Medical Billing and Coding Guidelines

It is a well-known empirical observation in many fields of business that only certain route or set of routes, called “Best Practices”, leads to desirable outcomes.  Businesses that fail to acknowledge or adhere to these best practices often end up lingering far behind in the race, and rarely develop into something substantial in their chosen field of endeavour.  Like in any industry, if clinics do not adhere to a set of best practices when it comes to Revenue Cycle Management, they might eventually end up on a path that leads to nowhere.

Medical Billing is continuing to experience a sea-change, like any other healthcare segment, in the face of federal mandates and increase in the number of those getting insured.  The clinics which have continued to submit claims like they have always done, have found to their dismay an increasingly large number of it getting rejected by the payers.  We at Billing Paradise have always remodelled our medical billing systems to reflect the current ground reality.  But even while doing so, BillingParadise has come to realize that the following can serve as a beacon of light to those billers confused by the ever so increasing billing complexity.

a. The Verification of Eligibility:  Foremost before anything else comes this criterion.  We guess there is no point in bemoaning later when a claim gets rejected, when the patient is not eligible to undergo a medical treatment in the first place.

b. Proper Preparation of the Bill:   The Bill provides valuable information to those who come next in the medical billing cycle, such as coders etc.  Therefore due vigilance needs to be exercised in its preparation.   Pt name, DOB, SSN, and other demographic information besides the doctor and facility information need to be entered accurately.

c. Knowledge about patient coverage:   Not all procedures and services under all circumstances are covered equally by all payers.  Certain payers have their own set of rules for the amount reimbursed and the circumstance under which a patient may be covered for a particular service or procedure.  Thus it becomes important to understand the variables under which a particular set of procedures/services/payers would reimburse a particular claim, such that expectations are set for that patient right at the beginning, and your clinic is well-aware of what copays or deductibles the patient will eventually owe you.

d. Medical Coding Competence:  Of course everything eventually boils down to this important step in the billing cycle.  Having the right set of in-house medical coders or outsourced medical coders will go a long way in ironing out many of the claims reimbursement pitfalls.

e. Electronic Claims & AR follow-up:   The good work of your in-house or outsourced team does not end just here.  Proper knowledge of electronic claims submission criteria along with dedicated A/R follow-ups with the payer will definitely help in minimizing denials.

Call us at 1-(888)-571-9069 or email steve@billingparadise.com  for all your medical data management needs like medical billing, medical coding, medical transcription etc.