Wound Care Billing Guidelines 2019

wound-care-billing-guidelines-2019Not only is wound coding and documentation is a daunting task, but also attracts intense inspection from auditors, with severe financial penalties for mistakes. And it’s only gotten more challenging with the new ICD-10 changes.

What is included in the wound care billing guidelines 2019?

An infected surgical wound, T81.4xxA, is among those 51 codes that are set to be deleted.

Now the coders will have only 15 additional codes added to an expanded T81.4- subcategory. This will give accurate reporting of the depth of the infection.

For instance, the coders will have the knack to specify whether the surgical wound infection is affecting the superficial incision surgical site i.e. T81.41-, the deep incisional surgical site i.e. T81.42-, or the organ and space surgical site i.e. T81.43-.

In wound care billing guidelines 2019; other surgical site and unspecified options are also available i.e.T81.49- as well as T81.40-.

The new wound care billing guidelines codes T81.41-, T81.42- and T81.43- will receive additional inclusion terms to help guide coders to the appropriate code choice. Subcutaneous abscess following a procedure and Stitch abscess following a procedure will be sited at T81.41-.

Three new codes have been included in 2019 ICD-10-CM to uniquely capture post procedural sepsis, T81.44- i.e. Sepsis following a procedure, with seventh character options A, D, or S.  Furthermore, the tabular instruction to use additional code to identify the sepsis is added to the new post procedural sepsis code T81.44.

Moreover, many of the new codes added to the 2019 ICD-10 code set are external cause codes to be used to describe exploitation of children and adults in the form of psychological abuse, forced sexual exploitation, bullying, or labor exploitation. This includes T76.51xD i.e. adult forced sexual exploitation, suspected, subsequent encounter and Z91.42 i.e. Personal history of forced labor or sexual exploitation.

It is important that all coding professionals review the changes to 2019 ICD-10-CM to ensure they do not experience rejected claims and a potential loss to cash flow. MBC will be providing valuable information about 2019 ICD-10-CM to help you ensure coding accuracy and safeguard your agency. Click here for more information and to register.

Are you all set for the new wound care billing guidelines changes? MBC certified medical billing and coding experts will. MBC offers thorough home health and hospice coding services performed by experienced coders at an affordable price. MBC serves as an extension of your team and work hard to optimize cash flow for your agency.

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What Are The Differences – an Interventional Cardiologist and Invasive, Non-Interventional Cardiologists?

What-Are-The-Differences---an-Interventional-Cardiologist-and-Invasive,-Non-Interventional-CardiologistsA healthy heart is essential to lead a healthy and happy lifestyle. There are a lot of things that can go wrong with your heart, and sometimes the symptoms that something is wrong are not always obvious.

A cardiologist is a health practitioner who specializes in diagnosing problems with the heart and surrounding arteries. What is invasive, non-invasive, and interventional cardiology?

Basics of Cardiology

Cardiology is a branch of medicine which deals the diagnosis, and care of the cardiovascular system. Since there are several facets of your heart’s function, the cardiologist has to reflect many variables when sorting what may be wrong with the heart. Some of these variables include your arteries, heart, or blood vessels.

To know about your overall heart health, your cardiologist will:

  • Review your health history
  • Examines and run tests for your blood pressure and blood vessels
  • Examining your lung function
  • Run tests like blood tests, X-rays, ECG as well as other specialized tests to determine the problem.

A cardiologist is not a surgeon. A cardiac surgeon is a different specialist who performs the actual physical heart surgery.

There are 3 primary types of cardiology: invasive, non-invasive, and interventional.

What Is Invasive Cardiology?

Invasive cardiology practices open or minimal invasive surgery to classify or treat physical or electrical anomalies within the heart structure.

Common 2 types of invasive cardiology:

  • Angioplasty

Angioplasty is a process where a tiny balloon is inserted into your clogged vein which further helps in pushing the plate against the walls, allowing better blood flow.

  • Stenting

Stenting is usually done in conjunction with angioplasty. A cardiac stent looks like a metal coil, in a smaller size which helps in holding and opening the clogged vein.

What Is Non-invasive Cardiology?

Non-invasive cardiology recognizes heart problems without using any fluids, instruments or needles inserting in the body.

The techniques include:

Nuclear cardiology

It includes various types of imaging which may use radioactive elements.


Using ultrasound waves are used to create images of the heart, and surrounding structures in order to identify how well the heart pumps blood, infections, and structural abnormalities.

Heart monitors

Heart monitors are basically one kind of tape recorders for your heart which monitors the electrical activity over a set amount of time.

CT scans

CT scans develop images which your then cardiologist evaluate for further heart and atherosclerosis

What Is Interventional Cardiology?

It is a non-surgical possibility which uses a catheter to repair damaged or weakened vessels, narrowed arteries, or other affected parts of the heart structure.

Heart conditions treated by interventional cardiology:

  • Coronary artery disease
  • Heart valve disease
  • Peripheral vascular disease

Liked what you read. For more such reads; and leveraging the in-depth understanding of the medical billing and coding process, connect with experts like MBC.

Medical billing has delivered the highest levels of customization when it comes billing and coding so as to keep your practice streamlined and flourishing. Effectively utilizing the outsourced model, the  MBC team has been able to bring the operating costs of our pharmacy clients by more than 42%.

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Reduce Overhead Expenses: Outsource ENT Billing & Coding Services

 reduce-overhead-expenses-outsource-ent-billing-and-Coding-ServicesYour growing, brand new, hustling otolaryngology practice is often wrestling with the idea of focusing more on patient care; ENT billing and coding, and looking for ways about how to flourish your practice. One of the best ways to overcome the time constraint and reduce overhead expenses is to outsource ENT billing and coding services.

In a high-compliance environment, outsourcing medical billing functions seem like a loss of control for some medical practices. In reality, outsourcing claims billing with the right provider like MBC can help enhances physician control over billing processes. Outsourcing has also been shown to Outsourced Medical Billing Services increase profits, productivity, and patient satisfaction.

In-House vs. Outsourcing to MBC

You might think that you save money by doing your professional medical billing in-house when the truth is that outsourcing can actually reduce costs.

When you step back and look at the big picture, doing billing in-house means hiring staff specifically to handle the billing, coding, and claims submissions or juggling staff from the front desk to the back office for this purpose.

It also means having computers, printers, and software on-site and up-to-date with the latest industry requirements and regulations. Considering the cost of an employee from recruitment to salary, benefits, and covering that person due to illnesses or vacations, and combining it with the cost for all the equipment and software needed to do the job, it really adds up quick.

Outsourcing to pro-medical billers and coders like MBC means hiring a team of qualified, trained, and experienced professionals who have all their own equipment and software already enabled. In fact, if one of those team members is out sick, on maternity leave, or takes a vacation, you will never know it, as someone else from the medical billing services will handle your account for you seamlessly.

Outsourced workers do nothing but handle your ENT billing and coding; they are highly trained in the most complicated regulations for billing and insurance.

Boost Revenues – When you outsource ENT billing, your accounts are being handled by a team of highly trained and experienced experts who work to expedite your claims with amazing accuracy.

If you are still on the fence about outsourcing billing ENT services or hiring a third-party to assist with audits, reviews or fast and accurate credentialing, take a look at the following list for all of the reasons provided by outsourcing medical billing and services:

Reduces Risk

When you are outsourcing medical billing services to a third-party service provider, you gain the benefit of a completely transparent billing process that is HIPAA-compliant and totally secure to safeguard the data of your patients against hacking or other types of data theft.

Industry Compliant

The healthcare industry has undergone many changes to regulations and requirements in recent years, causing many practices, clinics, and hospitals to scramble in order to stay compliant. When you outsource ENT billing to MBC you can rest easy knowing that our team is consistently trained in all of the rules, regulations, and requirements of the medical industry.

Claim Tracking

Another benefit to outsourcing billing ENT services to MBC is that the team who will be handling your accounts is trained to review and follow-up all payments to ensure that the insurance carriers are paying the bills accurately. Each and every outstanding claim is tracked until it is paid properly, working to reduce overhead and get you every penny that you deserve.

Call MBC Pro Solutions In Medical Billing Services

If you are thinking about outsourcing medical billing services for your medical practice or clinic, contact MBC can be the right choice for your ENT practice.

Our team can answer any questions you might have about what it means to outsource ENT billing. MBC can even assist in other ways, such as providing a comprehensive review of your current billing practices and offer viable solutions from our team of otolaryngology billing and services experts.

Call today for a FREE estimate on our services or for more information about outsourcing billing ENT services for your practice or clinic.

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Improve cash flow by outsourcing billing in Optometry

improve-cash-flow-by-outsourcing-billing-in-optometryIs your optometry practice getting your money’s worth with your in-house billers? Choosing the best medical billing service is a daunting task – Someone that you can trust with your process claims. If you are considering outsourcing your medical billing, and are still not sure about making the leap, here are reasons why you should outsource your billing services to a professional service like MBC.

The Advantage of Outsourcing Your Optometry Billing

You don’t have to do all that work

While you’re relaxing at home, a team like MBC is doing the hard work; completing eligibility and benefits verification, clearinghouse and payer rejections, billing, payment posting, and AR tasks.

It reduces insurance follow-ups

With denials and rejected claims, MBC’s team will be handling the stress of your insurance follow-ups.

Your staff doesn’t have to wait around as they will be spending their time on more important things.

Streamlines your billing process

Outsourcing optometry billing services to an expert like MBC will greatly improve your daily operations, so you feel on top of things—not buried beneath an enormous pile of paperwork. With all that extra time, your practice priorities can be addressed and streamlined.

Pay more attention to your patients

When you aren’t buried under the constant demands of insurance verification and filing claims, you can improve patient care when they walk through the front door, and during their visit.

Outsourcing optometry billing services to MBC will free up your time and energy, so you can welcome and appreciate the patients you serve.

Why You Should Outsource Optometry Billing To MBC?

Time is money. Optometry becoming one of the flourishing practices; now every hour of the day is valuable and your majority of that time needs to be spent on patient care. The truth is that you have other time-consuming tasks that distract you from providing quality patient care.

A common headache for many practices is optometry billing, which can quickly add up on the cost scale. When your staff is continually managing everyday billing tasks, like outstanding claims or insurance verification, they are dealing with complexities in between seeing patients that often cannot be solved quickly. These optometry billing issues start to compound, and soon your staff is buried under a pile of paperwork.

This team of MBC billing experts manages everything daily, so you and your staff can return to more important priorities. This improved process ultimately saves you time and money.

Ready to experience these advantages yourself? The MBC team will help you get started.

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Outsource Dermatology Medical Billing – Increase Collection by 20%

outsource-dermatology-medical-billing-increase-collection-by-20%Dermatology revenue cycle management is more than just dermatology medical billing. It is a service that manages the processes that impact your bottom line from first patient contact to paid account balances and everything in between. The procedure to manage your dermatology treatment center’s revenue cycle management begins before your patient visit and ends when there is a zero balance that is owed to you.

As a dermatology practice owner, it is an opportune time to get your business’ financial “house” in order, finding ways to increase revenue without increasing costs as it relates to your dermatology medical billing.

Time To Work Smarter & Not Harder

Dermatology practices are not resistant to volatile economic conditions that impact most other industries. Whether times are good or challenging today, dermatologists need to foresee and prepare for a drop in collections and a decrease in revenue at any point.

Unfortunately, spending an excessive amount of time managing your revenue cycle also make you suffer your practice by spending less time, energy and focus on patient care.

Consider Outsourcing Your Dermatology Medical Billing

Outsourcing your dermatology billing can lend extensive experience and expertise to help you increase revenue by 20%, maximize profitability and streamline your billing processes letting you focus on patient care.

If you are determined to outsource, sensibly consider vendor qualifications and ability to meet your practice needs. At a minimum, an outsourcing dermatology medical billing company should have:

  • Dermatology billing expertise
  • Experienced, professional billing staff
  • Quality service and proven business performance
  • Comprehensive, integrated solutions, including practice management, electronic medical record and inventory management systems
  • Strong leadership and management
  • Satisfied customers and solid references
  • Company stability and long-term commitment

By outsourcing your internal resources to focus on collections, or turning to a dermatology billing outsourcing company like MBC to handle all of your medical billing needs and more, you’ll be well on your way to enjoying increased revenue up to 20% and beyond.

How MBC Medical Billing & Coders Can Help?

At MBC, they find the solutions related to your dermatology practice billing problems:

  • How MBC can assist you?
  • Do you need to increase your collections?
  • Is your billing costing you too much?
  • Is cash flow a problem?
  • Are your claims submitted timely?
  • Are you worried more about medical insurance billing than practicing medicine?

MBC proudly support Dermatologists with outsourced medical billing services and collections. MBC is an experienced in the specialized coding requirements of Dermatologists in their practices of working with a wide range of patients with skin and any related conditions.

MBC has proudly earned a superior reputation for our local support of Physicians with a comprehensive range of outsourcing services.

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Reimbursement Methods: Fee-For-Service vs Capitation

reimbursement-methods-fee-for-service-vs-capitationAs the present USA healthcare trends focusing more towards value-based care, the fee-for-service reimbursement model is under intense scrutiny. Often labeled as an antiquated payment model, it promoted over-utilization by physicians and patients, while creating fragmentation among healthcare service providers.

The Affordable Care Act of 2010, along with MACRA legislation in the year 2015, has slowly helped to redirect healthcare payment reform away from fee-for-service to a capitation payment system. However; both models are widely used and they both have been criticized for various reasons. Now the present healthcare focus is emphasizing on quality, efficiency, care coordination, cost control, and preventive health, capitation is developing as the model of choice for the value-based care movement.

The traditional model of paying for individual services on a case by case basis is being challenged by the newly introduced alternative model known as capitation. Capitation is a quality-based system measured by health outcomes, patient satisfaction, and clinical compliance. It has proved to be a great system for cost-conscious employees, but it might not be for everyone.

Fee-For-Service vs Capitation

Capitation Method

This reimbursement method will be given the primary care provider or physician practice a set fee per year or month for each patient. This new model aims to offer a perfect balance of patient protection with incentives to restrain the costs.

This method gives doctors, not the payers, more control over decisions about care, while also restraining unnecessary spending.

  • It inspires clinicians to limit unnecessary medical services that raise costs without adding value.
  • It makes it stress-free for providers to use things like telemedicine that aren’t easily compensated under traditional fee-for-service models.
  • It makes costs much more foreseeable for payers and gives the doctors and other providers a more predictable monthly cash flow.
  • It can be simpler administer – a fee per patient rather than complicated billing and elaborate coding for every visit and procedure.

Fee For Service Model

  • Every patient visit, evaluation, treatment, procedure, test, etc. are billed by the provider to a third-party payer for payment.
  • The fee-for-service payment structure leaves the provider and patient “absolved” from fiscal accountability, which arguably encourages over-utilization by both parties, leading to an increase in overall healthcare costs over time.
  • If patients need more care than expected, the burden of cost overages lies with the payer, not the provider.
  • This arrangement creates a scenario with inherent financial uncertainty for the payer concerning medical care costs and payment, explaining in part the ongoing rise in health insurance premiums

Liked what you read. For more such reads; and leveraging the in-depth understanding of the medical billing and coding process, connect with experts like MBC.

Medical billing has delivered the highest levels of customization when it comes billing and coding so as to keep your practice streamlined and flourishing. Effectively utilizing the outsourced model, the MBC team has been able to bring the operating costs of our pharmacy clients by more than 42%.

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2019 OB-GYN ICD 10 Coding Updates & Changes

2019-ob-gyn-icd-10-coding-updates-changesWith the year 2019 approaching; there has been a buzz of new medical billing codes. The year 2018 has been a hectic for the medical and healthcare industry professionals as ICD-10-CM codes introduce nearly 500 changes, 33 of them in Obstetrics and Gynecology; as well as in several other specialties.

So what’s new to expect in the year 2019 OB-GYN coding?  The 2019 ICD-10 adds a code for maternal depression screening i.e. Z13.32 and two for personal history of sexual exploitation Z62.813 and Z91.42.

There are more than a dozen new codes for multiple-gestation pregnancies i.e. O30 series. And five of the added codes cover doubling of the uterus which includes complete, partial, unspecified, and other—the Q51 series, this means it requires sharpening the understanding and documentation to ensure the denials doesn’t happen. Staying on top of the new and revised ICD-10 codes coming Oct. 1 should be a priority for your ob-gyn practice.

New Codes Introduced for OB-GYN are:

O30.1 Triplet pregnancy

  • O30.13 – Triplet pregnancy, trichorionic/triamniotic
  • O30.131 – Triplet pregnancy, trichorionic/triamniotic, first trimester
  • O30.132 – Triplet pregnancy, trichorionic/triamniotic, second trimester
  • O30.133 – Triplet pregnancy, trichorionic/triamniotic, third trimester
  • O30.139 – Triplet pregnancy, trichorionic/triamniotic, unspecified trimester

O30.2 Quadruplet pregnancy

  • O30.23    – Quadruplet pregnancy, Quadra chorionic/Quadra-amniotic
  • O30.231   – Quadruplet pregnancy, Quadra chorionic/Quadra-amniotic, first trimester
  • O30.232   – Quadruplet pregnancy, Quadra chorionic/Quadra-amniotic, second  trimester
  • O30.233  – Quadruplet pregnancy, Quadra chorionic/Quadra-amniotic, third trimester
  • O30.239  – Quadruplet pregnancy, Quadra chorionic/Quadra-amniotic, unspecified trimester

O30.8 Other specified multiple gestations

O30.83 – Other specified multiple gestations, number of chorions and amnions are both equal to the number of fetuses

New Codes for Surgical Wound Infections

There is a whole new lot of new codes available for obstetric surgical wound infections. With the new coding changes in wound infections, you’ll find that there are now individual codes for deep incision sites, sepsis, organ and space site, incisional site, unspecified, and other. If you don’t add the additional character needed providing the detailed information about the wound sites, the payer will not be able to accept the code and the denial chances are huge.

Let MBC help you avoid claim denials and potential paybacks. With MBC’s Ob-Gyn Medical Billing and Coding partner; you’ll stay on top of the latest ICD-10, and HCPCS code changes, as well as revisions to ob-gyn coding guidelines, payer policies, CCI bundles, payer policies, modifiers, and much more.

MBC’s updated guidance delivered each month will equip you to keep pace with industry updates and conquer the myriad revenue-risking challenges that complicate your work.

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