Medical Coding As A Modern Necessity

Medical Coding As A Modern Necessity

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.

medical codingWhat 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.

modern medical codingMedical 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 Billing Basics

Medical Billing Basics

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.

medical billing basicsClosely 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.

medical billing basicsDenied 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

Medical Billing — 5 Mistakes You Must Avoid

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 mistakesMedical 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

medical billing mistakes to avoidA 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.

Medical Billing And Coding In-House

Medical Billing And Coding In-House

Whether your medical billing and coding should be in-housed or outsourced, there are certain things that are worth considering.  Nitin Chhoda shares the advantages of an in-house medical billing and coding for a small or new private practice.

medical billing and coding in-houseOne of the biggest considerations for many practices is whether or not to conduct the medical billing and coding in-house or to outsource the work.

The question tends to focus on costs, which makes sense.

If your practice can save money by hiring a company to handle the medical billing and coding for you, why hire someone in-house?

But of course, calculating how you are best served is not all that simple. The determination often depends on the size of the office, how many claims need to be filed per day, how many clinicians work at the practice, and the costs of related hardware and software.

And of course, does in-house medical billing and coding improve the rate at which your claims are accepted and paid, or will outsourcing improve collection rates?

Benefits of In-House Billers

The most obvious decision will have to do with the amount of billing that your in-house billers and coders can handle.

In a very small practice, where the receptionist can handle scheduling, medical coding, and medical billing without being overwhelmed, hiring out medical billing and coding is probably unnecessary. And there are a few benefits to having the medical billing and coding professional right there in the office with clinicians.

When you can talk to your medical billing and coding staff member directly, all the details can be accessed at any time about any claim. One downside of an off-site service is that you have less control over and less access to your billing history.

Some services will provide reporting as a scheduled service or on demand. But timing will still be hampered by the fact that the medical billing and coding staff handling your practice probably has a number of practices to worry about. The process becomes less personal.

medical billing and coding needsAnother benefit of in-house medical billing and coding is that the information only has to be communicated once.

In other words, in many ways an outsourced system will require that someone put in a decent amount of work to get the billing accomplished.

In the most efficient scenario, you could simply scan relevant documents and hope they understand what is written.

But outsourcing will not mean that all aspect of medical billing and coding will be handled elsewhere. Someone still needs to be available for communication and transfer of information.

Size Matters When it Comes to Price

As you can imagine, the larger a practice gets, the more efficient an in-house biller can be. If you have a very small office, hiring one or two staff members just to handle medical billing and coding careers will be very expensive. In a private practice, there is a fine line to be drawn between having one staff member to handle everything administrative, and having too much work for a single staff member to handle.

When staff members with lots of responsibilities get overwhelmed, all tasks begin to suffer. And when medical billing and coding suffers, the entire practice is put in jeopardy.

Medical Billing Professionals Working With the Health Care Management

Medical Billing Professionals Working With the Health Care Management

There should always be an open communication between the medical billers and the healthcare practice management.  Nitin Chhoda further explains how good communication will help to resolve any type of issues faster and more efficiently.

medical billing professionalsMedical billing professionals have plenty to worry about on a day to day basis; sometimes those bigger picture problems never get attention because there’s no time to think about anything but getting today’s work completed.

And medical billing isn’t the only profession that encounters this kind of challenge.

In most every field of work, there are people who spend time doing the work and then there are the managers who have a broader view and can make decisions for the entire practice.

Medical Billers and Management

Medical billers and health care management have to work together to find a balance between efficiency and becoming swamped. Many medical billing staff feel they have an unending set of tasks. By the time they get caught up with one thing, something else has come up and they have no time to step back and review their workflow or make things better for themselves.

On the other hand health care management may not realize that some of the most expensive problems with efficiency occur when medical billing people are overwhelmed. Health care management has the responsibility of reviewing the operations of the entire practice.

Having an Open Communication is Important

But indicators like rate of rejection or denial for insurance claims, or the accounts receivable aging reports don’t always tell enough of a story. Medical billers and health care management must work together to find solutions to the efficiency problems that exist.

When indicators are discovered, it may be time for a review of workflow and schedule pressures that the medical billing staff experience. Health care management can be a catalyst for improvements if the medical billing staff is approached in the right way.

Common Problems That Medical Billers and Health Care Management Can Solve Together

One of the most common problems that medical billing staff experience is the lack of a schedule for performing tasks. When things are just a little too busy, a medical biller may be forced to deal with whatever is most pressing at the moment.

But medical billers and health care managers should both know that the most efficient medical billing training of practices involve keeping a schedule and dealing with responsibilities in an organized way.

medical billing managementRather than simply giving the medical billing staff more time, health care management should be able to talk to medical billers about what is slowing them down or inhibiting their ability to check and correct their work.

Working out times when the medical billing staff can focus on drafting claims and making it a priority to review claims can actually save medical billers in the long run.

Most mistakes lead to rejected or denied claims, which is a huge problem for the entire practice. A rejected or denied claim has to be reviewed for mistakes and then re-filed. If the medical billing staff has time to review before sending, fewer mistakes will get through and fewer re-filing will be done. This saves everyone time and therefore it will save the practice money and relieve stress.

Medical EMR Solutions Give Clinicians More Power

Medical EMR Solutions Give Clinicians More Power

Clinicians who already use medical EMR know that this technology is helping them and their staff work more efficiently. Nitin Chhoda shares the many benefits that EMR can offer to your physical therapy practice, helping it succeed.

medical EMR solutionsThe ability of any clinician in any medical practice is limited by financial factors. If a practice doesn’t make a profit, or at least break even, nobody can continue to provide healthcare.

Because the prices of healthcare in the United States are so high, patients cannot afford to pay for their own healthcare.

The majority of U.S. citizens cannot afford to pay the average prices for healthcare. As a result, both patients and clinicians must rely on healthcare insurance companies.

Insurance companies provide a sense of financial safety to patients, and patients can better afford to make monthly payments towards healthcare than they can afford to pay a $20,000 hospital bill all at once.

About Medical EMR

For medical EMR clinicians and health care practice management, knowing that part of every bill will be covered by insurance provides some financial security, even in a market where the patients who need the services cannot pay for those services.

Medical EMR systems make everything about a healthcare provider practice run more smoothly and efficiently if implemented well. The upfront cost of a medical EMR may seem restrictive, but the benefits tend to outweigh those costs relatively quickly.

A medical EMR system can bring stability to a practice and can turn into a tool that clinicians use to better serve their patients.

Spending More Time on the Important Stuff

Most clinicians would spend a whole lot less time handling paperwork if they had the choice. The truth is that everyone who works in healthcare has to know how to fill out forms and make correct notes about their patients.

The same should be applied when it comes to medical EMR. This can even get in the way of how well a clinician can care for patients, especially in a busy practice where limited time is given for each appointment.

medical EMR cliniciansBefore and after each appointment, a clinician needs time to review the previous patient’s file as well as refresh their memory with information about the next patient’s medical history.

Medical EMR software makes doing these tasks faster and more intuitive. Rather than requiring that a staff member find a paper file and have it ready, the clinician can pull up the information on the computer in seconds, or even on a hand-held tablet computer.

Advanced Technology

Software is becoming more and more advanced, and not just because using computers is fun or flashy. Clinicians who use successful electronic medical records systems find that they are more efficient and can spend more time with patients when they use a medical EMR.

And of course, that staff member who used to pull files and return them to their place all day long can now spend time doing other, more important things.

Perhaps that staff member can now handle a more efficient and time-saving induction process, so that new patients’ health insurance information is more complete.

Medical EMR companies and billers benefit because they can reduce the number of rejections and denials. And patients can be better prepared for the costs that will come their way – allowing them to focus on their treatment plan.