Is Obamacare Preventative Healthcare? Does it Make Americans Healthier?

Is Obamacare Preventative Healthcare? Does it Make Americans Healthier?

One of the stated goals of the Affordable Health Care Act was to improve the overall health of Americans. As part of the goal, Obamacare created a National Prevention, Health Promotion and Public Health Council to manage the government’s goals and promote personal wellness.

ObamacareThe Council will make recommendations on how to move toward those ends and help people avoid serious health problems.

Obamacare includes a variety of provisions designed to promote a healthier lifestyle.

Many of those options may have little effect on individuals who already have serious or chronic health problems, nor do the initiatives take free will into account.

Obesity is of particular concern and has been designated as a security threat, based on a study conducted by retired military chiefs that make up the Mission Readiness group.

No Co-Pays For Preventative Services

Obamacare has created a list of government approved preventative tests and vaccines that will be available for free. They’re part of the guaranteed essential health services under Obamacare and no co-pays of any kind will be required from patients.

Free tests run the gamut, from mammograms, colonoscopies and those for STDs to immunizations and screenings for heart disease, high-blood pressure and cancer.

Counseling rounds out the array of no co-pay services provided under Obamacare. Individuals can avail themselves of consultations and advice from medical experts on diabetes, smoking, birth control and HIV, along with domestic violence, breastfeeding, depression and dietary needs.

Vaccines will prevent the spread of disease and screenings are valuable tools for identifying existing and potentially dangerous heath concerns.

Counseling provides patients with information they need to manage their health, but if individuals don’t act on the data to change detrimental habits they’ll still end up being treated for those illnesses.

No Behavior Goes Unrewarded

Obamacare approves and supports employer-based incentive programs to steer workers toward health and wellness lifestyles. Incentives can take the form of cash, funds deposited into a flexible spending account (FSA) to pay for medical expenses, or discounts on insurance costs.

Employers also have the ability under Obamacare to penalize workers that engage in behaviors deemed unhealthy, from smoking and weight gain to lack of exercise.

It’s a form of negative reinforcement that’s long been frowned upon as a method for disciplining misbehaving children, yet Obamacare gives the behavior a green light in the workplace.

Medicare Spending And Prevention Counseling

In addition to the free services accorded to others through Obamacare, Medicare recipients can work with their clinician to formulate a preventative health plan customized to their specific needs.

Plans will address current and future medical issues and condition management.

Healthy Choices When Eating Out

Fast food, restaurant cuisine and vending machines have been cited as primary sources that passively promote obesity.Obamacare

Beginning in 2011, all restaurants with 20 or more locations were required to provide nutritional data and calorie counts on menus to aid people in making healthy choices.

The mandate also extends to vending machines.

Obamacare offers an array of beneficial services and is a step in the right direction, but health can’t be legislated.

Obamacare doesn’t address many of the critical issues that can lead to the development of health problems or the element of free will. Only time will tell if Obamacare has been successful in creating a nation of healthier people.

Medical Coders – What are they?

Medical Coders – What are they?

Medical coding is often associated with medical billing, but the two are entirely different career paths. Coders use the information provided by the medical provider for treatment rendered and assign the appropriate codes for billing purposes.

The duties of a biller and coder may be combined in smaller practices and performed by the same individual. Nitin Chhoda shares the main responsibilities of medical coders and the attributes that they must have.

medical codersEducation Always Counts … Of Course!

A thorough knowledge of medical terminology and anatomy is essential for a medical coder. The average medical coder’s course is 15 months long and costs approximately $2,000.

Online training is available from a variety of professional organizations and at multiple colleges throughout the country.

A prerequisite is college-level human anatomy and physiology.

Students will learn how to assemble documentation and interpret guidelines for accurate coding. Courses will address the upcoming transition to ICD-10 codes, along with maintaining compliance and the ethical and professional standards required of a certified coder.

Medical Coders Must Be Familiar with Legalities

Remaining in compliance with government rules, regulations, guidelines and laws will play a major role in a coder’s every day duties.

Medical coders are in contact with confidential information that’s protected through regulations established by the U.S. Office of the Inspector General (OIG).

The OIG rules are designed to prevent fraud and abuse in billing.

Medical coders must also maintain compliance in the usage, dissemination and transmission of patient information as set forth in the Health Insurance Portability and Accountability Act (HIPAA). Known as the Privacy Act, it dictates how to handle sensitive patient data.

Medical Coders Know the Requirements and Compatibilities When Coding the Bill

An extensive array of data is collected during each patient encounter and it’s up to the coder to decipher any clinician notes and gather the documentation necessary to accurately code the reimbursement claim.medical coding

This is where knowledge of anatomy and medical terminology comes into play.

Medical coders are responsible for assigning the appropriate alpha-numerical CPT and ICD codes to reflect the practitioner’s diagnosis and subsequent treatment.

Medical Coders Should Be Familiar with an Integrated Software Technology

All the assembled data must be entered into a specialized medical billing software program or an electronic medical record (EMR) system in preparation for billing.

In practices that employ a single individual who acts as both the coder and biller, he/she will transmit the claim electronically to a clearinghouse for examination before being sent to the payer.

Show Me the Money …

Medical coders who undertake both coding and billing duties will be required to monitor claims to ensure they’re paid, follow up on late or denied claims, and interact with insurance carriers to collect the clinician’s fees.

Certified medical coders also work with patients on their portion of healthcare costs and file appeals with payers when required.

Medical coders hold considerable power within a practice and are professionals in a specialized field. They use their knowledge and ability to keep the flow of funds coming into a practice. They hold the financial keys to enable clinicians to plan, expand and pay the bills.

What are the Medical Billers?

What are the Medical Billers?

Medical insurance billers (MIBs) are the lifeline of a well-funded practice and the connecting link between patients, practitioners and insurance companies.

Billers affect the lives of hundreds of people each week and are an essential link in the reimbursement process. They collect payments for clinicians and ensure that insurance companies pay their portion of the costs for their clients’ healthcare expenses.

medical billerMedical billers perform a variety of functions, from entering the alpha-numeric ICD-9 and CPT codes that tell insurance companies the treatment a practitioner provided to interacting with patients on the balances they owe.

Medical billing staff works with sensitive data each day that requires confidentiality, integrity and ethics.

First Step — Data Collection

An MIB often functions as a coder and a biller, though the jobs can be exclusive of each other. Medical billers gather all the information associated with a patient’s encounter with their healthcare professional.

That information provides the documentation that will be used to support the payment requested from insurance carriers.

They decipher the data to determine the patient’s complaint and the appropriate CPT code to reflect the treatment provided.

Medical Billers Should Have Good Communication Skills

Medical billers spend a considerable amount of time interacting with others as part of the data collection and payment process. Clinicians must be queried to clarify patient encounter information and patients contacted about their payment obligations.

Medical billers also interact with insurance company representatives on reimbursement issues.

MIBs Must Always Verify the Facts

Medical billers are responsible for verifying patient insurance information, the correct billing format for each payer, and assigning the codes and modifiers that result in the practitioner’s payments.

They work with hard facts about patient policies, physician services and insurance company protocols.

Medical billers may also transcribe a doctor’s dictation about the patient encounter. Billers are knowledgeable in medical terminology, which helps them in assigning diagnosis and procedure codes.

Medical Billers Must Have Computers and Integrated Software

Medical billers spend a majority of their time behind a computer screen, ascertaining the facts of each patient encounter. They work with specialized billing software, like In Touch Biller Pro,or electronic medical record (EMR) systems, like In Touch EMR, that assist them in coding correctly, meeting the many submission demands made by payers, and transmitting claims electronically.

Consistent in Following Up Funds

Medical billers track and monitor each claim to determine its position within the reimbursement process. medical billers' software

They submit claims to clearinghouses where they’re examined for mistakes, errors and inconsistencies.

Clean claims are forwarded on to payers for reimbursement.

Medical billers track and monitor each claim to determine its status, ensure payments are made in a timely manner, and deposited in the practitioner’s account.

They work with clearinghouses and carriers if a claim is denied to obtain payment, and interact with patients on co-pays, deductibles and balances owed.

IMPORTANT:  Medical billers ultimate responsibility is to ensure that clinicians collect the maximum amount of money to which they’re entitled.

Medical billers wear many hats in their profession. They’re often one of the first and last individuals with which patients interact on financial obligations, and they comprise the key element in the reimbursement chain.

Medical billers document, code, transmit and follow payments to ensure their client’s financial status remains in the black.

Billing and Coding Errors – How to Minimize If Not Avoid

Billing and Coding Errors – How to Minimize If Not Avoid

The Affordable Health Care Act resulted in many changes for subscribers and alterations in the services carriers are willing to cover as part of insurance policies.

Those modifications directly impact how medical insurance billers (MIB) code claims. To assist billers in avoiding costly billing and coding errors, Nitin Chhoda examines the most common reasons for claim rejections and denials.

codingTo make payroll or purchase equipment and keep a practice operational, clinicians rely on MIBs to provide a steady stream of income in the form of reimbursed claims.

When the flow of revenue is interrupted with rejected or delayed claims due to coding errors, it can spell hardship for the practice and result in an investigation by regulators and law enforcement for suspected fraud.

Assumption of Coding

Every patient encounter is different and MIBs should never code on the assumption that “standard” treatment was provided. Billers need to consult with the clinician if they suspect missing information or simply can’t read the physician’s handwriting.

Documentation Problems

A number of documentation problems can arise when claims are filed, including missing or incomplete documentation that supports each item for which the practitioner is seeking reimbursement.

A criminal investigation could be done in the immediate future if a payer believes the MIB altered or recreated documentation to support a denied claim.

Mismatched Coding

The incidence of mismatched coding is a careless mistake and happens more often than one would imagine. It most frequently displays as billing a male patient for a treatment or procedure that is unique to female anatomy.

Important note: You can never overlook such simple mistakes because it can lead to claim denials.

Noncompliance

Each insurance carrier establishes its own set of rules and regulations governing claims. Billers can expect a denial if they don’t adhere to the payer’s specific policies, procedures and protocols.

Preapprovals

MIBs who fail to obtain the appropriate approval prior to treatment will find the practitioner’s claim denied. Payers are sometimes willing to make the approval retroactive in the event of an emergency when treatment was critical to save a person’s life.

Truncated Coding

Claims must include all three diagnosis levels for the greatest accuracy. Truncated coding may address the manifestation and episode of care portions, but not include the site of infliction.

Up and Down Coding

Coding at a higher level of treatment than was received exposes practitioners to fraud charges. Down coding is billing at a lower rate than appropriate in an effort to avoid denials. Payers who suspect this of happening can hold up claims for weeks or months.coding and billing

Unbundling

Coding is designed to include multiple actions as part of specific procedures and is billed as a whole. Unbundling bills those elements separately and could be viewed as an attempt at fraud.

Practitioners place their faith in MIBs to do their jobs quickly, efficiently and ethically. Mistakes in your physical therapy billing and coding can be easily rectified by simply double checking each claim before transmitted.

Being “creative” by unbundling or making assumptions about treatment that’s not supported by documentation can lead to charges, fines and litigation against both the clinician and the biller. Taking an extra moment to examine the claim will save days or even weeks in terms of delays and denials.

Healthcare Coding Basics

Healthcare Coding Basics

In the 21st century, paying for visits to healthcare providers is a simple process for patients. They simply present their insurance cards, make a copay and go on their way.

The system can be a nightmare for medical insurance billers (MIBs), who complete hundreds of reimbursement claims each week covering a wide spectrum of treatment. In the following article, Nitin Chhoda examines what MIBs need to know about healthcare coding basics.

healthcare codingMIBs will encounter a multitude of technical terms in healthcare coding that will affect the codes used when preparing a claim for reimbursement.

Billers will need to be fluent in medical terminology and healthcare coding procedures to accurately code claims.

The knowledge enables them to submit claims that are reimbursed quickly, meet the demanding standards required by insurance carriers, and maintain compliance with federal and state standards.

Documentation

Billers will be working with multiple and disparate healthcare coding documentation that provides substantiation to payers that the services, procedures and treatments provided were needful and appropriate to the practitioner’s diagnosis.

Each piece of documentation is the evidence that carriers will utilize for reimbursements and a single omission will result in a denial.

CPT Codes

The acronym CPT stands for current procedural terminology. CPT codes will be used on claims to describe the medical services and procedures provided by the practitioner.

CPT codes must match the services they represent to avoid denials and payment interruptions. This is very important.

ICD-9 Codes

The International Classification of Diseases (ICD) codes will soon be updated to CPT-10 to encompass new diseases and technology.  The alpha-numeric healthcare coding is the primary diagnostic tool used to document and explain the signs, symptoms, illnesses and diseases clinicians will encounter.

The codes provide insurance companies with essential information about a patient’s condition and resulting treatment.

Some billers will encounter alpha-numeric C codes and V codes:

  • C codes are used to identify the external causes of poisonings and injuries.
  • V codes are utilized to categorize factors that have a direct influence on a patient’s health status, along with encounters that aren’t due to an illness or injury.

Modifiers

There are times when a procedure is altered from its original description. Healthcare coding modifiers are used when a procedure requires additional time and expertise, or has extenuating circumstances.

Billers will use the two-digit modifiers in the CPT healthcare coding to report such occurrences. They provide MIBs with the means to bill very specifically and obtain additional revenues to compensate practitioners.

Modifiers are also appropriate when a technical component (TC) is involved.

Sometimes a clinician will need the use of equipment, labor and/or supplies to perform a procedure that is maintained by another specialist or medical facility.

healthcare coding basicsModifiers in healthcare coding are used to explain that those items are billable by entities other than the practitioner.

MIBs will encounter a host of different codes and medical terminology that must be entered on claims accurately to facilitate quick reimbursements and avoid costly denials and delays.

Medical billing staff who are familiar with the healthcare coding basics are well on their way to becoming masters in their profession.

The Typical Insurance Claim Cycle

The Typical Insurance Claim Cycle

The demand for medical insurance billers (MIBs) continues to grow and many individuals are eager to launch a career in the field.

The popularity of medical billing has given rise to a multitude of unfounded claims by scam artists who insist it’s a career path with minimal work and quick rewards. In this informative article, Nitin Chhoda explores the claim cycle and the MIB’s responsibilities.

claim cycleThe insurance claim cycle is the process of billing a third party entity that pays for the medical care of one of its subscribers.

The claim cycle begins the moment a patient makes an appointment with a provider and doesn’t end until the full amount has been deposited in the practitioner’s bank account.

Patient Paperwork

Medical histories, questionnaires and other forms impart necessary data about the patient’s past and current ailments, complaints, procedures and treatments.

A release of information is required so MIBs can file a claim and obtain payment from the patient’s healthcare insurance carrier. During the claim cycle, a release is critical, as MIBs can’t share the needed information with an insurance company without the patient’s permission.

Essential paperwork also includes a copy of the patient’s photo identification and their insurance card. Health insurance fraud is a very real crime for which MIBs must be wary. The insurance card contains information on who is eligible for services, along with exclusions, restrictions, limitations and prerequisites that must be met for payments to be dispersed.

Patients may also have coverage under multiple policies. Each insurance plan will have established deductibles and co-pays that constitute the patient’s portion of the final bill. Make sure that these are all reviewed during the claim cycle process. Always attempt to collect these fees before the patient sees the provider, or have the patient make alternative arrangements for paying.

Computing Power

All of the data must be entered into the MIBs billing software program or electronic medical records (EMRs) system where it can be accessed and retrieved for transmitting, tracking and monitoring reimbursement claims. Care must always be exercised in the claim cycle process to ensure the information is entered correctly to avoid delays and denials.

EMR technology is especially helpful, as it can identify users of potential claim problems.

A patient encounter form must be created and the appropriate ICD and CPT codes entered to substantiate the provider’s diagnosis and subsequent treatment. Any referrals, diagnostic tests and pre-authorizations must be documented, along with follow up visits if needed. The claim cycle process contains a full accounting of medical fees which must be entered and a claim form is always created that will be transmitted electronically to a clearinghouse.

Claims and Follow Ups

Once the claim arrives at the clearinghouse, MIBs will receive electronic verification. Clean claims that are free of errors are forwarded to the payer for remittance. Those with problems will be denied and returned. Clearinghouses and insurance companies are experts at finding even the smallest reason to justify delaying payments. So the billers must not end the claim cycle when they submitted the claims but rather when every claim has been reviewed and accounted for.

Once the claim is approved, it’s the task of the MIB to track the payment, see it securely deposited at the clinician’s chosen banking institution and recorded in the patient’s account.

claims cycle process

Overdue payments must be investigated and appealed when appropriate. Billers will need to contact patients about any outstanding balance, be prepared to send unpaid accounts to collections, or write it off as a loss at the provider’s discretion.

The insurance claim cycle is completed when each portion of the payment is collected from the insurance carrier and the patient.

With EMR technology, receiving remittance from commercial payers can take as little as 10 days, and 30 days for government operated plans. MIBs are a crucial element in the claim cycle process, working to ensure that the practices of their clients receive the funds to which they’re entitled.