There are some simple rules to follow to ensure that you’re getting the best reimbursements for your claims. First of all, make sure that you know exactly what the payer requires for reimbursement on these claims. Next, make sure you document exactly what caused the encounter and what the outcome was. This shows a logical flow of information and will better help the payer see that the services rendered will qualify for full reimbursements.

Additionally, be aware that the RVU system makes no adjustment for codes with modifier 25. Although a plan may pay such claims as the policy allows, insurers that follow CPT rules should generally be paying each CPT code in full in this instance as long as a distinct entry is made on the medical billing form. Additionally, make sure that your charges are consistent and reflect real pricings for services rendered.

A red flag for many payers is two of the following scenarios:

• Enter a $0 charge for the sick visit service (99201-99215), and bill the preventive medicine service (99381-99397) above the contracted rate
• Split the well care charge in half and apply it to the sick visit.

  Remember, raising your price on a single visit may get your entire claim denied. The right way is to charge the usual amount for your services and back up all services with strong documentation.

You may have had every intention of doing your own medical billing for your practice from the day you opened until the day you retired, however with the never ending changes and nuances in medical billing claims varying from cancelled codes to nonpayment of certain procedures because they simply weren’t reported correctly – there comes a time when you need to look at your revenue flow from your reimbursements and decide it might be time to outsource your medical billing claims.

Another reason to outsource is the small fact that many practices are losing up to one solid forth of their revenue due to small inconsistencies in reporting. Medical billing codes can change, the way a particular carrier wants their medical billing claim reported can change and Medicare never seems to stop updating and changing their criteria for what constitutes a fully reimbursable procedure.

Your staff can spend valuable office time researching medical billing claims or you can outsource your medical billing and let your staff do what they do best : service your patients and help keep your practice running smoothly.

If you’re ready to get away from the paper chase of never ending medical billing changes, consider outsourcing a proactive way to begin 2010.

When you decide you’d like to use our medical billing services, we know that each provide and practice is completely individual in their needs and we will consult with your to find out what your concerns are regarding your billing. We will set your office up to communicate your medical billing claims via secure transmission to our office. If you’re interested in the rest of our Medical Billing Services we can also do the following to help you and your practice:

We will do all your data entry for you. Your medical billing claims will be filed for you. Nearly all will be filed via electronic claims methods but we still can handle manually handling paper claims whenever necessary.

We can mail our statements to your patients that will be mailed on your behalf from our office. If you have specifics that you want on your statements and you have a certain way you like to handle collection accounts and past due notices, let us know, we won’t change a thing and will continue to bill and handle claims exactly as you wish. We can also handle your payments. As the payments and EOBs are received related to your practice. We will enter them in our database. Your staff can log into to a patient’s account at any time and see the updated information at anytime as the changes are immediate.

If you have a problem with denials, simply outsourcing will lower your denial rate to around 1% of your total medical billing claims, in the event there is a denial, we will fight to get your claim approved.

Actually outsourcing your medical billing and coding needs through a consultant is one of the smartest business moves you can make. Don’t think you have to use a local company, many medical billing firms have branch offices in an area near you, but others may be miles to hundreds of miles away, and thanks to the power of the internet with secure connections and software advances that allow you to transfer your patient billing records while upholding the utmost in privacy standards, with just a click of your mouse, makes the job of shopping for a medical billing consultant to hand the billing paperwork for your busy practice all the easier.

Your staff won’t have to spend long hours at the copy machine when you outsource, most records can be transferred via computer to computer using secure, encrypted technology. Many medical billing consultants offer real time updates of patient accounts, so if information is needed on where a particular claim stands, your staff can click and see!

Outsourcing to a medical billing consultant will insure that your claims are coded and submitted properly because that’s their business! There are no interruptions, patients asking questions, and general day to day running of your practice. A medical billing consultant can devote 100% of their time to handling your coding and claims. That way your cash flow is steady and your practice will grow!

Time is money in your practice and if you outsource your medical billing through a consultant you are definitely making the most of your time and because of your smart choices, you’ll see an increase in your revenue flow for your practice.

Medical coding and billing is an extremely skilled practice. When you outsource your medical billing claims, you have to have confidence that your medical billing partner will check the coding, put the medical documentation in order, make notations where needed and submit your medical billing claim through secure measures. 

You also have to know you have trust your medical billing partner. Be wary of medical billing companies that can’t show you what their policies are for storage of information or how information is transmitted. Each day claims representatives see personal information pass across their desks. These could be patient Social Security numbers, illnesses, or patient history information. Each one of these items is extremely confidential and you have to know this information will be held in absolute confidence.

Medical billing fraud is another large issue today. Medical billing staff members have a job in which it is very easy to commit medical billing fraud. Your patients’ accounts and your payers’ accounts are left in their hands. A good rule of thumb when you’re looking at medical billing partners to outsource your medical billing to is to ask for reference. Failure to provide them or if you’re given numbers that just never seem to answer or you leave a message that never gets returned should throw up a red flag.

When you’re ready to outsource your medical billing, do your homework and ask questions. Picking the right medical billing partner for your practice will ensure that all your claims are processed correctly and you receive the best reimbursements possible for each of your medical billing claims.

Need help with your accounts receivable? Outsourcing your medical billing claims can help with that problem too. We can offer practice management solutions to help your staff deal with the coding changes and knowing the best way to package your medical billing claims to get the most out of your reimbursements.

If you need credentialing, we can help you with that too. As you know, credentialing can be a painful process of filling out forms and then waiting for approval from various insurances. We will file your credentialing paperwork and then follow up until you are approved and we can handle any speciality nationwide.

The time to outsource your medical billing claims has never been better. Look into how outsourcing can save you time and money today.