Top 5 Reasons to Become a Medical Billing and Coding Specialist

Do you enjoy working with computers, pay exceptional attention to detail and aspire to work in the healthcare industry? If so, a medical billing and coding specialist position may be a viable option for you, and can lead to a rewarding career. To give you a little more insight, here are some of the top reasons for becoming a medical billing and coding specialist:

1. There’s a Demand for Qualified Medical Coding Professionals – The U.S. Bureau of Labor Statistics (BLS) reports that job prospects for medical records and health information technicians, which includes medical coders, appear to be good in the coming years. Employment rates for this field are actually expected to increase 20% between 2008 and 2018, which is much faster than the average for all occupations.*
2. Education Can Be Completed in Less Than a Year – Some medical billing and coding training programs can be finished in as few as 10 months, or about a year-and-a-half for an associate degree. Take time to explore your education options and choose a quality medical billing and coding training program. Ideally, the program you choose should also prepare you for industry certification, such as the Certified Professional Coder (CPC®) designation from the American Academy of Professional Coders (AAPC).
3. Availability of Online Medical Billing and Coding Education – Thanks to the convenience and flexibility of online medical billing and coding degree and diploma programs, you can accomplish your healthcare education goals without the common barriers of time and location. You’ll want to select a reputable, accredited medical billing and coding school with a specialized curriculum. These primary qualifications can help ensure that you receive a quality education.
4. Ability to Work in Healthcare Without the Typical Physical Demands – Many healthcare workers have to work extremely long hours and are required to move patients, stand or walk for long periods of time, clean up after patients and so on. As a medical billing and coding specialist, you will be able to assist healthcare providers and patients alike, all while working from your computer.
5. Potential to Work at Home and Set Your Own Schedule – Some healthcare providers outsource their medical billing and coding workload to fully trained specialists. This option gives you the opportunity to build your own home-based practice. As an independent medical billing and coding specialist, you have the freedom to decide what hours you would like to work and create an environment that fits your personal and professional needs.

Physicians to Manage Revenues amidst the Impending 26.5% Medicare Cut with a Medical Billing Service

Ever since Sustainable Growth Rate (SGR) began overshooting budgeted Medicare spend, physicians have been under the constant threat of Medicare cut. While Congress’ intervention has delayed the inevitable thus far, it may be a little tougher this time – Centre for Medicare Services (CMS) has already indicated that its fee schedule for 2013 is designed to initiate 26.5% Medicare cut if the Congress fails to intervene before Jan. 1, 2013. While physicians may still be optimistic of a breakthrough in their favor, they still need to be prepared for any eventuality. And if 26.5 Medicare cut is indeed set in motion, it would have a debilitating effect on physicians’ clinical and operational efficiency – practices may not be able to support operational expenditure, leave alone the thought of ‘profit’.

Despite the looming fear, practices can still find ways to off-set the impact of Medicare cut – transition to new payment and delivery models will help meeting the primary objective of improving patient care as well as moving to a higher-performing Medicare program.

Accountable Care Organization (ACO) is one such care model, which will increasingly become mandatory for care providers in the Medicare network. ACO requires physicians to form a clinical network that can achieve optimum clinical efficiency at minimum cost to patients. ACO works on the formula that a clinical network with A-Z medical services can considerably bring down patients’ medical expenditure. While physicians in an ACO get to be recognized for high performance, they also stand to benefit from shared-savings. Moreover, being in an ACO is indeed helpful in building credibility among patients.

The provision of Affordable Care will also help physicians counter the impact of Medicare cut. The significant thing about this reform is that it extends Medicare to every uninsured citizen in U.S. With roughly one-third of population expected to be Medicare beneficiaries, physicians can look forward to off-set Medicare cut with operational volumes from Affordable Care provision. But transiting to these novel care models may be seemingly difficult for physicians who have been used to protective health care models. Amongst possible challenges, understanding fee schedule, negotiating and renewing payer contracts, being conversant with multiple payer policies, and striking beneficial deal with payers will be more important. Moreover, a proper mix of public-private payers is more than advisable.

And, amidst these Medicare-cut-generated challenges, mandatory EHR, PQRS, and ICD-10 & HIPPA 5010 compliant coding too will add to the burden, which may be far too much to bear for physicians. With the in-house staff incapacitated to take responsibility of this enormity, outsourced medical billing services seem to be the only way out. Medical billing companies – with experience and competence in stage-managing transformation to high-performance Medicare models, managing mandatory EHR, PQRS, and ICD-10 & HIPPA 5010 compliant coding on behalf of physicians who are essentially focused on clinical efficiency – could provide helping hand.

Best 10 Ways to Prevent Claim Denial

How widespread is medical claim denial? According to the U.S. Government Accountability Office (GAO), the Department of Health and Human Services (HHS) collected data from insurers nationwide and found that the aggregate application denial rate was 19 percent in the first quarter of 2010.* That’s approximately one in five claims. Nobody wants their medical claim to be denied. Very often, claim denial is totally avoidable. Here are the 10 best ways to limit the amount of denied claims your office receives:

1. Ensure all patient information is available and accurate. For example, make sure the patient’s name is spelled correctly, the date of birth matches, and there are valid subscriber and group numbers.
2. Verify the patient is still covered by the insurance benefits provided before rendering services.
3. Coordinate benefits to make sure you have the right primary insurance listed, confirm the eligibility of benefits and verify the insurance information is up to date.
4. Contact the patient’s insurance provider to make sure the healthcare provider is a part of the policy’s network of planned participants. Also, check to be sure that the requested services are covered and that the services will not fall under a pre-existing condition clause.
5. Confirm any necessary referrals from the patient’s primary physician are on file before rendering services.
6. Check to see if prior authorization or pre-certification is required.
7. Be certain the doctor provided complete information and proper documentation. Request necessary medical records.
8. Bill the appropriate liability carrier if treatment is for an auto- or work-related accident.
9. Provide complete and valid CPT and/or HCPCS codes where applicable.
10. Make sure to file claims in a timely manner prior to the insurance carrier’s filing deadlines.

Billing “Urgent Care” As It Emerges As One of the Fastest Growing Specialties

Urgent Care

Urgent care is fast developing as a viable alternative to what has traditionally been known as “family practice”. The main reason behind this new-found fancy is that physicians can now operate from designated facilities without having to trek around offices, nursing homes, and hospitals. Additionally, urgent care centers are preferred to other similar types of ambulatory healthcare centers, such as emergency departments, and walk-in primary care centers by the scope of illness treated and facilities available on-site. It will not be long before we witness further addition to already 8,700 urgent care centers (UCCs) across the US.

While it is true that practicing Urgent care offers physicians an extended scope and avenue for revenue generation, there are certain criteria (established by The Urgent Care Association of America) that physicians must abide by. These criteria describe scope of service, hours of operation, and staffing requirements. A qualifying facility must treat walk-in patients of all ages during all hours of operation. It should treat an entire range of illnesses and injuries, and have the facility to perform minor procedures. An urgent care center must also have on-site diagnostic services, including phlebotomy and x-ray. Because of this inclusive medical service coverage, Urgent care medical billing has become far more complex than usual. Urgent care physicians will be called upon to deal with:

Code that allows urgent care centers to code and get reimbursement for the extra expenses involved in providing urgent care services

Code that allows the urgent care center to receive reimbursement at one flat rate (Global Fees for services rendered at Urgent care centers) for all visits coded with it

The usage of evaluation and management (E/M) codes as per EMTALA guidelines if it is a Type B emergency department

Facility codes in urgent care

National Provider Identifier (NPI)

E/M Code plus Procedure Code in Urgent Care

Level 1 E/M Code 99211

Codes for services rendered during extended hours

E/M Code + IV injection procedure code

Added to this complex coding is a reimbursement environment which has become more restrictive post a series of healthcare reforms recently. This additional burden of revenue cycle management (RCM) to an already overweighing clinical schedule may impede the very focus of clinical excellence. This is precisely the reason why physicians are turning to specialist billing and revenue cycle management from “urgent care medical billers”. Consequently, there has been an unprecedented demand for billers and coders in this domain.

At a time when the market is still peaking, Medicalbillersandcoders.com – the leading source for specialist billing and RCM services – has taken the lead in supplying the right billing and RCM sources to urgent care practitioners. Spread across all the 50 states in US, we provide experienced billing experts for urgent care billing & RCM for your medical practices.

3 Ways EMR Software Can Bring Value to The Health Facility

It's pretty well known that EMR software can bring a lot of value in your health care, but how?  In this article, we are going to cover the three main reasons why EMR software is rapidly becoming an important component for effective health organization.  Traditional print and the paper on which medical records are on the way out and they quickly replaced paper files of electronic medical records.  However, in order to effectively manage electronic medical records, you should have some type of EMR software that can do the job.  Here are 3 main ways that EMR software can help meet this challenge and bring tremendous value for your health care facility. 

1.  EMR software can help your organization to operate more efficiently, providing easy to find all of the patient record.  Often the patient will get the wrong files, and when it does, it mad scrambles to find the right files to treat a patient in an effective manner.  With EMR software electronic files are all easy to find, and then you can eliminate this problem all together. 

2. EMR software will allow doctors to work with ease.  Often, patients see multiple doctors for a variety of reasons, and doctors should be able to share confidential patient records in a safe, secure, and efficient manner. EMR software allows physicians to collaborate easily, which provides a high quality of care for all patients. 

3. EMR software also reduces the number of errors that occur in the patient files.  Doctors often can transfer information from one file or the other is wrong, because the physical file involved a certain amount of human error.  With EMR software, you can avoid a lot of human error, thereby increasing the quality of care that can be provided to patients.  With Electronic Medical Records EMR Quick change of software, it is about time that all health care organizations have stepped up to the plate and software EMR.  This will help your health care organization to operate more efficiently and provide better health care for patients. 

EMR Software and Its Advantages

A common electronic medical record software system, the need for electronic medical records service left.  There are many applications, software for EMR, which is a convenient and effective in this manner.  Typical management software designed to meet the specific needs of users. For example, the software is designed to meet the daily needs of the business, including patient record updates, as well as financial, regulatory, and clinical needs updating.

Electronic Health Record design standards

Effective system of electronic health records was developed with the full cooperation of physicians, medical specialists and health professionals to get the most productive results.  Due to its nature and structure, it can be taken one small physician practices and clinics, and large organizational structures.  With effective use of EMR software are included in the medical practice, it increases patient care, optimize business practices and offers dynamic financial statements.  Thus, the EMR system can make your business more sustainable one.

Implementation of its own

When implementing EMR software in your system of medical practice, it is usually not necessary for you to get an IT professional or computer professional.  The thing is, if your EMR developer does its job, it should not be the case.  A simple, rapid learning is a sign of a good electronic medical record system.  Thus, you can easily get moving with EMR software, pointing, and clicking and just "go for" system.  Medical records review, history, allergies, medications, and other technical patient treatment, usually on tap with no more than a few clicks.

An additional advantage is that with the use of EMR software you do not use invalid ICD-9 and CPT coding books for the patient and medical information.  Best in class EMR software will make your life much easier and much more organized and systematic.  This will allow you to schedule appointments with patients and prescribe drugs more easily and conveniently.  This software will not only save material resources, but also save you time.

Why go for electronic medical record software?

EMR software has made medical business easier and more efficient business. When the documentation process by means of software, time and energy are used for other production tasks.  The most attractive aspect of the program is that it is very convenient and easily adaptable. You do not need to be a computer Geek benefits of adapting it, and you do not have to go through a lot of the sessions to learn about how to install and use. You will get to enjoy it as you use it for a long time.  It also helps in converting long unmanageable paper medical records in the database software, which is easily controlled and the best way to protect your data.  Compare the advantages of EMR software that paper records, and the answer to the health care industry of tomorrow is pretty obvious.

When You Have to Replace The Existing ERP-System?

Implementing enterprise resource planning software requires a large investment of money, time, and effort.  It also takes time for the transition from the existing system to the new system. The company is in the ERP to optimize its internal processes and improve productivity.  However, after implementation, the organization will replace the existing ERP-system to get higher quality software, the best return on investment, reduced predictability of workload and improve.

There are various reasons why the organization will replace the existing ERP software.  If a company is using old techniques, it may be necessary to get new business process re-engineering, which is easier to use. In the previous program does not have specific features to support future expansion, the organization can look for replacement in accordance with the new requirements.  If the company has the resources, it will replace the existing system with new ERP software for technical progress.  Well with existing software ERP, the system can be difficult to manage if it is time consuming.  It might not be able to meet the new needs of the business, and this can make the organization to replace their existing software ERP. In addition, new acquisitions of smaller companies by market changes may change the business environment of the organization. In this connection it is necessary to replace the existing software, enterprise resource planning.

To replace the existing software, the organization should consider the requirements of the customer and the new ERP software benefits. The new program should be able to provide the functions required and must be able to be easily integrated into applications used. The customer's requirements must be well understood in order to learn the new requirements and to give the opportunity to find the appropriate software to be able to keep up with the competition in the market. The return on investment, which will be implemented in the new software should be evaluated.

New software must be able to provide a higher return to the organization. The organization must meet with the seller to assess the supplier. The advantages of the new software should be analyzed before looking to replace their existing software ERP. The best time to implement new programs should be defined. Allocation of resources and the time required to implement the new software should be defined for the business process re-engineering. The training will be necessary for the team members who will participate in the program. Organizations will have to form a staff for the legal system and business-critical applications such as to be able to reduce the impact of the change.

If organizations are facing challenges due to the existing system of ERP, would be inclined to go to the new software ERP, which will satisfy the transformed environment and the challenges.  The organization must constantly evaluate the situation to determine problem areas and decide on the replacement of the existing ERP.