Boost your OB-Gyn Cash Flow with Simple Steps

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The Current billing scenario is changing and it’s somewhat difficult now for individual practices to bill for all the services provided and also provide quality care. In Ob-Gyn practice, the services provided by physicians have come under security after repeated frauds under necessary procedures and care. The CMS has created the shift in billing from fee for service to care quality as the billing and incentive parameter.   This parameter would now largely affect the specialty which requires a long duration of care as the incentive amount would affect the total payment for the care and procedure.

So it’s becoming important for the medical billing practice to be critical for surviving in such a robust environment of billing and regulation.  One of the many reasons that the shift has been critical and more regulation changes would be set in place is because America spends close to 6 Billion USD on healthcare which is one of the highest compared to other developed nations. This, however, doesn’t add to the fact in terms of developed nation America lacks in terms of physical and mental health.  It’s estimated that 10 percent of the families have their medical bill unpaid or cannot afford to pay. This doesn’t include the families who would be paying the amount in the near future the number stands at 25 percent.

As an OB-GYN physicians try to manage both patient care and medical billing it’s important that they follow certain steps to reduce the burden only on the billing management team.

Upfront payment for the certain OB-GYN procedure

The main thing an training can do to enhance their income is to get cash from patients at the start of the visit. Suppliers should make it as simple as feasible for the patient to pay by including various distinctive installment techniques, including check, money, Mastercards, or PayPal. They ought to likewise attempt to illuminate the patient before the visit what they’ll be required to pay by inquiring about the patient’s protection data already.

Local coverage for diagnosis 

Local coverage for diagnosis (LCDs) is something each biller ought to be acquainted with, particularly how they identify with fortes and routinely charged administrations. LCDs clarify if and when a Medicare bearer will cover certain methodology, under what conditions a system is regarded medicinally essential and may likewise contain data on coding rules and repayment. Knowing which analyze are thought about therapeutically vital (i.e., payable) will likewise help a biller know whether the patient ought to sign an Advanced Beneficiary Notice. Monitoring any uncommon coding rules is likewise precious data that can help guarantee claims are submitted appropriately and repaid the first run through.

Try not to fear denials

Payers don’t generally take after coding rules. Giving documentation of why a case has the right to be paid can get the case handled. Try not to fear offers. Set aside the opportunity to compose that letter, assemble your evidence and present the interest to the insurance agency. You might be amazed at the outcomes. Nothing is all the more remunerating at that point getting the installment on a case you claimed effectively.

Settle on all choices in light of your maturing report, not your sentiments.

Practices that have the best income settle on choices in view of their strategies. They don’t construct it in light of to what extent they have been working with the patient or how well they may know the patient. They utilize target criteria around their maturing. As an activity, take a stab at concealing patient names when investigating your maturing report.

OB-GYN medical billing is going through a change of regulation in the current scenario of service and care. At Medical Billers and Coders we take each OB-GYN billing task with an in-depth understanding of the coding and insurance billing.

 

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7 Reasons: How Outsource Medical Billing Services Can Benefit Your Practice?

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The healthcare industry is constantly changing and evolving, and with these changes come more regulations surrounding medical billing. If you are yet to figure out in-house vs outsource medical billing services or if you are searching for significant reasons why you should outsource your medical billing services, look no further. We have compiled the top 7 reasons why a medical billing services company may be right for you.

  1. Check Patient Insurance Coverage Accurately

When a professional medical billing service company works as your billing partner, automatically the billing errors are reduced, resulting in your practice receiving payments and reimbursements quicker. A professional medical biller will work closely with insurance companies to better understand their process, resulting in a shorter revenue cycle for clients.

  1. Frees Up Your Time

Owning and managing a medical practice is far from a walk in the park. As a physician, you have enough to keep you busy without adding one more item to your plate. Hiring a medical billing coding company like MBC will let you focus on what you do best: treating patients.

They know that you don’t have time to be worrying about medical billing or if a claim was paid. Working with a medical billing company frees up your time and allows you to shift your focus back on what really matters, your patients.

  1. Keep Tabs On Changing Regulations

There are always new rules and guidelines to follow each year. Keeping up with all the changes can be time consuming and tough for any practice. By outsourcing your medical billing requirements to a pro like MBC, you are saved yourself from that hassle.

MBC being your medical billing and coding partner manages this expertly for you. They would make it a point to stay up-to-date with the billing and coding changes.

  1. Zero Capital Investment Required

When you outsource your billing services task to the company like MBC, you no longer have to worry on making a costly investment like buying expensive billing software. The expenses are greatly reduced.

  1. You Get More Time For Patients

 When the medical billing tasks are outsourced to MBC, health practitioners have more time to focus on the patients rather than handling the headache of their billing processes. It makes sense to invest your time into your core proficiencies like patient care and ultimately making your patients happy.

  1. Reduced Costs

An average practice spends about 35% of their collections on the medical billing process – too expensive. By outsourcing medical billing tasks to the experts like MBC; this costs can be curbed easily.

The necessity for hiring in-house medical billing team is evaded by outsourcing, as well as the money spent on training them and keeping them up-to-date with the latest regulations.

  1. Enhances The Cash Flow

When you partner with a revenue cycle management company to handle your outsourced medical billing, you could boost revenue potential as much as 33%.

A company like MBC offering outsourcing medical billing solutions doesn’t only demonstrates medical billing services but has state-of-the-art technological software and a staff trained to maximize coding for higher revenue capture.

Does Outsourcing Medical Billing Services To MBC Sounds Good To You? We would like to hear more from you.

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The Impact of QPP on Cardio-Oncology Care

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Many professionals or experts working in the healthcare IT industry, policy specialists and new industry stakeholders continue to investigate into the 1,473-page proposed “rule” released by the CMS or Centers for Medicare and Medicaid Services in July 2018 that provides updates on the OPP or Quality Payment Program and Physician Fee Schedule. This new update also summarizes the Medicare Incentive-based Payment Program (MIPS) and Advanced Payment Models.

Where we Stand on Healthcare Spending?

An investigation comparing health care spending, prices, utilization, and healthcare results across 13 high-income nations shows that in 2013 to 2016, the United States spent far more on healthcare than the mentioned high net worth countries, Despite this, Americans had poor health care outcomes, which also includes shorter life expectancy along with high rate of chronic conditions.

As an assessment, the US spends 17.1% of the gross national product on healthcare, but the United Kingdom spends 8.5% with the same healthcare outcomes. This model of higher spending with bad outcomes is not justifiable.

Each year, the federal government relies on the Sustainable Growth Rate to keep costs low. Every passing year as the spending increased, resulting in the formation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that stirred the focus from ‘fee-for-service’ to ‘value-based payments.’

However, this transformation has both proponents and detractors. But most importantly, it makes sense that to be the best guardian of healthcare dollars, physicians and healthcare units must focus on providing the best care to our patients at the lowest cost. The ‘value’ of your work is publicly reported and appreciated by patients as well as payers.

  • One important thing to remember here is that for participation in advanced alternative payment models, the Merit-Based Incentive Payment System (MIPS) for financial and quality reporting data collection was started in 2017 and will be used for payment adjustments or incentives in 2019.

The Impact of QPP on Cardio-Oncology Care and Medical Billing

Identifying opportunities to rectify the cardio-oncology care delivery along with billing and coding should be a win-win. The Cardiologist should know that taking full advantage of the QPP program will be vital to maintain and improve their reimbursement cycle. Utilizing the parts of the program which directly measure cardio-oncology processes and results will also ensure suitable therapy for the patients.

One of the main objectives of the QPP is to give cardiology healthcare facilities the flexibility to choose the procedures and measures which are meaningful to their practice.

Of the four categories defined, two of the areas; Quality and Improvement Activities – provide the opening to optimize clinical care specifically for cardio-oncology physicians. For the program, clinicians must pick six out of (about) 300 quality measures; one of them should be an outcome or high-priority measure. This Quality category has a 50% weight for 2018 data year that aligns with MIPS.

Quality Measures for increased Reimbursement

For a physician who wants to directly impact cardio-oncology care and take advantage of MIPS QPP via medical billing and coding, the following list has some worthy choices for Quality measures.

  • Have shared decision making and discuss/provide a care plan
  • Communicate through reports and coordination of care
  • As you deal in the cardio-oncology screen for tobacco use and provide cessation to manage comorbidities

The Centers for Medicare and Medicaid Services has an informational online tool that allows cardiologists  to explore the various measures that may best suit their practice.

What next?

As the QPP is pushed further in the next couple of years, the penalties and incentives will rise. There is no real option for not participating. Therefore, participating in the program is a clinician’s best option for success. For those healthcare units who manage a large number of cardio-oncology patients, keeping patient care and claims reimbursement on the same track is not possible. In such, aligning your priorities with experts in the cardiology medical billing and coding like us will help ensure that the quality measures are in check and the claims submitted via us aid is pacing your revenue cycle.

As far as the patient population in cardio-oncology increases, your ability to provide high-quality care in a lucrative manner will continue to grow in importance.

 

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Murphy signed Out-of-Network Healthcare Billing Law in New Jersey

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Governor Phil Murphy on August 30th, 2018 signed a bill that ended the decade-long battle to address the issue of the cost and impact of expensive medical bills for residents in the state.

In a statement, Gov. Murphy said, “Today, we are closing the loophole and reigning in excessive out-of-network costs to prevent residents from receiving that ‘big surprise’ in their mailbox.” “At the same time, we are making health care more affordable by ensuring these costs are not transferred to consumers through increased health premiums.”

The bill that was finally passed this year was sponsored by Assembly Speaker Craig Coughlin and Sen. Joseph Vitale (both D-Woodbridge).

The Assembly 2039 Bill

The Assembly bill 2039, requires hospitals to disclose to patients, which out-of-network providers will be billing them before a patient undergoes procedure or surgery.

With the new law in affect, the Governor said, the state will be able to rein in the “big surprise” bills residents find in their mailboxes after a hospital stay.

Murphy said, “Each year nearly 170,000 New Jersey citizens get medical bills which they didn’t expect. “Bills for services performed, unbeknownst to them, for professionals outside the networks.”

“No one likes to be blindsided. But that’s what’s been happening to residents who did not know they were getting out-of-network medical care until they received a bill in the mail,” Assembly Speaker Craig Coughlin added.

The new bill that turns into a law will allow for a state-regulated, binding arbitration process between patients and out-of-network providers to settle costs of an out-of-network bill.

The state Senate has also amended the bill to prevent insurance providers from using pricing benchmarks for services rendered by out-of-network doctors.

Self-Insured Healthcare Plan

A self-insured plan subject to ERISA that wants to be subject to the act would do so by filing an annual notice with the state and amending its plan documents to reflect that the benefits of the statute apply to the plan’s members.

  • If a plan opts-in, its members would not be balance billed for out-of-network charges for emergency care in excess of the deductible, copayment, or coinsurance amount applicable to in-network services, and the plan can take advantage of the act’s binding arbitration provisions.
  • The opt-in plan must provide each primary insured with a health insurance identification card indicating that the plan has elected to be subject to the act.
  • A self-insured plan subject to ERISA that does not want to opt-in need take any action. If the plan does not opt-in, its members may be balance billed for out-of-network treatment. If the provider and a member do not resolve a payment dispute within 30 days after the member has been sent a bill, the member or provider may initiate binding arbitration to determine payment for the services.
  • The arbitrator’s decision will include a final binding amount that the arbitrator determines is reasonable, and a nonbinding recommendation to the self-insured plan of its reasonable contribution for payment. Subject to an exception for financial hardship, the arbitrator’s expenses and fees are divided equally between the provider and the member.

The act takes effect 90 days after enactment which on or near August 30. Self-insured plans covering individuals in New Jersey will need to decide whether to elect to be subject to the act. We are awaiting regulatory guidance as to many details, including the opt-in election and the additional disclosure obligations for covered self-insured plans.

Please feel free to reach out to us at www.medicalbillersandcoders.com and contact if you would like to discuss the pros and cons of opting in or the potential impact of the act on your health plan or operations.

 

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Common Practice Challenges Faced by Orthopedic surgeons

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There are many distinctive as well as common challenges faced by orthopedic surgeons over and again. These encounters mainly hinder their business cycle, and sometimes you may also find orthopedic healthcare units closing down. Challenges like rising or unavailability of implants and its costs, healthcare reform implementation and a clean revenue cycle in the form of error-free medical billing and coding that amplifies the reimbursement rates.

When we talk about the orthopedics field its main role is in patient care. But, professionals working today are undergoing changes in their working environment and autonomy. Orthopedic surgeons and facilities can look very well look forward to this ongoing phenomenon as the ability to serve and help increasing numbers of our patients.

Here are few critical but common challenges facing orthopedics and how you can overcome these obstacles.

Are Implants Costly?

A big area of concern related to the revenue cycle management of the orthopedics in surgery centers is the implant costs and reimbursement rates.

Numerous procedures that we could perform and probably save the patient and insurance company money; like the open reduction internal fixation of a distal radius fracture, as of now are not possible at many centers in the United States. Also, some of the insurers will not pay for implants and pay only the facility fee. Very often, the total amount is less than the cost of the implants, making these procedures impossible to perform from a financial perspective.

Expensive implants that surgeons want to use are also a burden to profitable orthopedics. And experts in the field see this as a significant challenge for not only for a solitary orthopedic facility but to many centers.

As a solution to overcome this challenge it’s vital to look at the benefits and prove that it is worth the expense. If it improves your facilities RCM then it’s worth it. If it’s just like the ones that are already in the market, then you’d be making changes.

Equipment needed!!

Getting the perfect equipment at the best price is still a challenge for orthopedic practices. The surgery center setting may end up needing updated medical equipment as a situation arises where every surgeon may want to use a different product. However, doing so can quickly drive up costs and reduce the orthopedic center’s ability to make bulk and discounted purchases.

Orthopedic practitioners should attempt and standardize equipment when possible, allowing better price negotiation.

According to industry experts, all the new equipment at the center should be agreed on pricing before they can be used and purchasing orders are issued.

If your orthopedic center is successful and has the potential to undertake many cases in a day, the facility should have enough and updated equipment to facilitate the patients.

Inaccuracy leads to Claims Being Denied

Orthopedic medical billing is directly tied to your profitability. The income cycle needs to consistently flow into the practice, which clearly says that you’re coding needs to be clean.

When there are errors in the billing and coding processes it could hold up claims for a long period of time. Also keep in mind that even if you have the best in-house medical coding and billing team, they can make mistakes if they are overwhelmed, and much can go overlooked.

The solution to this problem is to perform audits on a regular basis. Medical auditing by professionals can provide areas of improvement for your coding team.

Medical billing auditors can diagnose under coding, bad unbundling habits, and overuse of codes. The coding staff will then be able to charge appropriately for documented procedures.

The up-to-date running of an orthopedic practice comes with various challenges. Some of which are scheduling appointments, creating a dependable team and the overall expenses of running your practice.

Let our experts handle your orthopedic medical billing and coding needs…

At Medical Billers and Coders we assure you of taking at least one thing off from the long-running list of your daily work, which is to make sure the practice remains profitable.

Our team of certified and professional medical coders and billers has needed experience you need and specialize in orthopedics and surgery.

Call us at 888-357-3226 today for a quote or click here to send us an email.

 

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Why you should tread carefully when using modifiers -25 and -59 in Urology Billing?

blog-why-you-should-tread-carefully-when-using-modifiers-25-and-59-in-urology-billingThe Urological Supplies Local Coverage Determination (LCD) provides for the use of modifiers with each submitted HCPCS code to indicate whether the applicable payment criteria are met KX modifier and to provide other information related to coverage and/or liability (GA, GZ and GY modifiers) when the policy criteria are not met. This article reviews the appropriate use of each modifier through Urology Medical Billing Services.

Proper selection of the correct G modifier requires an assessment of the possible cause for a denial. Some criteria are based upon statutory requirements. A failure to meet a statutory requirement justifies the use of the GY modifier.

By and large, Medicare use modifier — 25 on all E/M administrations connected with a minor procedure, which means the evaluation and management, ought to be paid for separately and not bundled with the surgical reimbursement. It might be important to point out that on the day a procedure recognized by a CPT code was performed, the patient’s condition required a critical, independently identifiable E/M administration well beyond the other services provided or past the typical preoperative and postoperative consideration connected with the procedure that was performed. Furthermore; Urology medical billing services implements new modifier —25 which implies the surgery will be done on the same day.

So, when should you ‘NOT’ use the Modifier 25?

  • When billing for procedures performed amid a postoperative period if identified with the past surgery
  • When there is only one E/M service performed during office visits (no procedures done)
  • At the point when on any E/M on the day a major procedure is being performed
  • When a patient came in for a scheduled procedure only

What is -59 Modifier mean when using in Urology Billing Services?

Modifier -59 indicates that two services not normally reported separately are appropriately reported separately under the circumstances. For example, if you see an accident victim in the emergency room and the patient requires fracture care on the right arm and some strapping on the left arm, you may need to attach modifier -59 to the strapping code to indicate that it was separate from and should not be bundled with the fracture care, which includes the initial cast, strap or splint. Modifier -59 should be attached to the lesser valued of the two services or to the code, regardless of value, that would otherwise be denied or is a component of another, more comprehensive code. This modifier is usually considered a last resort since its descriptor says that it should only be used “if no more descriptive modifier is available, and the use of modifier -59 best explains the circumstances.”

Modifier -59 would be attached to indicate that the biopsy, which is normally bundled with excision of the same lesion, was done on a separate lesion from the one that was excised.

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