All posts by yivanov@emeraldhealthllc.com

medical-coding-procedure-for-laceration-repairs

Medical Coding Procedure for Laceration Repairs

The Stitches, sutures, and wound covering comes into the Laceration repairs category. The insurance companies reimburse the medical bills for laceration repairs. That’s why it is essential to coding the bills for getting approval from the companies properly. If you are not sure how to make medical bills for laceration repairs properly, then you are in the right place. In this post, we will share detailed information on the medical coding procedure for lacerations.

Medical Coding Procedure for Laceration Repairs

medical-coding-procedure-for-laceration-repairs

How to perform Medical Coding for Laceration repairs?

Here are a few points that you should consider before coding for the bills. It is essential to understand the nature of the repairs and get the job done effectively.

#1 – Light Repair or Deep Repair?

As a medical coder, you should understand if the sutures or stitches are light or deep. If the stitches are to the uppermost part, then you should use simple repair codes. If the physician has stitched deeply, then use the intermediate laceration repair codes.

#2 – Location of the Stitches

Identifying the location of the stitches holds the utmost importance. The simple and intermediate laceration repair codes are categorized accordingly. As a coder, you have to choose the appropriate code for the location of laceration repairs.

#3 – Length of the Injury

Most of the time, the medical coders forget to record the length of the injury. It is essential to identify the length of speedy processing. Check the medical reports and mention the extent of the injury in the bills.

#4 – Number of Wounds

It’s sporadic for doctors to repair only a single wound. There must be multiple wounds sutured by the doctors. For the same, you should always check the number of injuries and code the bills accordingly.

#5 – Suture Removal

The stitches and Sutures are not permanent. The doctors will remove the Stitches sooner or later. But, the suture removals are not chargeable, and there is no need to code the same

Most uncomplicated Procedure for Laceration Repairs

The medical biller should always carefully check the medical reports. Without the same, it’s quite challenging to get the bills right. Bills should include all the Stitches and the Wounds. According to the points mentioned above, you should add the medical codes.

Considering the location of the injury, several wounds, and deepness of the same, you should select the codes. Fortunately, the simple and intermediate laceration codes do have classifications. So, choosing the right one is crucial for quick processing from the company.

For the closures of the wounds, the biller has to consider the depth. For the layered closures and stitching, the intermediate codes should be used. And for the fine stitching on the upper parts of the skins, the simple primary medical codes should be applied. In short, for the simpler procedures, the simple codes are applicable. For the problematic and complicated process, the intermediate code combinations should be used.

There are some complex billing codes. Only Deep Repairs require complex ICD and CPT codes. If the physicians or surgeons go beyond the layered repairs, these codes are used. The lesions and the stitches on the integumentary system are billed under the complicated codes. They are very rare and not used very often.

Final Words

Medical coding and billing is a challenging task. It requires speed, knowledge, and the precisions to code the bills. Well, the laceration repairs are one of the most common types of repairs that physicians do. Fortunately, the insurance companies accept the laceration repairs for reimbursements. This is what the American Medical Association has prescribed as the procedure for laceration repair billing and coding.

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HIMS Coder Educator – Career, Education, Salary and Additional Skills

Amongst all of the available jobs in the Medical Billing industry, the HIMS Coder educator is the most lucrative job. It is one of the most prestigious jobs in the industry, which is loved by millions. Well, if you are interested in this job profile, you need to know about everything. Here, you’ll get every bit of information about the job of HIMS Coder Educator. 

HIMS Coder Educator – Career, Education, Salary and Additional Skills

hims-coder-educator-career-education-salary-additional-skills

Roles and Responsibilities of HIMS Coder Educator 

The role of the HIMS coder educator is very diverse. But it mainly involves training individuals who have joined the field of Medical billing and coding. Here are a few core responsibilities of the HIMS Coder Educator, which you should know. 

1. Creating in-depth Study material and training modules for the HIMS coders. Along with the same, the HIMS Coder Educator has the responsibility of conducting the training sessions. 

2. Training the Staff with the Technical Aspects of the Billing Systems. In short, it’s Information Technology training with essential software programs. 

3. Preparing and maintaining the Departmental Training records and study materials. 

4. Reviewing and Understanding the Core performance areas of the new trainees. 

5. Develop an Educational Calendar for the Training Sessions for new joiners. Coder educators need to maintain the educational calendar. 

6. Working as the Knowledge Support Specialist to provide onsite technical support to the newly joined trainees. 

7. Keep the staff updated with the latest Regulations and the Medical coding standards. 

Educational Qualifications for HIMS Coder Educators

The role of the HIMS coder and educator is full of responsibilities. With the job of training all of the newly joined recruits, the coder educator needs to know the industry. Here are the educational qualifications required to become the HIMS medical coder educator. 

1. The Coder and Educator must have the necessary knowledge in the medical industry. The candidate must possess the Degree of Masters in Business Administration from a recognized university or college. 

2.Must have received Advanced Training in Health Information Management Systems principles and the adult learning principles. 

3. The candidate must have advanced knowledge of the Medical Coding and Billing regulations. Also, he/she must know the medical staff rules and regulations. 

4. The understanding of Medical terminologies, rules, regulations, standards, and laws regarding Medical coding and billing is a necessity. 

5. Having a Certification in Medical Coding is beneficial along with the RHAI, RHIT, and CSS certification. 

Salary Estimates for HIMS Coder Educator 

The salary is the only thing many people join this industry. The pay scale in the medical billing industry is better than the other sectors. According to the reports from 2012, the average salary of the HIMS Coder Educator was between $50,000 – $75,000/- per annum on average. The salary fluctuates depending on the skill set of the employee, company size, workload, and expertise. 

Soft Skills Requirements 

Every job profile requires a set of soft skills. Without the soft skills, the original skillset of the employee becomes ineffective. For the job of HIMS Coder Educator, these are the soft skill requirements. 

1.Must have Effective Educational, Training, and TeamWork skills. 

2. The HIMS coder educator must possess sophisticated communication skills. 

3. Advanced knowledge of the Healthcare management software programs is essential. 

4.Must have the Knowledge of Quality Assurance and Accreditation standards in the industry. 

Scope of the HIMS Coder Educator Job Profile | Final Words

The Medical billing and coding industry is flourishing rapidly. With the growth in the medical industry, the requirements of the coders and billers are increasing. Well, the HIMS Coder Educator has the most responsibilities in the company, as he/she has the job of training the recruits. HIMS educators usually work in the hi-tech environment in the large offices. So, nothing is frustrating in the work environment. Although the job profile requires you to handle the physical records, so it’s beneficial if you have some physical endurance. Otherwise, there is nothing wrong with this job profile for anyone looking to enter the industry. 

medical-coding procedure-for pre-operative insurance clearance

Medical Coding Procedure for Pre-Operative Insurance Clearance 

The patients who are in critical condition are brought to the hospital. In such cases, the doctors have to provide medical care to such patients immediately. As the patients will have insurance coverage, it is essential to start the pre-operative and post-operative clearances from the insurance company. The authorization is possible after determining the medical condition, but for the pre-operative checkup, you should file for insurance clearance. 

Many medical coders fail to properly file the insurance clearance for a pre-operative checkup. The insurance companies are quite strict about issuing reimbursement for the same. That’s why proper billing and coding is essential. In this article, we will learn the correct medical coding procedure for pre-operative clearances. 

Medical Coding Procedure for Pre-Operative Insurance Clearance

medical-coding procedure-for pre-operative insurance clearance

Pre-Op Clearance and Authorization Issues 

Most of the insurance companies do not provide pre-op clearance. The insurance companies don’t treat the pre-operative checkups as a necessity. In rare cases, the companies offer approvals to the doctors. Some of the medicare checkups are covered under the insurance. Sometimes, the companies don’t accept the claims even if they are known as the medical necessities under different acts. 

Pre-Op Clearance Requirements 

According to the experts, getting clearance from the insurance companies is a tedious task. That’s why they’ve prescribed the requirements that ensure timely issuance of the authorization. Here are the pre-operative clearance claim requirements. 

1.Reference to the request of pre-operative checkup requirements. 

2.The specific Medical Condition that requires the pre-operative checkup by the Physician. 

3.Request or recommendation from the Physician for conducting the pre-operative checkups as a medical necessity. 

Procedure for Obtaining Pre-op Clearance 

When the patient is presented to the hospital with the preexisting medical condition and the checkup requirement, the standard operating protocol should be followed. Here is the exact procedure for filing the claim for pre-op clearance. 

1. Collect the documents with the patient’s name and medical condition evaluation. 

2. Forward a copy of the documents to the evaluations and management service. After that, send the same to the surgeon or Physician. So, they will provide a recommendation for the procedure.

3. Use the correct Medical code for Primary Diagnosis. 

4. Use the appropriate medical code for secondary diagnosis. (If Any).

5. Code any other diagnostics if prescribed by the Physician. It is essential not to miss any condition before filing the claims for clearance. 

Using appropriate medical codes is essential. Without the same, it is doubtful that the patient will get medical clearance from the insurance company. There are different ICD-10 codes for various pre-operative conditions. 

According to industry experts, doctors can bill for standard pre-op procedures. The condition for the same is to reduce the overall package. So, the pre-operative charges can be adjusted in the bills. It is possible in emergencies, but the medical companies don’t allow the same. 

Final Words 

Getting insurance authorization for the pre-operative conditions is essential. As the people who have eye surgery might require treatment for hypertension, getting reimbursement for the same is beneficial. That’s why it’s an integral part of medical coding to do the perfect coding and billing. In this post, the coders will get an idea for preparing the exact coding for obtaining pre-op checkup clearance from the companies. 

What is the Difference Between DME Supplier and DME Provider

The DME means nothing but Durable Medical Equipment. The DME’s are often useful for a long time for the patients. The items such as Walkers, crutches, wheelchairs, bath chairs, etc are Durable Medical Equipment. The doctors may provide the patients with the DME. But sometimes, the doctors may prescribe to buy them from the certified DME supplier.

For the medical practitioner, the Durable Medical Equipment Regional Carrier (DMERC) license is essential. The DMERC license is useful for dispensing Durable Medical equipment. If the insurance supports the DME under the coverage, then the medicare patients need to have the DMERC license. There are several types of Medicare insurance covers. Some covers hospital care costs. Others cover the cost of providing services. But there are a few insurance companies that cover the DME supplies. The DMERC system defines the differences between the DME supplier and DME provider. Here is the difference between the DME supplier and DME provider.

Difference Between DME Supplier Vs. DME Provider

DME Supplier

The term DME supplier constitutes physicians, chiropractors, and others. The DME supplier can supply the DME in certain cases. The supplier is the person who dispenses Durable Medical equipment. The third-party seller can be the DME supplier. For claiming the insurance reimbursements, anyone should have the DMERC license. The certified suppliers are the only ones that can recommend the DMEs to the patients.

For the DME’s that are purchased, the reimbursement for repairing, maintenance, and replacement is covered. Only a few products are liable for insurance reimbursements. To claim the reimbursements, the DME supplier should obtain a signed, dated, and written contract from the member.

DME Provider

The DME provider is the one who is requesting the DME from the supplier. The licensed DME provider should recommend the necessary equipment to the patient. If the equipment is covered under the insurance, it should have proper maintenance terms. The rental of the DME is possible in a few cases. When the equipment is on the rent, it is owned by the DME provider.

The DME provider always supplies the equipment to the patients. So, the provider will charge the rental and maintenance fees. That differs according to the patient’s condition. In short, the DME provider prescribes or orders the DME from the supplier. Also, the provider may rent the equipment as per the requirements.

Final Words for Difference Between DME Supplier Vs. DME Provider

Durable Medical Equipment requires proper installation and maintenance. This helps the patients to stay in a safe environment. The DME supplier and providers must train the patient and caretakers. They should train everyone to properly use DME. So, to stay eligible under the Medicare part B insurance system everyone should get third-party accreditation.

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How Work from Home has Changed Medical Billing Industry

Due to the pandemic situation worldwide, no one is willing to work from the office. To all of the digital jobs, a Work from Home solution is adopted. Every job that requires the use of computers and the internet is now a remote job. The employees can sit in their homes and do the job from the bedroom. The medical billing industry is not an exception to the online revolution of Work from Home. Fortunately, the medical billing industry works in the backend and doesn’t have to be on the field, i.e., the hospitals.

The backend work can be done from anywhere. Be it the office or the bedroom of the employee. Only the computer and working internet connection is what needed to work from home to the medical billing industry employees. But the pandemic situation has changed the medical billing industry very much. In this post, we will discuss the various aspects of the medical billing industry, changed after the COVID-19 pandemic, and the work from home culture.

How Work from Home has Changed Medical Billing Industry

how_work from_home has_changed_medical_billing_industry

What Does a Medical Biller Do?

The medical biller, as the name suggests, creates the medical bills. They bill the insurance companies on behalf of the patient. It’s the job of the medical biller to create a proper invoice. He has to use the appropriate billing codes while creating the bills. The same bills are then sent to the insurance companies for approval. As the hospitals, be it small or big find it difficult to file the claims manually, the medical billers do the job with ease.

That’s how the medical billing industry works. Creating the appropriate bill is not the only job the billers do. They do have to work on the receivables and get the payment done. They have to contact the insurance companies and get the insurance claim approved. It’s a tedious job that involves a lot of raw skill.

Changes Brought by Work from Home Culture

Most of the offices are closed for now. To prevent the infection, it’s better to close the offices and follow social distancing. That’s why most of the medical billing staff is working from home. The exception is for those who are working as in-house hospital staff. Most of the medical billing employees have received the work from home assignments. Here are a few changes in the industry, brought by the WFH culture.

#1 – Realization

Yes! Realization is the first change in the medical billing industry. Most of the industry experts thought that Work from Home is not possible for this industry. According to a few experts, WFH culture would never thrive in this industry, unlike the software and IT industry. But, everyone has now realized that it’s possible. Now, the industry has a proper system that allows the employees to work from home.

#2 – Software System

Almost all of the medical billing companies have a unique system in the offices. But now, they had to get the system setup for every employee. The issue of software compatibility arrived here. But the IT teams and software vendors already had the solutions for this issue. Due to the unique software programs designed for Work from Home management, it became more comfortable for the employees to start working. The Desk monitor software, attendance software, team meeting software, and the billing software itself. The initial setup stage was tedious for almost everyone, but after a few days, everything is set up. All of the companies are working from home, and the offices are closed.

#3 – Cost-Cutting

The most significant benefit that any company has noticed is cost-cutting. This lockdown and work from home resulted in automatic cost-cutting. The companies now don’t have to bear overhead charges for office space. They don’t have to incur the electricity charges for the office. Also, they don’t have to worry about the transportation of the employees. As everyone is in the home working hard on computers, it’s saving a lot of money for the companies. Except for the office rent, there is no need for paying other bills, which always costs a lot.

#4 – Productivity

It’s one of the most important factors to consider. Most of the employees thought that they couldn’t work correctly from home. As you are in your comfort zone, laziness will kick in, ruining productivity. Also, as there is no one to keep an eye on employees, the companies cannot check if the employees are working or not. Fortunately, nothing like the loss of productivity happened. It was the first few days that had a loss of productivity, but fortunately, everyone recovered fast. Now, the companies have a system to track productivity, check the project completion status due to the sophisticated system.

Final Words

This is indeed a difficult time for almost every industry. Due to the increasing spread of the virus, the health system is overwhelmed. That’s why it is better to stay safe and work from home. Fortunately, the medical billing industry has gone through a lot of changes. The positive changes have paved the way for a fully-online working system. Nowadays, almost every aspect of the business has gone online. So, in the future, Remote Medical Billing companies will work efficiently in the market.

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How to Efficiently Handle Medical Coding for Cardiology Coding and Billing 

Cardiology is one of the toughest medical expertise fields that has a lot of demand. Due to the increased heart complications, the patients are facing Cardiology procedures in the hospital. Fortunately, all of the insurance companies do support the Cardiology procedures under insurance coverage. So, it’s easier for patients to undergo the necessary treatment. 

But for the medical coders and billers, it’s hard to handle the cardiology coding and billing. It’s the most complex part of medical coding and billing, with tedious procedures, multiple complications, frequent changes, and whatnot. The external factors are non-adjustable. But factors like knowledge of current standards, delays, and human errors are possible to avoid. Well, in this post, we are talking about cardiology billing and coding. We are going to share the tips for efficient medical coding and billing for the cardiology department. 

Efficiently Handle Cardiology Coding and Billing medical-coding-for-cardiology-coding-and-billing 

There are multiple ways to handle the coding and billing for cardiology efficiently. Well, all you have to do is to follow these tips and get the job done easily.

#1 – Reduce Human Errors

The human errors prevent the bills from getting approved. Without approval or authorization, the hospital won’t get money. You are being paid for getting the bills approved. As the new medical billers find it difficult to memorize the ICD-10 and CPT codes, you should try to memorize them. Memorizing the ICD-10 and CPT medical codes will help you reduce human errors. 

Also, not hurrying up depending on your memory is essential. It would help if you did not hurry while making the bills and using the codes. Sometimes, you can mix up the codes, and that will reject your bills. So, carefully check the medical condition and then enter the medical code. 

#2 – Staying Up-to-Date with Coding Standards 

Medical coding standards are always changing. The standards become outdated in a few months. So, it’s essential to keep track of the medical coding standards. Usually, the companies take small workshops on updated coding standards. But if anyone has missed any of them, then it might be the problem. So, staying up to date with the latest medical coding standards proves to be an efficient way. 

#3 – Counting Comorbidities 

The comorbidities are the conditions, which are present along with the current illness. The doctors may discover additional illnesses. The underlying conditions might be causing cardiac illnesses. If the billers include the same in bills, then it will attract more reimbursements. With the additional illnesses, the patients might receive more reimbursements for additional care. 

So, coding additional illnesses is beneficial. For example, the doctors may find diabetes in the patient getting treatment for a heart attack. So, you should add the code for diabetes in the bill to get additional reimbursements. 

#4 – Combination Codes in the Bill 

For the conditions that have comorbidities, the combination codes are present. Using the combination codes increase the relevancy and chances of approval. For example, the medical code for congestive heart failure with acute kidney injury would be a combination code. It’s different from the code only for congestive heart failure. With the correct combination code, you get an appropriate amount of reimbursement. The doctors may ask you to make a bill with certain combination codes. Usually, using the combination codes will save the time spent in cardiology billing. 

#5 – Diagnostics Coding 

Coding for the diagnostics is the key for quick authorization. If you keep coding for the symptoms, then the insurance provider may not provide authorization. So, it’s essential to ignore the symptoms alongside the diagnostics. If the doctors have specifically mentioned the same in the notes, then it’s okay to code the symptoms into the bill. Otherwise, not coding the symptoms and only focusing on the diagnostics will save you time. 

#6 – Participate in Audits 

Participating in internal and external audits helps everyone to learn more. Having the chance to learn more about internal issues and errors is helpful. With the knowledge of your errors, you can improve further. Internal and external audits expose the weak links between the doctors, nurses, administration, and others. In this way, you can easily strengthen relations and start working efficiently. Also, this helps you to know more about the documentation, cardiology billing, and coding efficiency. Nothing is frightening about the audits, but consider it as the way of learning. 

Final Words 

Cardiology is a medical field that requires the utmost attention in every aspect. Be it the medical aspect of the billing aspect. Everything needs precision. With human errors and the delays, the Cardiology billing is one of the most difficult fields. With these tips, any biller can efficiently start cardiology coding and billing. 

how-to-choose the-podiatry-medical-billing-service

How to Choose the Podiatry Medical Billing Service? 

The podiatry is different from Pediatrics, and there is nothing to confuse between these two. The podiatry is nothing but the study, treatment, and the surgery of the foot, ankles, and lower extremity. This is a separate branch of medicinal and surgical science that treats the issues related to the lower extremity of the body. The medical billing and the insurance claims processing for the podiatry are very different. Although the insurance claims are quite easy and quick. The medical billing companies are always happy when they get the podiatry clients, as the billing and claims procedure is pretty straightforward. 

But, choosing the right podiatry medical billing service is essential. Not all companies have expertise in the same. That’s why we share the top tips that will help you shortlist the best medical billing companies for Podiatry. 

How to Choose the Podiatry Medical Billing Service? 

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#1 – Understanding Podiatry Guidelines 

Podiatry is the branch of medical science that deals with the foot, ankles, and the lower extremities. This branch is pretty different from the other medical branches. So, the health department has laid out a few guidelines for Podiatry billing services. The company you are going to outsource the billing task should understand the podiatry guidelines. If you hand over the project to the inexperienced company, you will have to regret it for a long time, as non-compliance always attracts hefty fines and delayed insurance claims payments. 

#2 – Software compatibility 

The hospitals use the Electronic Health Record software programs for all of the administrative tasks. Also, the EHR software programs are compatible with the medical reporting system, verifying the lab reports and sending them to the patients. The compatibility of the same software provided by the Medical Billing company should be compatible with the Podiatry billing. If the software does not contain all of the necessary medical codes and procedures, it’s useless. 

#3 – Billing Experience 

The company with the medical billing experience in the bag will always be helpful for your needs. Such companies can handle billing and compliance complications with ease. There are only a few companies that have experience with Podiatry billing. Companies like emerald health provide excellent podiatry billing services to the hospitals. So, hiring such companies is always a plus point for your hospital. 

Final Words 

Medical coding and billing is a tedious task, and you should let the experts handle the same. Most of the significant medical organizations have understood the same fact and hired medical billing outsourcing companies. If you are willing to outsource the podiatry medical coding and billing, you should always take proper care. Follow the tips mentioned in this post and proceed with hiring the best company that suits your needs. 

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What are the Key Medical Billing Terminologies that Everyone Must Know?

Medical billing is a tedious task, and only qualified people can do the job. Without the medical billing and coding, it is difficult to bill the patients for receiving the treatment. Well, as it’s one of the most complicated billing systems, it has separate medical billing vocabulary. There are a lot of terminologies that common people don’t know much about. If you want to learn more about the Medical billing terminologies, then you are in the right place. In this post, we are going to share the detailed information about the key medical billing terms that everyone must know. 

Key Medical Billing Terminologies 

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Medical billing is a complicated task. Even the medical billers find it difficult to create a simplified bill. There are multiple terms, which the common people don’t know at all. We are listing some of the key medical billing and coding terms, which will help you to understand the bill from the hospitals. 

Allowed Amount / Approved Amount 

Allowed or Approved amount is the amount that is approved by the Insurance company. If the amount is lower than the total bill, then the remainder has to be borne by the patient himself. The insurance companies usually allow only a few percents of the total bill.

Appeal 

The appeal is the legal challenge to the decision made by the insurance provider. When the insurance company denies to pay for the bill or partly pays the same. The appeal status appears on the medical bill provided to the patient. 

ATD or Applied to Deductibles 

The Applied to Deductibles is the term used to indicate the amount that is deductible from the insurance plan. Also, it is the amount that any patient owes, that contributes towards the annual deductibles. 

AOB or Assignment of Benefits 

The AOB or Assignment of Benefits is the terms used to indicate the payment of the bill from the insurance company by settling the claim. Usually, this term is used when the payment is processed and sent to the hospital after filing and claims and completion of the processing. 

Beneficiary 

The beneficiary is the person receiving the benefits from the insurance claim. Usually, the patient is counted as the beneficiary, but in some cases, the hospital is considered as the beneficiary. 

Charity Care 

Charity care is a free service to patients. The patients who cannot afford certain medical procedures can apply for charity care. In this, the insurance company will pay for the additional costs even if the policy can’t cover the same. 

Clean Claim 

A clean claim is the perfect insurance claim, which contains no errors. The clean claims are pretty rare, and most of the time, they are processed within no time. 

Co-Insurance 

As the name suggests, Co-Insurance stands for the division of the insurance percentage between the two parties. The second party can be another insurance company or the beneficiary himself. 

Deductible 

A deductible is nothing but the term used to explain the amount that the user has to pay for starting the insurance cover. It’s known as the down-payment or first-premium in other countries. 

Downcoding 

Downcoding is the term used to identify the medical procedures that are not performed. The insurance company finds no evidence of the surgical procedures performed; then it will downcode. They will remove the code from the claim and process the insurance payment to the hospital. 

Managed Care Plan

The managed care plan is the insurance plan that covers the treatment from the authorized physicians and the hospitals. The specially authorized hospitals under the network are eligible to file the claims in this plan. 

Medical Necessity 

Medical necessity is the term used to tell the insurance companies that the minor procedures that are not part of the plan were performed. Most of the time, the insurance companies will pay for the medical necessities as they are essential for keeping the patient alive. 

Non-covered charge or N/C 

A non-covered charge is what the name suggests. It’s the charge that is not covered by the insurance companies. The charge has to be borne by the patient himself. The hospitals will recover this charge from your pockets. 

PEC or Pre-existing Conditions 

The insurance companies ask for the pre-existing conditions from the patients. If the patient has any of the PEC, then the companies exclude him/her from the insurance cover for the specific ailment. 

Preauthorization 

The preauthorization is the term used to indicate the authorization from the insurance company before performing certain medical procedures. The pre-authorization allows the hospitals to know if the insurance company will cover the procedure charges or not. 

Supplementary Insurance 

Supplementary insurance means the secondary insurance that is available along with the primary insurance. When the primary insurance covers only a few ailments, the supplementary insurance can cover the other ones. Sometimes, primary and supplementary insurances are redeemed in case of multiple ailments. 

UCR or Usual Customary and Reasonable 

UCR means Usual Customary and Reasonable. It is the amount that is covered by the insurance provider. When the UCR is exceeded, the patient is liable for the extra charges incurred. 

Final Words 

The medical billing is complicated, and we don’t know most of the charges for our bills. The medical terminology is essential to understand, as it helps to know how and why we are charged for receiving medical treatment. These are the common medical billing terminologies that you will spot on the hospital bill. Now you know the meaning of the same and can approach the medical insurance companies or the hospital for inappropriate billing or clearing some doubts. 

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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?

choosing-to-outsource-medical-billing-is-a-wise-decision 

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-best-medical-coding-company-for-your-hospital 

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?

how-to-select-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