reach the carriers and they complete processing, they issue a check and prepare an Explanation of Benefits (EOB). The checks and the EOBs would be sent to the pay-to address with the carrier or in the HCFA. Pay-to address is the common address that the provider has set up to receive checks and EOBs from carriers and patients. This is most likely a PO Box address set up in arrangement with the bank where the provider has an account. The checks and EOBs are received on all working days. The bank deposits the checks every day into the provider’s account, prepares a deposit statement and sends the statement, EOBs and copies of checks every day to the provider. The provider forwards them to the billing office for posting.


The Basic Formulae used in Payment Posting is:


Allowed Amount = Paid Amount + Pt. Responsibility

Patient Resp. = Copay + Co Ins. + Deductible

Information can be found on EOB , Billed amount will be found with every CPT , Insurance will allow some amount and paid, and some can go for patient responsibility also , Information on EOB then entered into the claim keeping in view the above formulae. Reason Codes are very important which should be read and entered into the claim.

Its not an end of payment Posting, its not an Data Entry Job , all the claims are not paid, sometime it denied and sometime amount applied for patient responsibility , which can be understand by reading reason code and if there is patient responsibility, then balance should applied on patient Account and if there is a payment on insurance and not processed properly or some mistake , then it should be re-submit to Insurance or transfer to the concern department for furthur review.

Payments can be entered through different methods:

EOB POSTING
LINE ITEM POSTING
ACCOUNT POSTING
etc

Terms which is needed to understand for Payment Posting:

Allowed Amount:


This is the amount allowed by the carrier. Not all carriers and in all circumstances allow the entire amount billed. Certain carriers have fee schedules based on which they make payments. These fee schedules determine the allowed amount. A Fee Schedule is a list of reimbursement amount for each procedure. These vary according to various localities. This allowed amount is the maximum that a carrier will pay for a particular procedure.


Co-Insurance:


This is a part of the allowed amount, which the carrier has determined that the supplementary insurance or the patient is responsible to pay. This will be mentioned clearly in the EOB and should be billed to the secondary carrier or to the patient.


Deductible:


This is an amount that the patient owes the carrier every year apart from the premium. The patient has to pay this amount before insurnace started to pay.

Write Off:


This is an amount that the provider has to remove from his books. There are two types of write off: One is contractual write off and the other one is adjustments. Contractual write off are those wherein the excess of billed amount over the carrier’s allowed amount is written off. The fee schedules of each carrier will be loaded in the billing system. When you are posting the EOBs these fee schedules in the system also called system allowed amount would pop up. The difference between the billed amount and the system allowed amount will be the write off.Adjustments are amounts such as discounts, professional courtesy and other special items that are identified by the provider as those that need not be collected or collected at a lower rate.

EOB - Explaination of Benefits

What is EOB and its Sample

Definition of EOB (Explaination of benefits)

Explanation of Benefits or EOB is the detailed statement of the carrier’s determination of the claims processed. The determination can result in a payment or a denial.

The Explanation of Benefits contains the following information:

- Name of the payer
- Name of the provider
- Pay-to address
- Name of the patient
- Name of the member
- Member id #,
- date of service
- procedure code
- Billed Amount
- Amount allowed
- co-insurance, deductible
- amount paid by the payer. (the amount paid by the payer is equal to the amount shown by the check. )

Sample of EOB:





Click on EOB Picture to enlarge image size

Clearing House Definition - Benfits and Services

It plays an important role in medical billing process

What exactly does a clearinghouse do? Well, for one thing, they check claims for accuracy. But, the biggest thing they do is re-format the data you send to them to a format that a given carrier can read.

How Clearinghouse Works

The billing software creates the electronic file (the electronic claim), which is then sent to your clearinghouse account thorugh software. The clearinghouse then scrubs the claim checking it for errors and then once the claim is accepted, the clearinghouse securely transmits the electronic file to the specified payer with which it has already established a secure connection that meets the strict standards laid down by a HIPAA.

At this stage, the claim is either accepted or rejected, but either way, a status message is sent back to the clearing house which updates the claim's status in your account. It then alert's you that you have an accepted or rejected claim. If rejected, you have a chance to make the needed corrections and then re-submit the claim. Ultimately assuming there are no other corrections needed and the patient's insurance is valid, you'll receive a reimbursement check along with an explanation of benefits (EOB), all very simple. Not

The same sort of activity takes place every night within the federal banking system as our checks and banking activities are sent electronically from local banks to central ACH repositories (Automated Clearing Houses) and then on to banks of origin across the country, and then back to local banks -- all done electronically, and somewhat instantly.

Thus today, you have dozens of regional medical clearinghouses throughout the country all serving the same role; that of scrubbing claims and then transmitting the claim information securely to insurance carriers electronically.

The best clearinghouses offer added features that provide a whole new level of claim intelligence for revenue cycle management that makes their services extremely compelling from a financial perspective, and as well, highly desirable from an office-staff efficiency point of view.

Clearing House Premium services includes:

- Eligibility Verification
- Electronic Remittance
- Claim Status Reports (Know the status of a claim at all times)
- Rejection Analysis
- Online Access
- Printed Claims - Have non-par claims automatically dropped to paper but
still be able to track them electronically.
- Patient Statement Services
- Support

Main Clearing House Benefits

Here are the main benefits of using a electronic claims clearinghouse

Using an electronic clearinghouse to send claims:

Allows you to catch and fix errors in minutes rather than days or weeks
Results in significantly higher claim success --fewer rejected claims.

Allows you to catch and fix errors in minutes rather than days or weeks.

Results in significantly higher claim success --fewer rejected claims.

Rapid claims processing: Submitting claims electronically can reduce your reimbursement times to under ten days.

Eliminates the need to prepare claims and manually re-key transaction data over and over for each payer.

Submit all your electronic claims in batch all at once, rather than submitting separately to each individual payer.

It provides a single location to manage all your electronic claims
Avoid long hours of being on-hold with Medicare and Blue Cross inquiring about claim errors.
Vastly improve vender relationships with insurance carriers.

If you subscribe to a good clearinghouse, you'll be speaking with a knowledgeable support person within just a few rings.

Shorter payment cycles lead to more accurate revenue forecasts.

Reduce or eliminate need for paper forms, envelopes and stamps.

Plain and simple, using a clearing-house will greatly simplify your claims processing.

Charge Entry Process can be found here
Steps ingvolved in Medical Billing and Coding Process

Charge Entry Process in Medical Billing

Summary: This article would help you to understand the required field and procedure of Charge entry:

The document which used for charge entry process is Super-Bill which give basic information of ICD and CPT codes required for Charge Entry.

Fields which required in Charge Entry

1: Patient Account No. (Which is assigned to patient at the time of registration)
2: Facility ID or Hospital ID
3: Doctor ID or Provider ID
4: PCP ID - optional
5: POS (place of service)
6: DOS (Date of service)
7: Member ID
8: Dignostic Codes (ICD codes)
9: Procedure codes (CPT Codes)
10: Modifiers
11: Units
12: Billed Amount - (Billed amount is entered against every procedure code).

Enter all above fields in a claim and amount against every procedure codes and make sure that the tree created between ICD and CPT codes should be correct and enter modifier with procedure code when it is required.

Above were the steps and field involved in charge entry process and claim creation
More Information:
understand the process of Patient Demographic
Complete Medical Billing process

Medical biller

MEDICAL BILLER

Medical Billers is a responsible job who make sure everyone is being billed correctly. Some of this involves talking with patients and/or health insurance companies on a regular basis to make sure all invoices are paid in a timely fashion. The biller should understand how to read medical invoices and coding language. This is perfect spend time on analyzing invoices and data.

Medical Billing at home is possible but there are many scams which advertise medical billing at home and according to US governemt statistics, only 3% of the medical billers are working at home and earning.

Medical Biller in US earn about $13 to $15 per hour.

Medical coder

MEDICAL CODER:

In medical billing, a medical coder is an individual who uses a set of published codes for reporting services provided by a health care provider to an insurer of the recipient of the care

Medical Coders don’t have too much interaction with insurance companies and patients. This job is perfect for someone who would prefer to spend time analyzing and coding data. Every duty performed in a medical office has a particular code assigned to it, and it needs to be coded properly in order for proper billing.

CODER TRAINING:

Medical coding training is necessary in order to perform medical coding understand terminologies. It can be avail from some institute or online.

Few Link which provider medical coding training:
http://www.allalliedhealthschools.com/faqs/medical-coding-career.php
http://www.meditec.com
http://www.ahima.org/medicalcoding/medical_coding_training.asp

Steps Involved in Medical Billing and Coding Cycle

Below are the medical Billing and coding steps and every step have its own importance which cant be neglect and Quality assurance should involve in each step.

steps involved in medical billing:

- Entry of patient Demographics
- Medical Coding
- medical Billing
- Charge Entry
- Claim submission to insurance
- Payments Posting
- Accounts recievable Management and follow-up
- Denial Management
- Management Reporting

Medical Demographic Entry process in outsourcing companies

Medical Demographic Entry process in Outsourcing Industry

Demographic Entry capabilities includes:

• Ability to work off scanned images as well as Electronically Submitted Demographic Entry Sheets
• Ability to correctly process insurance Information (selecting appropriate PO Box etc) as necessary including HMOs, PPOs, IPAs

Demographic Entry process steps include:

1: Demographic information scanned and send through email, fax or directly copy on servers
2: Information then directly entered into software.
3: Internal Quality Assurance performed at three different levels:

- Individual
- Team
- Independent Audit Team

Medical Billing Process

Medical billing process Steps

To Get detail information about these steps, you can check out different articles divided in different categories.