physician billing guidelines – Medical Services


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Physician Billing Guidelines

There are many guidelines that go into medical billing.  Physicians billing guidelines are often complex and hard to understand.  It is important that you have a good idea of what ICD-10 is and how to use it effectively in billing. For starters, ICD-10 allows doctors to pay close attention to what they are billing patients. If you bill a patient incorrectly, your claim is going to be denied by the insurance companies. Most insurance companies today say that they want to help physicians to get paid easier.  However, most physicians don’t feel that way.

Many physicians today feel that they are at war with insurance companies.  They often feel that insurance companies don’t want to pay them the fair amount of money that they are do. Most medical professionals would agree that the system is set up so that the insurance companies profit more money. However, is this truly the case? In actuality, it is not.  If you understand and know how to code properly in ICD-10, your revenues should increase each year.  Many medical billers will tell you that they are the best. They will tell you that they have been billing for years and that insurance companies are hard to work with? However, is this truly the case?

In our experience, you need to have a proper education in ICD-10 coding and billing in order to get paid well on your claims. You cannot get paid well on your claims if they are filled out incorrectly. If your coder know how to submit claims properly, you should not get them returned to you by the insurance companies. Many insurance companies will return claims that are not properly filled out. Many people take offense to insurance companies that reject claims. It makes the process a bit depressing. Many people that work with insurance say that it’s not the insurance companies fault.  There are standards in which a medical practice must follow.

The main problem with medical billing today is that it is costly to hire a trained coder.  Many hospitals, treatment centers and private physicians’ offices are now outsourcing their work to private medical billing companies. It is cheaper and they get you higher returns.  Reputable billing companies should make you see an increase in revenue every few months. You should see an increase in revenue after your first six months of working with them. It should be able to convince you to either stay with the company or move onto someone else.

An important physician billing guideline is to follow all HIPAA laws.  It has always been a requirement to obey the law.  Medical billing is regulated by the United States government. Other billing is often not regulated. However, the laws have gotten even stricter with ICD-10.  There is no more room for error.  If you have incorrect claims filled out, you will see that your reimbursements are not mailed out to you.  When ICD-10 first got released, many billers were reporting that their claims were being sent back multiple times.

The good news is that a lot of medical billing companies took their time to learn ICD-10 long before it was released.  The new coding system got released on October 1, 2015 and the entire world took advantage of it. It is necessary to see a new beginning when it comes to coding. Learning how to understand coding is a beneficial way for you to look at your practice. In actuality, your billing is the most important part of the practice. Without proper billing, your practice will shut down. Many physicians are now working for hospitals or treatment centers because they cannot afford to keep their doors open.  A lot of doctors blamed their medical practice losing business because the insurance companies wouldn’t pay them. However, as a professional medical billing company, we know that this is not true. Our clients often see a 20% to 30% increase in revenues.  Our clients stay with us for long periods of time because they know that we have expert billing skills. Ideal Billing Solutions helps physicians to keep their doors open and increase their revenues on a year to year basis. It is easy to hire Ideal because we are friendly and easy to talk to.  We have a proven track record that works.

If you still choose to use your own in house billers, make sure that they understand that there could be different billing plans for the time that a patient spends with the physician. Each individual service is often put on the same claim.  Let us say the patient has an x-ray, shots and a physical. Often, the treatments are put into one claim.  You have to find the proper code for this. If the biller says, “I will just do this claim as I did everything else in ICD-9”, you will fail.  The codes are different and longer now.

Today, electronic medical billing is used in the United States.  In 1996, the HIPAA law was passed. It stands for the Health Insurance Portability and Accountability Act.  This means that a patient’s privacy is protected.  You must keep your patients medical information safeguarded. If it is not kept under safety, you can face serious fines.  There is also the fair debt collection act that must be followed. This means that there are certain rules as to how and when you can collect on debt that is owed to you.  There are certain rules that medical billers must follow when it comes to collecting on healthcare debt.

Physicians today are often given many tasks that they must complete.  The days are long over where you could do things semi okay and get paid on a claim. Today, physician billing guidelines have gotten more strict and harder to follow.  The deeper that you get into medical billing, the more you realize that you need a college degree to understand billing these days. Most men and women that want to build a career go to medical billing school.  They often get associate, bachelor and master’s degrees in billing.  If you are a coder, it is a requirement to have your ICD-10 coding certificate. A lot of overseas companies that promise to give you cheaper rates that USA companies are not certified and often do not follow strict United States government rules.  If you are working with a medical billing company overseas and they don’t know what HIPAA means, change companies quick!  If they are not certified in ICD-10, fire them immediately.  It is a legal requirement to have your coders ICD-10 certified.  If not, you could be facing some serious fines.   Before working with a professional medical billing services company, make sure that they are fully HIPAA compliant and know coding well.

 

 

 

 

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