Healthcare Practice Management

Medical Terms Talking the Talk and How to “Get” Them, Part 2

by Nitin Chhoda PT, DPT | Jun 16, 2019 | Physical Therapy Documentation

Nitin Chhoda shares how to become familiar with terminology, tests, treatments and procedure.

Becoming fluent in medical terms becomes easier with practice, but to many it may seem as if they’re speaking a foreign language at first.

The prefixes, suffixes and root words aren’t part of the ordinary vocabulary for most people and medical jargon is a specialized language.

Along with medical terms, individuals working in a medical setting will also need to be cognizant of the terminology for tests, treatments and procedures.

Practice and Memorization Makes Learning Medical Terms Easier

Anyone in the medical profession must learn the medical terms and students of the healing arts have become proficient at developing strategies to help them memorize medical terminology. Committing small groups of prefixes and suffixes at a time to memory is only the beginning.

Begin seeking prefixes, suffixes and root word in literature, advertisements, magazines and even online. Associate suffixes and prefixes of medical terms with their meanings, dissect them into their component elements and try to determine the ultimate meaning. The technique is an easy and meaningful way to learn.

Medical Terminology for Treatments, Tests and Procedures

Along with a specialized vocabulary and understanding of anatomy, those in the medical profession will be required to have knowledge of medical tests, treatments and procedures. Tests are examinations that measure something about the patient, while a procedure is a course of action designed to achieve a desired result.

Treatments are also procedures, but a procedure relieves an illness or addresses an injury.

Suffixes and prefixes of medical terms will be used to describe treatments, tests and procedures, along with the specialties of those within the profession. For example, a physician may want a closer examination of a lump on a patient.

He/she will order a procedure (biopsy) to take a sample of the tissue, to be examined (test) by a doctor who identifies diseases of tissues (pathologist). If cancerous, chemotherapy (treatment) may be prescribed.

The importance of medical terminology becomes apparent when billing for services. There are hundreds of services that a clinician might be required to submit a reimbursement request for, from allergy tests to x-rays. The codes for various services must match the diagnosis, symptoms and results of the physical examination or the patient’s healthcare provider will deny the claim.

Medical terms, tests, procedures and treatments are all part of the medical billing learning process especially for those engaged in the medical profession, but there’s no need for individuals to panic or throw themselves into information overload.

Learning a few prefixes, suffixes and root words at a time and practicing those skills by breaking down terms into their component parts will help train the brain.

Individuals will be surprised at how quickly medical terms become part of their vocabulary and how easy it is to understand and add new terms.

Supply, Demand, and Combatting Limited Reimbursements of Insurance

by Nitin Chhoda PT, DPT | Apr 28, 2019 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

The way healthcare insurance is viewed and paid for has evolved significantly over the last century and the law of supply and demand is the rule of the day.

The business of selling insurance is a multi-million dollar industry, the sole purpose of which is to make money for the company providing the services.

Patients no longer visit their local insurance provider to obtain coverage. Insurance is packaged and sold like cars and the latest deodorant through state-of-the art advertising agencies.

Supply and demand dictates that if there’s a consumer need for a service or product, someone will provide that product or fill that need.

The Law of Supply And Demand

Consumers mistakenly believe that as more customers enter the market and purchase insurance, the cost will eventually go down. In a capitalistic system, that’s not necessarily true. If the revenues to be made are great enough, the cost will continue to increase as insurance providers strive to make ever greater profits.

Healthcare insurance providers charge the maximum amount that the market will allow for premiums.

The result is that consumers pay more for their healthcare insurance and malpractice insurance continues to skyrocket for medical professionals. Practitioners must charge sufficiently for their services to cover these costs and make a profit, while remaining competitive enough to attract new clients.

Payments versus Actual Costs

Healthcare insurance typically pays hospitals, labs and medical providers a set fee for services. In many instances, that payment doesn’t cover the actual costs involved.

Medical professionals must then decide if they will accept the insurance reimbursement as full payment, bill the difference to patients and face additional costs involved in collecting the debt, or if they want to offer the service at all.

To offset costs, medical providers need to create multiple revenue streams. Depending upon factors that include geographic location, clientele, patient load and availability, clinicians can do this through a wide variety of means. They can charge parking fees, write a book, schedule speaking engagements, add new services or develop new products.

Playing the Money Game

The primary way practitioners are paid is through reimbursement claims, which is normally prepared by medical billing professionals, to insurance companies, but there’s a dirty little secret lurking in the shadows. Insurance companies invest the funds they collect from clients to make more money. Each month that the firm can retain those funds, the company makes more on its investments.

That means healthcare providers are often forced to wait for up to three months to be reimbursed for their services. Insurance providers have teams of specialists whose job it is to calculate the fair market price for medications, office procedures and surgical interventions.

Insurance companies say these teams are eliminating waste, but the truth is that their job is to identify ways to reduce reimbursements paid to medical professionals.

Clinicians who choose not to offer specific services run the risk of losing clients to competitors who do.

If they accept insurance company reimbursements as the total payment for services rendered, they lose money.

Increasing patient numbers is one way to grow a clinic’s revenues, but creating multiple revenue streams is the most desirable. Funds coming in from a wide variety of sources will benefit practices in times of feast or famine.

Medical Coding As A Modern Necessity

by Nitin Chhoda PT, DPT | Jun 24, 2018 | Electronic Medical Records, Medical Billing, Physical Therapy Billing

Nitin Chhoda provides reasons why medical coding is necessary and the role it has in a private practice setting. By defining what medical coding is and what codes are involved, it helps simplify the process for practice owners and staff.

What is medical coding?

Medical coding is an important step between the treatment of a patient and medical billing for the procedures, tests, and services. Clinicians will talk to patients, administer or order tests, and write down notes about each visit.

Those notes may describe what the patient needed, and in turn a medical coding staff member will translate each billable item into the assigned medical code.

Every doctor, medical clinic, and hospital must record a patient visit and include any procedures and tests performed. No matter whether the patient, their health insurance company, or another party is paying the bill, medical coding will take place to document how the bill should be drawn up.

What are the codes that are used?

There are a few kinds of necessary codes that medical coding staff members handle. The first is ICD-9 codes, or the International Classification of Diseases codes.

The number 9 refers to the version of this form of classification, and in 2013 a new version will be introduced, ICD-10. CPT codes, or current procedural terminology codes provide a list of alphanumeric codes used by medical coding professionals in the United States.

HCPCS codes, or Healthcare Common Procedure Coding System codes, are used for Medicare and other insurance programs. All codes were developed in an attempt to streamline and standardize the way medical procedures and tests are described and billed.

Why is this necessary?

The most interesting thing about medical coding is that it comes from an interest in standardization. The fact is that most medical procedures can be described in a single way – medical tests and processes have been developed over time, and while that development continues, clinicians are taught a right way to do things fairly consistently.

Medical coding allows a medical facility to bill for anything using a standardized system.

If one hospital performs a surgery and describes it differently from another hospital, even though the procedure is essentially the same, a health insurance company is going to have a hard time determining whether or not they truly are the same procedure.

Rather than spending the time guessing about the appropriate amount that should be billed, medical coding allows everyone to agree in advance that a certain code can be billed at a certain rate.

Does that really work?

The sad thing is that this attempt at a system works in some ways and fails in other ways. The first problem is that health insurance companies change their billing requirements constantly.

Even if a certain medical code is used for a certain test, the billable amount for that test may have changed. Laws attempt to keep things flexible and reasonable, but everyone is still trying not to spend any more money than they absolutely have to.

On the other hand, medical coding has made it possible for trends in diseases and public health and safety problems to be tracked at local and national and even international levels. This kind of information and the data collected through medical coding can help to improve medical care.

Medical Coding Latest Trends

by Nitin Chhoda PT, DPT | Jun 17, 2018 | Electronic Medical Records, Physical Therapy Billing, Physical Therapy Software

Medical coding is a complicated task, and requires constant updating. NItin Chhoda shares the main tasks of a medical coder and the importance of using certified people.

Because medical coding is such an important task, many clinics assign a medical coder to do the job. Sometimes the medical coder and the medical biller are the same person, especially in a smaller clinic.

But medical coding is a complex task that requires a detail oriented approach and specific knowledge. Some of the most recent trends in medical coding have shown an increase in the demand for certified medical coders.

Updates to Codes

A certified medical coder for physical therapy billing is required to spend a certain amount of time studying medical coding before they become certified.

You don’t have to have a degree or certification to work as a medical coder, but you do have to understand medical terminology and have a good education in physiology and anatomy.

Reading what a clinician has written and assigning the appropriate medical codes would be hard if you don’t know what the clinician is talking about.

But another advantage of hiring a certified medical coder is that they will be required to take continuing education courses and re-certify regularly. That means that when changes are being made to medical coding websites, the medical coding staff member will be updated through courses.

One very important change that is coming soon is the switch from ICD-9 codes to ICD-10 codes, which will occur in October of 2013. An additional 100,000 codes will be introduced into the system, and the ICD-9 codes only number about 13,600 codes. This change is going to affect every single health care provider in the country.

Education and Job Outlook

As a result of the need for skilled medical coding professionals, the job of a medical coder is looking pretty steady for the next decade and beyond.

Competitive certification programs are popping up all across the country. For people looking for a steady and well-paid job, medical coding is a good option these days.

There have been a few recent trends in medical coding education. Most significantly, more and more medical clinics want to hire certified medical coders rather than someone they will have to train themselves.

A skilled and experienced coder will be able to handle the job efficiently and they will be learning how to deal with changes and updates as part of their re-certification courses. With this kind of confidence-inducing education, certified medical coders are a well-respected part of successful medical practices.

Paperwork vs. Electronic Medical Records

Another big adjustment that is rapidly changing the way medical coding is done is the introduction of electronic medical records. For some coders, this sounds like the best idea yet. EMR systems might make their jobs faster and more efficient, allowing for coding and billing to occur side-by-side within the computer program.

Some medical coding professionals are not so enthusiastic. They see plenty of potential for problems with security and privacy. But as electronic systems evolve and the need for better electronic security arises, it seems that security companies are developing the proper privacy measures to accommodate a paper-free medical coding environment.

Medical Billing Basics

by Nitin Chhoda PT, DPT | Jun 10, 2018 | Medical Billing, Physical Therapy Billing, Physical Therapy Management

The basics of medical billing and its role in the physical therapy business are shared by the licensed physical therapist, Nitin Chhoda. He emphasizes the difference between medical billing and regular businesse billing.

Closely followed by the process of medical coding is the medical billing step. These two important parts of any practice are closely related and intertwined.

They work together like the contract administrator and the biller who must base billing on the details of the contract.

In small practices, the medical coding staff member is the same person as the medical biller. It is likely that this trend will continue as medical coding and medical billing systems become more efficient and more integrated.

What is medical billing and why is it different from other forms of billing?

The primary difference between medical billing and any other billing is that medical billing requires an incredible amount of attention to detail and specific codes for each procedure. Naturally, there are other billing processes that are similar, but medical billing seems to be one of the most complex of them all.

Medical billing is what health care providers and health insurance companies go through to get medical expenses paid to the health care provider. The first step is the visit of a patient to the health care provider. The clinician will attempt to diagnose the problem the patient is having in an attempt to classify the exchange for the health insurance company.

Medical Coding and Billing

The billable services are then coded by the medical coding staff member and those codes are used for medical billing to the health insurance company. The rates for services are pre-set by the insurance company and the clinic, which is why clinics only take certain types of health insurance.

They have to negotiate prices with each company they work with. If there are any mistakes in the medical billing service and process, the insurance company will reject or deny the claim.

A rejected claim is a bill that has some clerical, invalid codes, or any other minor detail that can be a cause for rejection. Rejected claims must be researched by the medical biller and re-submitted correctly.

Denied claims have been processed but the insurance company has deemed them unpayable. A denied claim can be re-submitted or appealed if the medical biller believed the denial was unfounded.

Medical Billers and EMR

Medical billers have to deal with about a 50% rejection and denial rate. There are so many opportunities to make mistakes and insurers are much quicker to deny or reject a claim than they are to pay one.

The back and forth can be frustrating and exhausting. But more importantly, this paperwork headache is incredibly time consuming. Medical billing has turned into a very inefficient process and medical billers can start to feel that they are wasting incredible amounts of time just because of a tiny mistake. Medical billing can be a tough job.

Electronic medical records are attempting to streamline the process, however, and the job of the medical biller may get easier in the very near future. Many EMR systems are actively marketed as easy-to-use for medical billing. They can decrease the occurrence of mistakes and speed up the corrections process.

Medical Billing — 5 Mistakes You Must Avoid

by Nitin Chhoda PT, DPT | Jun 3, 2018 | Medical Billing, Physical Therapy Documentation, Physical Therapy Management

Nitin Chhoda reveals the 5 mistakes that a practice owner should avoid when it comes to medical billing. In order to have a successful practice, time management and prioritization are crucial to the billing process.

Medical billing mistakes are easy enough to make, and unfortunately even the smallest mistake can cost a practice a lot of time and money.

While there are some mistakes that simply cannot be avoided, there are some basic rules for avoiding the major mistakes that most medical billers and medical clinics make.

#5: Understand the Explanation of Benefits

The explanation of benefits, or EOB, is going to sound like the final word from the insurance company every time. But the EOB should be used as a tracking tool and should be carefully read and understood each time your practice receives a payment.

Insurance companies take any opportunity to point out the medical billing mistakes being made, which can make it feel like they are detail oriented to an unimaginable degree. But the truth is that they make mistakes, too. And it will be up to you to catch them.

#4: Follow Up on Every Submitted Claim

In the medical billing world, once a claim is submitted, there is often the sense that it has been dealt with and now it’s time to wait and see what happens. Medical billing is hard enough and takes a lot of time, so once the paperwork is in the hands of the insurance company, billers are unlikely to want to spend any more time thinking about the claim.

But time and again insurance companies let things go or don’t receive claims, and the practice suffers the consequences. Large sums of money are lost every year because nobody has run an aging report and reviewed unpaid claims.

#3: Create a System that Works

This may seem obvious, but every practice needs system for photocopying IDs and insurance cards, planning time for regular billing, and ensuring that claims are filed and checked on in a reasonable amount of time.

Delays that medical billing claims experience cost the practice money. Set aside time for each task and make sure that a procedure is followed for every patient and ever visit.

#2: Know Medical Coding Practices

A medical biller may or may not the be the same person as the medical coder, but either way the biller should understand the basics of medical coding.

The medical billing mistakes that cause claims to be denied or rejected often have to do with incorrect codes or insufficient medical coding.

#1: Billing is the Biller’s Top Priority

Especially in smaller practices, the staff member who handles medical billing service may have a whole host of jobs to do. They could also be the medical coder, the receptionist, and the scheduler. The problems arise when the medical billing is not given high enough priority in the list of things to do.

Without efficient and timely medical billing, the practice will suffer. Unfortunately we cannot rely on goodwill and good medicine to ensure that patients and clinicians experience a mutually beneficial outcome. Medical billing has to be a high priority, including the previous four ways to avoid mistakes.