Mistakes to avoid while coding for preventive medicine services


Medical Coding is more complicated today with different overviews regarding medical codes according to the insurance companies. The documentation and coding for diagnoses/procedure are becoming a one-sided question of the medical billing.

“You’re given codes are incorrect and can please check them or EOB with wrong codes reason. Such situations can be definitive of the need for medical coders who have specialized in the practice specialty.”

These aren’t words a doctor or charging staff part needs to get notification from the insurance companies. Regularly the issue is about whether an administration you gave was preventive or procedure for a given patient.

The verification matters to the patients since Medicare and private insurance providers quite often pony up all required funds for accurately coded preventive prescription administrations however frequently require a copay (or full installment from patients with high-deductible designs) for administrations to treat an intense or unending disease. Make certain that preventive visits are coded thoroughly. Today, as we seek a better billing management we also see a better coding channel through which patient, insurance companies, and coders can effectively understand the requirements.

Another mix up that has installment suggestions for you and your patient is picking the wrong preventive prescription code. CPT characterizes a preventive pharmaceutical administration (99381 – 99397) as an age-and-sex proper thorough history and physical exam that incorporates expectant direction and hazard factor diminishment. These codes are characterized by the patient’s age and whether he or she is new or set up. Screening tests and the arrangement and organization of immunizations can be charged independently. The far-reaching history and physical exam are not synonymous with the exhaustive history and physical depicted in the assessment and administration documentation rules. Or maybe, the degree of the history and exam is reliant on the age and sexual orientation of the patient.

Most assessment and administration (E/M) administrations are chosen in light of the level of history, exam, and therapeutic basic leadership reported in the note. Yet, in the event that directing, coordination of care, or both overwhelm the visit, CPT educates doctors to choose a code in view of time. Incidentally, CPT characterizes “rules” as a doctor spending in excess of 50 percent of the time on that action.

This is executed contrastingly for office and office administrations.

In the workplace, a doctor chooses the level of administration in light of up close and personal time, when in excess of 50 percent of that time is gone through talking about with the patient and family the conclusion, guess, hazard and advantages, directions for administration, and training. You can check just up close and personal time. Time spent out of the exam room checking on records, seeing pictures, or finishing documentation can’t be tallied while choosing the level of E/M benefit.

In the healing facility or another office setting, then again, the aggregate time computed to decide the level of E/M benefit not just incorporates the eye to eye time spent directing or organizing care with the patient and family yet in addition whenever spent on the unit all in all planning the patient’s care. Despite everything, you should spend in excess of 50 percent of your opportunity on directing or coordination.

Why Choose Medical Billers and Coders to outsource your Medical Billing Service?

Medical Billers and Coders a professional Medical billing company with over 19 years of experience. We have set standards for our medical coders which help them to achieve the required performance from every claim submission.  A team of experienced coders and billers look to achieve a 100 percent reimbursement within 30 days for claim submission.

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How to maintain the general surgery billing in ASC facility?

How to maintain the general surgery billing in ASC facility?

Ambulatory surgical centers (ASCs) play a unique role in providing outpatient healthcare to the US population. By providing specialized services outside of the hospital setting, ASCs allow patients greater access, a higher level of convenience, and more focused and cost-effective care when undergoing procedures that do not require overnight stays.

Billing for services performed in an ASC is similar to a hospital, where the physician submits one bill for professional services, and the hospital or ASC submits a separate bill to cover the costs of the facility. In comparison, procedural services performed in the office setting are reimbursed by Medicare and several insurers with an additional site-of-service differential calculated into the payment to cover the physician’s expenses related to staff, equipment, and overhead to provide the service.

Coding for Ambulatory Surgery Centers is a specialty unto itself. It is a facility service, but Medicare requires ASC’s to send their bills to the professional fee – Part B payers but using the facility fee Part A claim form.

There is a whole different set of regulations and bundling edits to use for ASCs. Many ASCs use the same codes as the surgeons, but that can be a revenue “kiss of death” and create compliance exposure for every shareholder-or-partner in the ASC.

The rules of the game are different for ASCs than for surgeons or for hospitals; at times ASCs must follow the rules for doctors, and at other times they must adhere to the hospital’s rules. A simple modifier used incorrectly can deliver a “fatal blow” to an otherwise clean claim for thousands of dollars.

Many ASCs are partially owned and managed by national ASC development and management companies. We code for quite a few, offering them a consistent level of coding accuracy and responsiveness across all of their locations. Some of their ASCs are located in smaller cities and communities that don’t have deep labor pools for experienced ASC coders. With HIPAA-compliant document management and remote access to electronic medical records, we can code for those ASCs as easily as if we were at the next desk.

ASC Coding Need

  • Well trained ambulatory surgical center coders for are hard to find.
  • Few ambulatory surgery center coders are certified, and few certified coders have ambulatory surgery center experience.
  • Ambulatory surgery center coding guidelines are complex, change often and are different than those for physicians; codes and modifiers that work for physicians are not always acceptable for ambulatory surgery centers.
  • Coder turnover, vacations, and family leave create cash flow peaks and valleys.
  • With so few coders specializing in this niche, it is difficult to find and hire experienced ambulatory surgery coders, even in large metropolitan areas. ASC’s in smaller communities and tight labor markets have trouble filling openings.
  • The wide range of specialties represented at ASC’s is beyond most coders’ capabilities.

ASC Coding Services

  • Ongoing ambulatory surgical center coding coverage for all or part of your caseload
  • Temporary ambulatory surgical center coding coverage for vacations and sick leave
  • Second opinion coding services
  • Backlog coding resolution services
  • Compliance “peer” reviews
  • Physician documentation training
  • Physician documentation deficiency reporting
  • ASC Coding “helpline” services
  • OIG and RAC audit defense

An ambulatory surgical center (ASC) is a healthcare facility that is dedicated to providing medically necessary surgical services to a patient in the outpatient setting. ASCs are paid according to a unique set of regulations and standards under the Medicare program, under Medicaid, and under contractual agreements with private commercial health insurers.

Professional medical billers are conversant with the applicable regulations and contractual obligations that govern the reimbursement of services provided by ASCs. As with the rest of the healthcare industry, new covered procedures are added and deleted on a regular basis, as well as the services that are considered a part of the surgical package.

As experts in the financial aspects of healthcare delivery, professional medical billers provide advice on which services can and cannot be provided by an ASC. They do this in conjunction with certified medical coders, who advise on the documentation requirements needed to report specifically covered HCPCS codes to make sure procedures are being performed in the appropriate venue.

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A checklist for your practice to succeed in your value-based reimbursement

A checklist for your Practice to succeed in your value-based reimbursement

Healthcare is moving towards a parameter based revenue system, with the patient care, patient diagnoses and billing all will decide the reimbursement. Though patients today have much more control over their billing and many of the private healthcare insurance provide them with a facility of choosing different billing options, doctors and physicians have been on the receiving end. The regulations have been very effective when it comes shifting the total billing management towards fee-for-service and to have the curb on the healthcare industry rising cost. As many predict that the transition would not be simple as most of the healthcare industry is depended on the simple rule of service based fee, while the value-based model will complex billing cycle already burdening the providers and doctors with paperwork. Though both value-based and fee-based model is a regulations burden both on providers and payers, a value-based model will help the emergence of better medical billing.

The rising cost of healthcare and the need for affordable care for the people are the biggest priorities of the value-based reimbursement. For payers, one of the reasons value-based reimbursement could lead to better-channelized management of the revenue but you have to monitor different parameters.

Risk Management of Value-based care

Commercial payers can actualize shared hazard, and capitation full hazard while making installment contracts connected to an incentive rather than volume which will later help in developing frameworks to reduce the cost of monitoring and then billing. Value model also means contracting will put a greater obligation on suppliers to deal with their income and could conceivably enhance mind coordination. Expediting more concentration hazard could enhance social insurance quality execution and cost proficiency. Value-based billing means a social constraint on the revenue which the providers can charge and in turn helping to deal with risk management.

A bit of the supplier’s aggregate potential installment is attached to the supplier’s execution on cost productivity and quality execution measures. While suppliers may, in any case, be paid a charge for the benefit for a few their installments, they may likewise be paid a reward or have installments withheld. For esteem based contracts, this reward isn’t paid except if the suppliers meet cost proficiency or potentially quality targets. Health IT systems matter for value-based care payment.

The HFMA or better known as the Healthcare Financial Management Association is strongly supporting the IT infrastructure before venturing towards the other factors of an alternative payment model. Many Payers have been reluctant to invest in the proper IT infrastructure but as value-based reimbursement will move over the years towards various complexities the IT arrangements can help you organize the billing issues.

Payers will need to work with the provider network to effectively capture the data for the billing and there would be a need for the end to end documentation to help population health management. IT infra is just not making your data secure but today this data is helping providers to analyze patient condition and predict the future diagnoses.

Value-based care would bring in the accountability for various steps in healthcare which were till now ignored. A measured approach would help in getting the payer and the provider on board to help them relate to different payment models which don’t relate to any collision in the billing.

To help your billing and to make the transition of value-based reimbursement smooth for the providers and payers we at Medical Billers and Coders (MBC) have assigned a team who co-ordinate with providers to help them set up a documentation channel and payers an IT infra and communication source.

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How to Unveil the Independent Side of Optometry?


The world and business of optometry practice has changed beyond all recognition in the last three decades. This is due to the emergence and growth of the multiple sectors and the ever more sophisticated range of clinical testing equipment that is available.

Against this backdrop, a vibrant independent sector still holds a substantial presence and provides an important option for patients based on clinical excellence. It also offers a very different career path for newly qualified Optometrists and Opticians.

So, coming to moot question – is a job in an Independent optometry practice the right option for you? The following criteria might justify your decision.

Be prepared to work hard

While independent optometrists are not subject to hospital like targets they still work very hard and often put in long hours and of course have all the tasks that go along with running a business to deal with.

They need to do this willingly because of the passion they have for what they do and because it is a vocation for them. People with ambition should know that achievement only comes with hard work – are you really ambitious?

Cravings of Knowledge

Independent optometry facilities are at the forefront of new treatments and normally the pioneers with new technology. They are constantly looking for new and better ways to provide the best possible health care for their patients.

Only meeting CET requirements will not cut it with most independents – they also want to see the same craving for knowledge from their people that they have themselves. If you have a longing for learning and knowledge then you should fit in with the Independent culture. Go into the details of HER, check with your revenue management team, look what are the new advancements in medical billing and coding for optometry, and so on.

Make the job your passion

Most independents love what they do. It is not just a job but a vocation. It all fits in with their passion for the sector and their willingness to work hard.

Remember that if you are of the same mindset and truly see your profession as a vocation then you should fit in with the Independent sector.

Always be a team player and not the boss

Many independent practices are small and therefore everyone working in the practice whether owner or employee needs to work closely together, be flexible and get on with each other day to day. The size of the team does not matter it is the commitment to be there for others that does matter. Can you work effectively as part of a team?

Think about the patient and not your business

In an independent optometry facility talk about patients and treat them as one of yours. They are interested in delivering clinical excellence and ensuring long term eye health for the people they treat.

Often they will know their patients from many years of consultations and hold an in depth record of their clinical history not just on file – but in their heads! They care about the people they treat. In fact many patients become long term friends! Is this the sort of working life that appeals to you?

Make a long term goal

Most entrepreneurs and in this scenario optometrist are passionate about their sector and they believe they offer the best eye care option.

They want to see the sector continue to flourish and to offer the choice of clinical excellence for their patients. Many are looking for people to succeed them into ownership of their practices when the time comes for them to enjoy their retirement.

They will welcome people who have similar ambitions to the ones that they had when they entered into practice. If owning your own practice is an ambition then the Independent sector is the only option for you.

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5 Strategies Payer should Follow after Patient Discharge


Today’s hospitals have more than a casual interest in ensuring that inpatient care is complemented by an effective post-discharge care management program, especially as it pertains to the health of our nation’s elderly.

That’s because just such a program can stem the flow of readmissions, decrease excess healthcare use, minimize the need for nursing facility placement, and substantially reduce emergency department visits. All of this results in positive financial and quality implications for the hospital, the patient and the healthcare system itself.

The discharge process remains a major challenge for healthcare leaders who wants to improve outcomes and reduce readmissions, in large part because patients often don’t understand the instructions. A recent research suggests that implementing follow-up care strategies can improve the process; including treating it more like the admissions process and dispensing medications at that point.

  1. Coordinating patient follow up and monitoring

Many patients don’t see a physician promptly after they have left the hospital. In fact, 65% of Medicare patients had no interaction with a physician between the time they were discharged and when they were readmitted. This constitutes a significant gap in care for the patient. This gap in care allows health deterioration to go unnoticed by the care team until severe complications arise that requires readmission. Physician follow up is a critical part of the patient’s care plan, but sometimes patients don’t have the motivation to make and keep their appointments. As you build your post discharge follow up programs, appointment reminders and scheduling become key components of a successful hospital readmission reduction strategy. Not only do you need to be able to facilitate the appointment, it’s equally important to educate the patient as to why the follow up is needed.

  1. Emphasize on care model than business model

Communication with the nurses, when it comes to discharging patients; it was discovered that often kept patients at the facility for longer than medically necessary, recognizing the financial benefits associated with a prolonged stay. The patients really wanted to go home but the care facility won’t let them. The system was driven more by the business model than the care model. That was one of the first things which were identified as a tremendous opportunity to improve upon.

  1. Educating patients

Another key strategy that payer should follow after patient discharge is to educate patients throughout their hospital stay. Start teaching and educating people from the day they come in, making sure they are prepared to take care of themselves at home.

Every interaction with patients is an opportunity to educate patients, about their condition, medication, post-discharge plans and follow-up plans. Patients that understand more about their condition and their care will feel more involved in their care process and less detached.

To educate patients during transitions of care, such as from the hospital to a long-term care facility or to home, is especially important for the patient experience because understanding what to do post-discharge eases patients’ anxiety. “A ‘cold’ discharge process can leave a patient feeling like a number. Empowering the patient with pertinent information and support tools makes a huge difference.

  1. Make a positive patient experience

Hospitals where leaders emphasize the importance of patient satisfaction and where staff is trained in patient satisfaction strategies will be more successful. Create a culture that values the patient experience. We have all of our management staff making rounds, talking with patients, talking with families, so they’re close to what the patients are experiencing.

Training staff to adopt a patient-centric approach to patient care can also help hospitals emphasize the importance of patient satisfaction. It is important for a payer to have a perspective to treat each patient like your family member treated, understanding that the hospital which is a common place for the professionals but; it is a unique situation for patients and families. Additionally; hospitals should acknowledge that treating patients goes beyond one individual, as treatment also affects the patient’s family.

  1. Proactive discharge planning

Usually the care transition processes, discharge planning starts two days before a patient leaves the post-acute care facility, typically between days 20 to day 22. It is important to have a discharge plan made as soon as the patient is admitted to the post-acute facility. This proactive discharge planning identifies the exact number of days the patient should stay at the facility to achieve the desired functional goals valuable information for both payers and the patient’s caregiver or family.

Proactive discharge planning also aids patients’ transition from the skilled nursing facility to their homes by highlighting any non-clinical needs patients might have like feeding or bathing etc. which gives families plenty of time to figure out how to meet those needs, whether themselves or through a home care service.

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How Chiropractic Billing Experts Dealing with Rising Billing Questions from Patients?


Managing a chiropractic facility and chiropractic billing and coding is a complicated undertaking. It stands especially vital when you factor in the ever-changing requirements and regulations of having to do with health insurance and federal/state government programs.

A modernized and efficient financial process is crucial for any successful practice, and is a key to a healthy revenue cycle.

One aspect of billing that you must consider is whether or not your current or future staff can handle the entire financial workload of chiropractic medical billing and coding.  If you happen to have a staff that has not worked with accounts receivable or taken on financial responsibilities previously, you may need an offshore billing team.

You must consider what you would like your staff to be accomplishing throughout the work week.  If you would rather have them marketing your practice and gaining clientele, then a third party billing team sounds necessary for you.

Here are some points to ponder up regarding the rising Chiropractic billing questions:-

Should you go for In-House or Offshore billing system?

In-House billing can be a quality option for an established chiropractor with a high quality staff.  If you already have a high client base and a highly trained staff, you may go for a specialty medical biller and coder. If your staffs have the expertise and the time to collect the money that is owed to you, then in house makes sense for your practice.  If your staff will not be marketing because your client base is efficient, then they may have the time to run your financial department. This way the question asked would also be lowered.

Improve your billing system as the practice grows

As a chiropractor, your practice will eventually grow; and so will your medical billing and collections workload.  You should (not) be worried about your practice growing… It is a good thing!

That is why you spend money on marketing; you know that it will increase your profit immensely.  But that does not mean that you should be unprepared when it happens.  With growth the patient questions will also amplify.

What you did not think about when you began to build your practice is the added work load you will encounter as your revenue rises.  The way to prepare for this growth is to outsource your chiropractic billing as it is very simple.  There are too many benefits for outsourcing your billing rather than ignore them.

Will outsourcing the billing and coding undertaking lesson the patient queries?

Let’s just start with why you picked Chiropractic as a profession. Reasons are many, but basically it to care for patients and make money.  In order for you to spend your time caring for patients, you must not be concentrating on the day-to-day operations of running your practice.  If you have a dedicated billing staff, your time can be spent doing what you were meant to do, which is treating patients.

A common question a chiropractor encounters is “Why should I hire someone to do what I can do myself? I don’t want to pay the 8% of monthly collections, which is that is my hard earned money.”

Yes, that is your hard earned money and it should be in your pocket!  You will not lose this 8% if you outsource your billing, infact the unseen gains are many. Your billing staff will actually collect more revenue monthly and your profit will increase.  Your numbers will rise and your workload will decrease.

Outsourcing chiropractic medical billing can help to eliminate patient questions and inevitable headaches and financial loss that come with them.

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