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Why Choosing to Outsource Medical Billing is a Wise Decision?

Medical billing is the most significant helpful resource for the medical industry. Be it the hospitals or clinic, everyone depends on the medical billing. It is a new form of the medical industry. To ensure the smooth financial flow to the hospital, medical billing is essential. There are thousands of big hospitals that rely on medical billing services. Many companies provide medical billing services. 

The medical billing service providers ensure proper billing. Also, they ensure the patients pay off their bills on time. Not just these, but the service providers also focus on insurance payments and accurate billing. Well, it’s an essential regulatory factor for the hospitals to follow medical billing codes. That’s why most of the hospitals have in-house billing staff. But that’s quite an administrative load for the hospitals. That’s why outsourcing medical billing has become a norm in the industry. 

If you are willing to outsource medical billing, then you should do the research. It’s not easy to choose the right medical billing agency. You should follow a few steps to select the right medical billing service provider. Here, we are going to share a few reasons why you should choose the medical billing provider. So, understand more about the reasons and choose the best one.

Why Choose a Medical Billing Service Provider?


Hospitals and clinics prefer outsourcing medical billing. But what are the reasons behind the same? We are going to discuss the same here. Here are a few reasons to outsource medical billing tasks. 

#1 – Cost Cutting 

Maintaining an in-house medical billing staff is expensive. If you do not have good profits, then it’s costly. Supporting the in-house team will dent a hole in your profits. That’s why it is essential to outsource such tasks. The medical billing providers will help you with cost-cutting. The services are so transparent that you can easily cut some costs. 

#2 – Accurate Billing 

Medical Billing providers are very accurate in their jobs. Such companies ensure accuracy while generating bills. As everything is done by abiding the laws, the billing is transparent. While having an in-house billing staff, there may be some discrepancies. But with the medical billing providers, there is no chance of having any discrepancies. To avoid the issues due to differences, outsourcing medical billing is essential. 

#3 – Experience 

Medical billing is a tedious task. The biller has to accurately use the medical codes. Without medical codes, it is impossible to generate medical bills. Also, it’s a tedious task to create the bill and pitch the insurance claims. Well, for all of these tasks, you need a strong experience. The medical billing service providers have a lot of experience in their bags. The new hospitals and clinics may not be able to find experienced staff. So, selecting the medical billing for your business is a must-do thing. 

#4 – Technology 

Medical billing requires high-end software and technology. The maintenance of such things is challenging. When it comes to the new hospitals, they can’t manage such technology. Thankfully, the medical billing services like Park Medical Billing has the latest technology. The sophisticated software programs are made especially for medical billing. As you cannot get hands on them, outsourcing the services is very important. 

#5 – Pricing and Payments 

Outsourcing medical billing helps in cost-cutting. The big hospitals find it very efficient to hire medical billing. Instead of paying the salaries to the in-house staff, they pay the commissions. The medical billing companies work on a commission or percentage basis. They offer minimal commission, which is better than spending the salaries. Also, such companies collect the payments on our behalf and transfer the same to our accounts. It’s a secure payment system for both the patients and hospitals. 

Final Words 

Medical billing is an integral part of the medical business. Hospitals and clinics should have to focus on medical billing and coding. It’s impossible to collect payments from patients without medical billing. In short, without the medical billing service providers, the hospital industry is a handicap. I hope you’ve learned why you should select the best medical billing service, provider. 



How to Select the Best Medical Coding Company for your Hospital? 

Medical billing and coding companies help thousands of hospitals. Medical billing and coding is a tedious task. The hospitals are always on a lookout for the best medical coding company. Outsourcing medical coding is way easier than having in-house staff. With a ton of experience, the medical coding companies complete the job quickly. 

If you are looking to hire a medical coding company, you are in the right place. Hiring such companies right away is not a good idea. You have to do in-depth research. Otherwise, you’ll end up with the wrong company. In short, without research, hiring any medical billing company is very harmful to your business. So, you should carefully select the best medical coding company. In this post, we are going to teach you how to choose the best medical coding company. Follow the steps mentioned in this post. So, you can swiftly find the best medical billing company for your hospital or clinic. 

How to Select the Best Medical Coding Company for your Hospital?


What does Look in a Medical Coding Company?

You can spend hours or even days in research. But we are providing the simplest and most efficient way of research. By following this way, you can easily pick the best medical coding service, provider. So, follow these tips, and look for the best companies in the medical coding field 

#1 – Experience 

In Medical coding and billing, you need to look for the experience. The experienced company will be able to do the job efficiently. They can quickly generate bills. Also, they can easily collect payments and process insurance claims. You might not find the experienced medical coder for your in-house staff. You know why? Because all of the professional coders are employees of such companies. You should get more information about the experience of the company in this industry. 

#2 – Processing Time 

Medical billing and coding is a time-consuming task. Generating accurate bills and approaching the clients takes some time. But it should not take more than a few days. In short, the quick processing time is what you are expecting. Get more information about the average processing time of the medical coding company. Shortlist the ones that have the shortest response time. You want quick results and not time-consuming companies that do no good for business. 

#3 – Office Location

Many people neglect this point. They don’t take information about the office location of the company. With the office location, you can get a clear picture of the company operations. In recent days, many companies are working from outside of the USA. You should avoid such companies. Your top priority should be the companies in the United States. If they are close to your business, then it’s great. Even if they are on the other coast, it’s quite okay. But do not go with the foreign companies that provide medical coding and billing services. 

#4 – Client Testimonials

The client testimonials are the most significant source of identifying company credibility. You can check for the customer testimonials of the companies. Many hospitals are outsourcing medical coding tasks. You can ask your colleague hospitals, other doctors, and check the online reviews. You’ll find the client testimonials everywhere. Gather all the testimonials and filter the best ones. So, ask for recommendations, and you’ll get a lot of them. Use them wisely and choose the best one according to your needs. 

Final Words 

Hospitals and clinics must follow medical billing guidelines. Without medical billing, it’s impossible to run the business. Well, the industry is enormous, and you’ll find immediate help. Instead of hiring the so-called professional coders, you should outsource the job. In-house staff maintenance is expensive for everyone. That’s why outsourcing medical billing and coding is a wise idea. 

Following these four points, you can select the best medical coding company for your business. So, do all the research and outsource your burden of medical billing to the service providers. or you can hire Emerald Health LLC for Medical coding 

What Are The Different Signs Your Practice Should Outsource Its Medical Billing?

For running a medical practice, the most important thing that is necessary is medical billing. However, the overall process for Medical Billing is not always easy as it looks like. The main motive of the Medical practice is to gain good revenue and flourish more in that field. For this, one must keep on with the medical practice and improve the different services that they provide.

Also, you may think that medical billing can be done by yourself. This means that you will complete the total medical billing process in-house. But if you are planning to develop more and flourish then you just contact a medical billing service provider. However, it may need some investments.

But this will help you to recover all kinds of issues related to billing. Also, it helps in making an impact on the bottom of the line. Let us check the different signs depending on which your Medical Practice must outsource its medical billing.

Few Signs of Outsourcing the Medical Billing

Well, there are a lot of signs depending on which the outsourcing of medical billing is done. But you must first find the most important signs. They are given below accordingly:


Engagement of Staffs

To run any kind of organization the primary thing that is necessary is the engagement of the staff. A good staff is what makes an organization reach its top position. Some mistakes that also lead to the decrement of the company’s growth are:

  • Not taking any care for collecting the important details of the patients. Important details mean information on the insurance, correct address for billing, and lots more.
  • Staff working for the organization is taking their things very lightly. They are not giving the necessary effort for taking care of the patient and fulfilling their needs.

However, these things may be a bit difficult for the staff to cope up with. But for flourishing your medical practice, you must look into this matter and take the necessary decision. Otherwise, instead of flourishing, your business will go down at a huge rate.

Not Having a Lot of Experience

Experience in any kind of work is quite necessary for flourishing it. The staff that is present in your organization for medical practice must have such experience.

The experience is necessary because as everything around the world is improving, improvement in medical billing is also very much necessary.

  •  It is almost a full-time job for maintaining all the medical bills. Your staff must be quite well experienced in handling the bills of the patients. This reflects on the service that your medical practicing organization is providing.
  • As the field of medical practice is improving and developing, the various organizations, which provide insurances are also evolving. The staff must be very much aware of these changes in insurance providing companies and work accordingly.
  • The staff of your organization must be able to resolve issues of patients related to billing quite easily. This creates a good impact as well.

Impacts on the Services Provide to the Patients

Well, as we all know a good impact and reputation are all a company primarily needs to flourish. If you are running an organization for medical practice, reputation is very much necessary. This will help in trust-building and further improvements.  To make a good reputation and enrich the brand image:

  • Try providing the best services to the patients.
  • Try to solve the issue with their medical billing.
  • Make sure that they provide a good review against your medical practice organization.

Final Words for Outsourcing the Medical Billing

Thus these are the most important signs for your medical practice that must outsource its medical billing. If you are new in the field of medical practice, you should definitely consult any medical billing services. They will help you with all these methods and guides to improve your medical practice.


Best Methods to Choose the Correct Medical Billing Solution for Practicing

Efficient Billing is the most crucial point in the case of financial health that is necessary for any kind of medical practice. Through the various types of claim processes, billing, collection, and compliance is the most essential factor.

The overall medical organization that is practicing cannot grow without the help of the employees and appropriate billing services. As per the present-day condition, as the competitors in the health care industry is increasing on a large scale. Medical billing is the most important thing that one must look into.

So if anyone who is into any medical practice needs to have the correct medical billing solution, medical billing is very important for success in such a field. Here are some tips that will help you choose the right medical billing solution.

How to Choose the Correct Medical Billing Solution for Practicing


Analyzing the Prices of the Services

Well, if you think that choosing the medical billing company, just looking into the low price, then it is not a good idea. If the medical organization that you are running is moving backward in terms of cost, then it merely indicates that the medical service is not good enough.

In other cases, it is seen that the services that the medical billing company provides are not up to the mark. Honesty is what helps an organization flourish.

1. Low prices are the main attraction for users to use your services. So do not expect that raising the rates will help you attract more consumers. Try lowering the prices.

2. For avoiding any kind of loss or disappointment, you must keenly look into the various types of pricing. Also, make sure that the services that you are providing are good enough.

3. Check the history of the vendor and consider it accordingly. His will help you in choosing the best medical billing provider for your practice.

Check the Transparency

Doctors, in the world of medical science, always have to face some kinds of problems with medical billing services. Let us have a look at those issues first.

  • Delay in the generation of various claims.
  • Having no follow-ups on a daily basis.
  • Promises those which are not true.
  • Bad work.

Well, as soon as you give your commitment to any kind of medical billing services, all you have to do is avoid the above-given things. Solution for the above issue is given below

A solution to Improve Transparency

To avoid all the problems with your medical billing service provider, all you have to do is simply go through and check the history of the medical billing services first. Do not rely on fake promises. Check the transparency practice of the service. Then only rely on them.

Protection of your Data

As we all know that security is the most important thing. The security of essential data in the case of medical practice is quite an important task. And hence, whenever you are willing to choose any kind of medical billing provider, make sure to ask for the following things given below

1. Ask about the total security system they are providing.

2.Check if the security system that they are providing is up to your needs.

3.Go through the total security protocol that the medical billing service provider is offering, for sharing relevant data over a network.

Also, try and see a live demonstration here. This helps to trust more on the medical billing service provider.

Final words of  Medical Billing Solution

Thus these are the three best methods or tips to choose the correct medical billing process. It is more reliable if you want a medical billing services provider, who has been in this field. By the way, it can be suggested that the providers who have experience are the most trustworthy one.



A Quick Guide to improving your Medical Billing Collections

Patients are experiencing a lot of difficulties in paying the high-deductible bills when they are opting for medical facilities. Similarly, it also becomes difficult for all the retail medicine owners to collect payments from all the patients or companies offering insurance. The collections of medical billings are an essential part of today’s healthcare facilities.

Every day many providers are finding it challenging to meet the rising requirements for maintaining the documentation. It further involves collecting payments from patients. To ensure that the process becomes easier, here are the best and effective strategies. You can use it to improve the collections.

How to improve your Medical Billing Collections


The transparent process must be created during the collections

A seamless process during the collections becomes an essential part of improving the collections. Well, most of the patients are well-aware of the expense included in buying the medicines. And hence, it is also necessary for them to know the importance of collections.

When you tend to create a transparent and crisp collection process, you can educate the patients on the costs in the billing. You can bifurcate the entire bill into segments, giving them the right set of the incurred charges.

Managing claims in the right way

Most of the generated medical bills have about 80 percent of errors as per statistics. Most of the claims, because of these common errors, get rejected. Also, when you want to claim medical insurance, you need to produce a bill. It must acquire all the right information included in it. If you end up submitting the wrong data, the claims get rejected, and it might take several weeks for you to correct these errors and reclaim it.

Moreover, make sure that the ID number of the insurance, name, and date of birth is correctly included in the claim form. Also, don’t send the duplicate bills or submit any illegitimate information.

Execute the right coding structures

Most of the medical coders tend to use common and standardized codes when they are processing the claims. This process makes it easier for them to increase their productivity. However, most of these codes can go wrong when there is any set of data missing in the information provided. If the information doesn’t match with the system-fed information, it might break the loop of the coding structure.

And hence, don’t input many digits into the ICD-10-CM, CPT, or any other codes. Moreover, try to avoid using any invalid modifiers and diagnosis codes.

Promptly handle the rejected and denied insurance claims

It becomes essential for you to understand the basic difference between the rejected and the denied claims. Rejected claims are the claims that need processing. This means that the claims are not, however, processed in the system because of various obvious reasons. Denied claims are already processed and hence, they don’t meet the criteria to need processing.

It may happen when the patients have breached any aspects mentioned in the contract. Also, many vital errors you cannot neglect. And hence, in both cases, you will have to deal with it promptly. You will need to ensure that you resubmit within the stipulated deadline.

Tracking Performances and Areas of Improvement

As the healthcare industry is growing at a rapid pace, we have witnessed many changes that are being taken into consideration. Within the healthcare industry, change is being done to improve the experience and efficiency. You can also enhance the billing procedures that you are following to ensure that your ROI is increasing every year. You can make reformations to your strategies and come up with valid billing rules. This way, you can collect more funds from the patients and medical insurance companies easily.

Above-listed is some of the effective and efficient strategies. You can implement within your store to improve your billing collections. It is also essential to make significant changes whenever it’s required as per the market trends and standards. This way, you can maximize your profits or revenue.


Outsource Medical Billing Services – Sit Back and Relax

A well-functioning healthcare company includes doctors and caregivers. But the silent and invisible engines of the medical machinery are its staff. They are in charge of devising and also conducting different services. For example, hassle-free, cost-effective and thorough solutions to claims processing and submission. Outsourcing medical billing services offer massive benefits. These include superior and advance systems, advanced technology, and Improvisation are a few. A skilled pool of labor, knowledge, and organized pattern of the workflow are also a few benefits. Availing third party services for medical billing is a trump card to smoothen bottom lines. It makes the entire process quick. So, it helps companies to achieve better benefits.


Factors For Choosing Best Medical Billing Services

You should not trust your medical billing with the medical coders that have no certification. EHRs make the claims cycle faster and eliminate needless work. Fortunately, Federal government compliance minimizes the risk of data security leaks. Technology smoothens the tedious process of billing. Additional benefits are cost-cutting and acceleration in billing. Denials Management issues are avoidable with automation. Enhancing patient experiences leads to establishing positive relationships. Centralized billing services enhance revenue generation and improve returns. Equipping the in-house team to new work conditions is also of prime importance. Timely and methodical presentation of accounts and reports also leads to success. The increased attention given in preparation of medical documents minimizes errors and risks. Because the reports are prepared by third-party, stronger decisions with increased transparency can be taken. These factors are requirements and consider before choosing medical billing.

Advantages & Disadvantages of Hiring Medical Billing.


# Advantages of Hiring Medical Billing.


1.Increased control and monitoring

By outsourcing the medical billing services, a business does not lose control over the operations. They have greater control and monitoring over its functioning and monetary aspects. A well-trained and committed team of billing professionals increases the overall benefits.

2.Increased Revenue

A large chunk of cost and time in terms of the salary, infrastructure, upgrading of the billing software and purchase management is moderated. Overheads are reduced to a great extent and turnaround time is also less. Timely claims submission and increased returns result in the maximization of revenue generation.

3.Greater focus on patient care.

Providing hassle-free medical service to patients is an ongoing process. Handling the treatment of patients and the billing issues simultaneously is a tedious task. Outsourcing to third parties results in a concentrated focus on a patient’s treatment. so, that leads to patient satisfaction.

4.Reduced billing errors.

The maintenance of health records and claims submission electronically fastens the returns process. It reduces the risk of errors in billing. Because the errors often take place in the old method of medical billing service maintenance.

5.Greater billing compliance.

HIPAA compliant healthcare industry offers medical billing and office solutions to all scales of businesses. A trusted organization will look to ensure comprehensive policies deeply integrated into all operations. Supplementing these policies with internal and external audits makes the process completely secure.

6.Trained specialists.

A Medical Billing Service provider has the team. the team consists of highly professional and skilled medical coders. So, they provide extremely precise billing and claims processing. They review and follow up on all payments and claims. Outstanding claims are tracked until the full payment is cleared, which in turn reduces overheads.

7.Enhanced transparency and consistency

The automatic generation of performance reports provides extreme visibility in billing and claims. There is no need to micromanage the dedicated team of staff. Because The third-party you are going to hire will have to perform certain services for success and take charge of year-round needs.

8.Proper data management and less turnaround time.

Hiring a medical billing company to handle all the billings and upkeep of records ensures organized presentation and greater safety. The electronic claims submissions reduce the turnaround time of processing vital patient data.

# Disadvantages of Hiring Medical Billing.


1.Variable costs

Medical billing companies charge a percentage of the billings and collections of the month. Therefore, the more you bring in, the more you end up paying. So, this makes it very difficult to estimate the expected billing expenditure. Costs tend to rapidly fluctuate between slow and busy months of the year.

2.Hidden fees

Hidden expenses are also part of the transition from in-house billing to outsourcing. Find out whether there are any startup charges, a fee for printing statements and reports or canceling membership. To set up a work arrangement between the medical office and outsourcing company, a legal fee is incurred. Hiring a person to act as the mediator or observer between the healthcare organization will cost you.

3.Hands off the control process.

Outsourcing medical billing might seem an optimum solution but it is easier to talk about it than making it work. It is difficult to relinquish the monitoring and control of the process to another third party.

# Conclusion

Outsourcing allows the healthcare company to deliver the best service. Medical billing services require a lot of precision and dedication. That’s why physicians and also medical practitioners prefer outsourcing medical billing. The healthcare company needs to render high-quality services to patients. This helps them achieve greater goodwill. Also, this helps them contribute to future scalability and patient satisfaction. The hospitals benefit from hiring the medical billing services company. They can outsource all accounting and claim submissions. By doing this, they can focus on forming core business strategies.

hire-medical-billing-company - seven-important questions

Hiring Medical Billing Company – Seven Important Questions to Asked !

Hiring a medical billing company is essential for any healthcare provider. It helps them focus on healthcare services. Instead of working on billing and accounting, they can focus on serving the patients. It greatly reduces the burden of processing daily billings, insurance, collections, and administrative tasks. Outsourcing medical billing activities are advantageous for medium and large-scale organizations. It is vital to know the answers on how to determine our selection of the right billing service. A wrong choice may lead to bigger failure, whereas correct selection can help companies grow many folds. The questions listed below play a crucial role in the success of the business company in the long run. Refer to these questions and choose the best medical billing company.

hire-medical-billing-company - seven-important questions

Q1.What’s the Work Experience of Medical Billing Company?

The complex medical billing services industry can be conquered by sheer experience, not certification. The majority of the claims to be submitted are pretty straightforward. However, it is vital to coping with the rapid surge in the billing at unforeseen times. With a robust skillset, knowledge, and experience of the staff, such situations can be dealt with. Continuous ongoing training and keeping the staff up-to-date is what makes them irreplaceable. Therefore, for large scale of business operations with a range of specialties should avail the services of a third party. It applies for medium-sized projects looking for expansion shortly as well.

Having another doctor’s reference, which has opted for a similar service, gives a hands-on view of the service provider.

Q2.Will my organization’s revenue generation increase in the future?

Get an explanation and logical rationalization behind the promised benefits and the actual benefits received. Outsourcing the task of accounts and delivering billing services, reduces time spent on training staff in-house, and also reduces payroll. The third party is likely to be more organized in recording claims, and this leads to timely responding to claims.

Q3.What are the types of reports service providers will offer?

The presentation of reports certifies the efficient functioning and smooth workflow of the billing process. So, the Accounts Receivables report reveals the claims left unpaid by the insurance companies. The Payment Trend Report displays collections receivables from patients to clear their claims. The Key Performance Indicators explain the most profitable procedures. Vital revenue decisions can be made based on the Insurance Analysis Report. Keeping a solid track of the pending payments is necessary for the patients with the Patient Payments report. Noting the clearinghouse rejected claims helps in identifying a pattern and common issues to avoid future claims.

Q4.How much is the service likely to cost the company?

Pricing is the primary factor that comes to our mind before hiring the services. Satisfactory outcome entrust him with maintaining the coding and claims submission task. It is important to clarify whether it is a flat rate or a percentage. In the case of adopting a percentage, the rate will go down as the claims collection goes up. One should also clear his mind by being aware of add on fees that pop up at later stages. These fees include start-up fees, termination fees, patient collections follow up, and conversion fees, if any. Fees are usually lower in the start because it is calculated excluding the monthly cost.

Q5.How is the Handling of my Accounts?

Be it privacy and confidentiality of patient data or their reporting frequency; both are essential. It is necessary to provide customized and on-demand reports. Handling of accounts become insured and transparent when the staff knows billing software and sustainability. The handling of accounts becomes insured and transparent when the staff knows the standards and billing procedure. HIPAA law governs that all entities comply with the pre-specified regulations to keep the data safe. That’s why the Compliance officers also do the periodic checks to be certain about the security.

Q6.Is Your Medical Billing Company has Affiliation with Local Businesses?

Choose a billing company, which is well informed about the regulatory modifications and industry changes. All reputed companies have personal, and project-based references and billing agencies’ conduct is expected to be the same with all its client companies. The best way to judge the suitability of the medical billing company under question is looking for contacts and feedback from previous clients. So, the Billing organizations joining local associations show greater responsibility and desire to build a strong positive association.

Q7.Does your company offer assistance in Denial Management and Plan for Emergencies?

The professional denial management team handles the rejection claim smoothly. It aids in tracking billing registrations and medical coding process weaknesses. It also aids in reducing the same issues from occurring in the future.
Medical billing is the key to the success of a healthcare organization. It can upset not just a few patients. But it also leads to a great deal of money and reputation loss. A sound backup plan ensures the continuity of service. In case of any unforeseen emergencies or natural disasters, the backup plan comes to rescue.

Search for a responsive medical billing company

You’ll get clear insights for choosing Medical Billing Service providers from these seven questions. Speed and availability are factors healthcare providers look out for. The prerequisite of a good medical billing company is to have a constant flow of revenue. But it should without compromising with patient needs. You should not allow the administrative burdens to hamper your patient’s treatment. Hiring a Medical Billing Services company will ease the tension and discomfort.


Role of Medical Billers and Coders in Healthcare :Everyone Must Know

Coders and billers are amongst the top-most career choices and highly valuable service areas in the healthcare industry. To complete the patient’s care cycle, there aren’t just the doctors and nurses in the scene. Of course, theirs is a huge role but they aren’t the only ones who are on the go! People working at the backend too have a vital part to play in the institution’s successful functioning. If the coding and billing job isn’t carried out efficiently, the healthcare institutions won’t get paid. The efficacy of the skilled personnel is what literally compounds or alleviates the patient’s stressors. Moreover, retaining high levels of proficiency makes the reimbursement process as ethical and optimal as possible. So, if you are a certified professional, you are wanted. There’s a nationwide requirement for medical coders and billers.

Role of Medical Billers and Coders in Healthcare.


Medical Coding

From the point of examination to the tests and the treatments, a medical coder assigns standardized codes to all of the procedures that are used during the billing process. Based on these specific records, the collection process is initiated. Essentially, there are three different code sets that a medical coder deals with regularly. These include:

ICD Code – International Classification of Diseases

CPT Code – Current Procedure Terminology

HCPCS Code – Healthcare Common Procedure Coding System

Now that you have a hint of what’s medical coding about, let us get into the details of the code sets. Since these are what you’ll be working with, it is important to have a know-how of the three major types of medical code sets.

DIAGNOSIS CODES – Demonstrate the medical necessity

ICD Code – International Classification of Disease

Established by the World Health Organization (WHO), this set of codes came into use from the 1940s. Several updations have been made since its inception and the numbers that follow ICD— inform that exactly which revised version is currently in use. The ICD codes are diagnostic codes that describe the cause of an illness or the patient’s death. So for instance, in the United States, ICD-10-CM refers to the International Classification of Diseases, Tenth Revision, Clinical Modification (technical name). Talking of the ICD-10 code set, it contains around 10,000 code. However, on the other hand, the ICD-10-CM (Clinical Modification) code consists of more than 68,000 codes. All in all, the ICD codes tell us about the correct diagnosis of a doctor along with the patient’s condition. This is how billing makes sense – the procedure matches the diagnosis and the claim is accepted.

Plus, to give you a bigger picture, as a medical coder, you will have to deal with more than 60,000 Diagnostic Codes and somewhat 70,000+ Procedure Codes.

PROCEDURE CODES – Alerts the payer of what procedures have been performed

CPT Code – Current Procedure Terminology

Published, maintained as well as updated (yearly) by the American Medical Association, the CPT code set documents those procedures that are majorly performed at the physician’s office. The codes are even copyrighted and consist of three categories that are all based on five-digit numeric codes. To elaborate on these, the categories are as follows:

Category I corresponds to Medicine, Anesthesia, Surgery, Evaluation, and Management, Pathology, and Laboratory along with Radiology.

Category II includes an alphanumeric code which is usually added alongside the category 1 code. These, however, are optional code sets but AMA anticipates these to lower the administrative burden. The codes are more accurate, specific and informative on the performance of the facilities as well as the healthcare professionals.

Category III codes relate to the technological emergence in the medical field.

As a medical coder, you are supposed to be dealing more commonly with the Category I and II CPT code sets. Addendums used with these CPT codes add more accuracy. Various procedures need supremacy when it comes to detailing. So, this is when the CPT Modifiers come into play. These are again developed by AMA having two-digit alphanumeric codes. CPT modifiers offer you additional information, for instance, on which side of the body a procedure is performed or has it been discontinued, etc.

HCPCS Code – Healthcare Common Procedure Coding System

Shortened to just Hick Picks, these codes are developed by the Center for Medicare and Medicaid Studies (CMS) and are maintained by the AMA. So, things that aren’t covered by CPT codes including any medical equipment, procedures, and services come under HCPCS. Besides, it also is relevant for services such as outpatient hospital care, Medicaid, and Medicare, and chemotherapy drugs, etc. Hick Picks consists of two different levels:

Level I – This one’s very much like the CPT code sets

Level II – This one’s divided into 17 diverse sections each of which concerns just the specificity such as Rehabilitative Services.

Hick Picks must align with the diagnostic code to justify a procedure. All of this is again the medical coder’s responsibility and to also ensure that the doctor’s reports are accurate in terms of the diagnosis listed along with the procedure that’s mentioned.

Medical billing

Under this section, we will introduce you to the basics (not in-depth) of medical billing so you can understand the day to day activities of a professional medical biller. Now that you are aware of what are the duties of a medical coder plus the practice of specialized code sets, here comes the role of the medical biller. He/ she is responsible for using the ICD-10 medical codes which are provided by the coder itself and accordingly produce the bill. So first, the biller will create a claim for the insurance provider. Next, the company evaluates whether the claim is genuine and makes the returns. Lastly, the medical biller determines the patient how much they owe out of their pockets. It is the medical biller’s hard work that makes the after-processes much simpler. All of this is done on the patient’s behalf and therefore the billing process is easy to understand. It is a comprehensive process but an integral job in the modern-day health care industry.

Although the diagnosis and procedure codes track the effectiveness of a procedure or the spreading of disease, in the United States, their major use is during the reimbursement process. So, the codes help you bill accurately. Going to the doctor isn’t a one on one interaction process. It’s a part of the larger system – a system of information exchange as well as the payment. This is a three-party system that includes the patient, healthcare provider along with the insurance company. Healthcare providers may include physicians, hospitals, therapists, emergency rooms outpatient facilities, etc. It is the duty to negotiate as well as arrange the payment that makes the institution survive (essentially). If you are wanting to enter this sector, understand that you will always have to make sure that the healthcare providers are accurately compensated for whatever services they perform or the facility they provide. Information regarding the patient as well as their procedures is compiled into a bill for the reference of the insurance company also called the claim. This may contain details such as insurance coverage, patient’s medical history, demographic info, procedural reports and so on. So, precisely interpret the insurance plan and produce a particular patient’s claim documents.

As a biller, you will add essential information concerning What, Why Who, When along with How Much. The documents are to be both formally as well as factually accurate. Once the claim is compliant, it is sent to the payer. After the approval, it comes back to you with the amount they will segregate. You will then ask the patient to cover up the balance.

Everyday Activities

1.Working with the patients

After the completion of any medical services for a patient by the health providers, the patient is presented with a bill. This bill lists the cost of the procedure, balance, amount covered by insurance company along with factoring the deductible. You are also responsible for dealing with the medical records of the patients.

So, where the coders are there to translate the patient’s medical records from the reports into the desirable codes, a professional biller extracts those records as well as the insurance plans to precisely produce the medical bills.

2.Working with computers

The healthcare industry, or for that matter any line of business today makes use of one or the other personalized software. In hospitals or clinics, these are particularly employed to keep track of the patients, schedule the visits, store the essential medical data and therefore, help the business run smoothly.

3.Creating claims

A major part of the biller’s day is spent in creating as well as processing the medical claims. You must be familiar with the type of claims that will be accepted by the patient’s insurance firm. Consequently, adjust the claims and make sure it’s compliant. Usually, the claims are clean and processed much easily which effectively accelerates the reimbursement process.


This is a vital activity of a professional medical biller. You are constantly conversing with all the people involved during this process. You are the ultimate waypoint in the process along with being responsible and accountable for notification, clarification, and follow-up.

To sum it up in simple words, Procedure Codes deal with the WHATs of the patient’s visit and the Diagnosis Codes determine the WHYs. However, it is the biller’s effort to create an appropriate medical bill that will, in turn, let the services going.

5 ways Emerald Health Medical Billing will help you in 2020-Easy Steps✅

In the modern-day world, we search for two things in any system. First, it should be simple to use, it should be efficient in a matter of cost and time, and third, it should be effective. When it comes to financing it is even harder to manage without professional help. So here we will discuss 5 ways Emerald Health Medical Billing will help you in 2020.

Emerald Health is obliged to take care of your medical billing services for you. We are focused on the unique needs of every practice. With the expertise in every kind of medical speciality, we are bound to give you a stable billing service. You can outsource your billing and be relieved from that stress by handing it over to the best professionals. We will ensure your media claims achieve the best first-pass rate possible. Each claim will be manually checked before sending and then every claim is followed upSome may believe that outsourcing the medical billing will lose control, but in reality, due to professionals handling your services, it will increase your control over the process. Thus, resulting in increased profitability and the efficiency of work. So here’s how in 5 ways Emerald Health medical billing will help you in 2020.

Top 5 ways Emerald Health Medical Billing will help you


1.Efficiency in the Process

As we’re getting closer to the future, the only thing constantly making its way is efficiency. This system will increase your efficiency by reducing the processing time and paperwork in the manual billing. The people handling it will be professionals so they understand how the system works. It will reduce your stress for any excess procedures that need more attention.

2.Errors will Reduce

When there’s only one team doing different tasks, the chances of human errors will increase. For eg. If your single team of doctors is taking care of your medical billing, the probability of errors increases. Outsourcing your medical billing to the people who expertise in their fields will actually minimize the errors in the process.

3.Reduction in the Economical Expenses

If we want to cater to the medical billing service in the house, then it will actually require a dedicated team of people which in turn means catering to larger staff requirements. This is the very reason medical facilities prefer outsourcing their medical billing.

If you outsource your billing the staff requirements at your facility will decrease and a team of professionals will do the same work for you at a minimal cost. And they’ll find the most cost-efficient way of doing so.

4. The Delay in the process will be Reduced

The deadline is the most crucial thing. In house team handling multiple things can result in a delayed process. Outsourcing it to the team who are appointed for doing medical billing, will decrease the delay in the claims and billing procedures to a great extent.

5.Improvement in the Management

Once you outsource your billing process you in house staff can take care of their assigned task with complete concentration. It is also a great way to increase the admiration of your hospital. Doctors are known for their noble profession of catering and serving the needs of their patients, Emerald Health Medical Billing relives the administration to concentrate more on patients and relives them of any stress related to billing. The goal of Emerald Health is to help you grow and simply the patient’s care.

In conclusion, Outsourcing of Medical billing is most efficient and futuristic. It will save the most important resources you have i.e, time and money. We are in 2020 and we need efficiency in every aspect of the system which it has to offer. Thus, this is how 5 ways Emerald Health Medical Billing will benefit you in the year 2020.

5 Ways Professional Medical Billing Service Can Improve Your Bottom Line

Some practices feel that outsourcing their medical billing may result in a loss of control. Here are 5 Ways Professional Medical Billing Service Can Improve Your Bottom Line.

In fact, outsourcing your medical billing and revenue management to a trusted, professional service improves your control over your billing, revenue, and bottom line.

Practices that have outsourced their medical billing have seen an increase in profitability, productivity as well as patient satisfaction.

5 Ways Professional Medical Billing Service Can Improve Your Bottom Line

1. Reduced Staffing Costs

expert billing specialists doing medical coding

Reduction in staffing and overhead costs is a big reason why many small and medium medical practices outsource. Medical billing and claims processing requires a team of people if you wish to manage it efficiently. Hiring, paying salaries and benefits, training and overheads can make it quite expensive for a small or medium-sized practice.

On the other hand, when you outsource to a professional service provider, they are able to achieve economies of scale, providing the same function at a fraction of the cost.

2. Efficient Processes

Outsourcing billing and administrative tasks make in-house processes smoother and reduce paperwork.

3. Minimizing Errors

Outsourcing to a service provider who has expertise in billing and coding can help your practice reduce the loss of revenue associated with claim denials. Accurate coding and claim submission improve your practice’s cash flow and bottom line.

Chiropractic Billing and coding process

4. Reduce Payment Delays

Delays can hit your bottom line. In the case of in-house billing, your staff needs to divide time between claims processing and patient-centered tasks, such as answering phones and collecting information. This means delays in submitting and following up on claims.

5. Improve Patient Satisfaction

When you outsource your medical billing, your in-house staff is free to help and support patients. Happy, satisfied patients who receive prompt services are more likely to come back and refer to others. Faster and accurate claims processing also contributes to better patient satisfaction.

5 Ways Professional Medical Billing Service Can Improve Your Bottom Line

To learn more or to take advantage of the top specialty medical billing services in Massachusetts, such as internal medicine billing service or pain management billing company, call or email Emerald Health LLC in Massachusetts at 855-650-9906 Today. Emerald offers a free revenue cycle assessment and phone consultation. With an A+ rating, Emerald Health helps small-to-medium-sized medical practices improve their bottom line.