Medical Billing Coding Specialist | Why you should become one
Mar30

Medical Billing Coding Specialist | Why you should become one

Medical Billing Coding Specialist A Career as Medical Billing Coding Specialist Medical billing coding specialists are largely responsible for making sure medical practice office reimbursement and revenue cycles run very smoothly. When a physician performed the service, the medical billing coding specialist will then generate a superbill or a charge sleep. They will then scrub the claims before they send it out. Making sure the CPT Procedural codes and the diagnosis codes are appropriate based on the Physician’s documentation on the patient. Maximizing reimbursement is the biggest challenge for the Medical Billing Coding Specialist making sure the practice are getting reimbursed appropriately. Medical Billing Coding Specialist must be a pro-active individual and accuracy is an absolute must. This career I must say is a very promising career. Medical billing coding specialist is a medical profession field that deals with the procedure for processing patients medical claims involving data and information which include health records and insurance information for reimbursement. This procedure involves learning a large numbers of codes with each code representing a particular symptom, diagnoses, and medication.  Every patient account has to be accurately recorded, registered and tracked accordingly in order to appropriately claim payment for services rendered by the health service provider. Medical billing and medical coding professions are two different kinds of jobs; Medical billers communicate directly with the patients and the medical insurance providers to monitor invoices payment and the payment period. Medical coders, on the other hand, do not frequently come in contact with the insurance providers and the patients; they spend most of their time accessing and coding patients’ data. In the medical field, every action carried out need to be coded correctly in order for correct billing to take place. Therefore Medical billers and medical coders working hand in hand for accurate Medical billing and coding to be conducted which leads to correct and proper claims. Below are the reasons why you should be pursuing the career of medical billing and coding.                         Office Based Medical Billing Coding Specialist – how much are you worth? Want to work in the medical field but not to be in contact with patients or body fluids? The answer is Medical billing and coding career. Medical billing and coding is an office based career in the medical industry where the individual does not have to come in contact with body fluids and patients as the norm in the medical field. These outstanding individuals are responsible for submitting the medicare services claims for reimbursement to the insurance companies due to treatment offered to the client of the insurance firm by the medical facilities. Are you analytically minded and oriented? Then a career in the field...

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Incident to Billing Performed by a Nurse Practitioner or Physician Assistant
Mar26

Incident to Billing Performed by a Nurse Practitioner or Physician Assistant

Billing for services Performed by a Nurse Practitioner or Physician Assistant can be critical to your practice making sure you are maximizing reimbursement and you are not losing money. These services are described as incident to billing. Incident to billing for services that are defined as those services that are furnished incident to physician professional services in the physician’s office (whether located in a separate office suite or within an institution) or in a patient’s home. These services are billed as Part B services to your carrier as if you personally provided them, and are paid under the physician fee schedule. Note:  Incident to billing services are also relevant to services supervised by certain non-physician practitioners such as physician assistants, nurse practitioners, clinical nurse specialists, nurse midwives, or clinical psychologists. These services are subject to the same requirements as physician-supervised services. Remember that incident to billing for services supervised by non-physician practitioners are reimbursed at 85 percent of the physician fee schedule. For clarity’s sake, this article will refer to “physician” services as inclusive of non-physician practitioners. To qualify as incident to billing for provider services must be part of your patient’s normal course of treatment, during which a physician personally performed an initial service and remains actively involved in the course of treatment. You do not have to be physically present in the patient’s treatment room while these services are provided, but you must provide direct supervision, that is, you must be present in the office suite to render assistance, if necessary. The patient record should document the essential requirements for incident to service. Keypoints for Incident to Billing Services: The health giver is receiving direct supervision from the medical physician on the date of service. The service is a part of the current treatment plan of which the medical physician did the initial evaluation, plan of treatment and course of treatment. The supervising physician is actively involved in the course of treatment. Health Providers such as Physician Assistants, Nurse Practitioner, Physical Therapists, Occupational Therapists & Speech Therapists are example of health providers that might me providing services under the group or a solo practitioner. These providers are all under the direct supervision of the Medical Doctor who did the initial evaluation, plan of care and course of treatment. Services are rendered to patients as if the supervising MD saw the patient himself. If the Insurance Companies that your practice participates with credentials for instance the PAs, upon issuance of his/her provider number with the insurance company, your practice must start billing that insurance company under his/her provider number rather than using the supervising MDs provider number, under the group number or tax ID number. Though incident to billing services are being paid at 85%...

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3 Steps For Accurate Billing Evaluation and Management Services in Your Practice
Mar25

3 Steps For Accurate Billing Evaluation and Management Services in Your Practice

3 Steps For Accurate Billing Evaluation and Management Services in your Practice Begin by asking questions when determining the accuracy when billing for evaluation and management. Step# 1 – Is the patient seen face-to-face in the last 3 years? The 3-year rule describes that an established patient is someone who was seen by the same physician (or any physician) under a group and of the same specialty or sub-specialty. One good example is: A patient with a chronic back pain comes in to your office. Dr. John who is a part of the group, a Physiatrist saw the patient. The history shows that the same patient was seen by Dr. Smith 30 months ago for the same problem and both physicians are under the same group and with the same specialty. This patient is considered as “Established Patient” following the 3 year rule for Evaluation and Management. Step# 2 Determine if the Patient is New or Established when billing for evaluation and management So when billing for evaluation and management, just remember that a “new patient” is defined as an individual who has not received any professional services from the physician/non-physician practitioner (NPP) or another physician of the same specialty who belongs to the same group practice within the previous three years. An established patient is an individual who has received professional services from the physician/NPP or another physician of the same specialty who belongs to the same group practice within the previous three years. So by reading the above, it is very easy to determine what type of patient are you going to be billing for – New or Established patient. You also must be aware that it is possible you have different sub-specialty in your practice. For Example: A Family Practice physician is the primary care doctor for an established patient comes in to the office with a sports injury. The patient was then seen by a Family Practice physician whose “Sub-specialty” is Sports Medicine . This patient becomes a “New Patient” due to the fact that the patient was seen by one of its physicians who has a different sub-specialty from the other physician (under the same group). Choosing the right patient type (either New or Established) require a “Face-to-Face Encounter”. Some physicians may experience providing a non face-to-face encounter like going over the diagnostic reports over the phone – this does not automatically establish a “New Patient” type since there is no face-to-face encounter had occured. On the Medicare Claims Processing Manual – section 30.6.7, it says there – “An interpretation of a diagnostic test, reading an X-ray or EKG, etc., in the absence of...

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How to Bill for Depo Provera Injection
Mar25

How to Bill for Depo Provera Injection

How to Bill for Depo Provera Injection This type of injection is performed as an intramuscular injection to prevent pregnancy. Your physician should submit claim using CPT® code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). In addition to this will be your HCPCS Code for the Depo Provera Code… Please LOGIN HERE to view this content. Or, REGISTER HERE Find this article useful? Please comment below and share what you just found from this website! Go ahead - please click "SHARE"EmailTweetShare on...

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Obesity Medicine Medical Billing, Coding and Reimbursement
Mar22

Obesity Medicine Medical Billing, Coding and Reimbursement

My 2 days Speaking Event at the Obesity Medicine Conference in Washington DC was a big success. Met a lot of physicians who just love what they do and so passionate in providing ONLY the best quality care for their patients. Find this article useful? Please comment below and share what you just found from this website! Go ahead - please click "SHARE"EmailTweetShare on...

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