What is the Best State to Become a Medical Billing and Coding Specialist?

“Go West, young man, and grow up with your country,” wrote John B.L. Soule in his 1851 editorial during the expansion of the west. The Bureau for Labor Statistics reports that in 2008, the annual salary for a medical billing and coding specialist ranged anywhere from $20,440 to $50,060. Keeping that range in mind, what is the best state to head to if you want to become a medical billing and coding specialist? Soule’s original statement to head west is not too far from the truth.

Salaries State by State

In 2008, the American Health Information Management Association (AHIMA), conducted a salary study of around 11,000 medical billing and coding specialists. The study found that geography was a key factor in salaries. The states with the highest compensations were:

1. California
2. The District of Columbia
3. Massachusetts
4. Connecticut

How Can I Become More Valuable to a Medical Billing and Coding Employer?

If you’re looking for long-term job security and ways to advance your career, you may be interested in becoming more valuable to medical billing and coding employers.

Below, we’ve outlined a seven-step plan for you to achieve increased value and professional growth in the medical billing and coding job sector.

1. Complete Training Courses

Medical billing and coding are complex fields. The professionals you will compete with for jobs generally possess a good amount of specialized training and experience.

Research online or on-site medical billing or coding courses and select one that matches your job goals. Even if you have a full-time job and little free time, you can choose from an array of online training programs that allow you to set the pace of study. Inquire about whether the program you choose covers topics important to medical billing and coding employers such as:

1. medical terminology,
2. medical coding manuals,
3. Medicare and private insurance claim processing guidelines,
4. handling denials and appeals,
5. maintaining regulatory compliance, and
6. avoiding accusations of fraud or abuse.

2. Join a Professional Association

What is The Overall Demand for Medical Billing and Coding?

General Demand for Medical Billing and Coding Professionals

Though the medical billing and coding profession is always looking for qualified people, demand in the field for medical billers and coders is escalating almost exponentially due to an aging population and changes in medical technology.

According to the Bureau of Labor Statistics’ Occupational Outlook Handbook (2010-11 Edition), in 2008 there were 173,000 professional medical insurance billers and coders in the United States, with the predominance of these individuals working in hospitals and varied health care facilities including small medical practices and outpatient care centers. Medical billing and coding demand, even through temporary job agencies and professional services firms, accounted for 40 percent of opportunities in hospitals and the rest in provider offices, nursing care, outpatient centers and home health service areas.

Certainly all dimensions of the health information field are exploding as the healthcare field shifts patient documentation to electronic data storage methods. For positions related to medical billing and coding, demand will, as a consequence, provide lots of options in the market, as tightening legal requirements for insurance policies and evolving government regulations make the need for maintaining accurate medical records that much more critical to an operation.

Do I Need Medical Coding Certification to Get a Medical Coding Job?

If you want to know whether you need certification to get a medical coding job, the short answer is achieving medical coding certification is preferable and it will benefit your career. However, if you do not currently have a medical coding certificate, you will find tips below to help you get your foot in the door of the medical coding job market while you work on attaining credentials.

Four Ways to Pursue a Medical Coding Job without Certification

While achieving medical coding certification demonstrates that you possess the skills needed to perform the job well, certification isn’t required by law. If you have relevant office or billing experience and you can present yourself as an exceptional candidate to employers, you may be able to start down the path of a medical coding career before attaining certification. Use the following tips to present yourself as a worthy candidate for a medical records or coding job:

What Kind of Experience is Needed to Get Medical Coders Jobs?

Whereas a medical assistant or nurse once typed out invoices after hours for medical practices, today even the smallest clinics have computerized their billing to save time, improve coding accuracy and protect their revenue stream. The result is a demand for medical billing and coding professionals with proper experience.

The General Market for Medical Coders

The U.S. Bureau of Labor Statistics rates medical billing and coding as one of the 10 fastest-growing allied health occupations. Demand is further intensified by an 18 percent shortage of qualified candidates, according to surveys by the American Hospital Association. This market demand is good news for individuals who are interested in pursuing a career in medical coding and billing; especially for those who have previously performed medical coding in some realm of their previous employment.

Though billing and coding are distinct disciplines, individuals who seek medical coders jobs ought to be skilled in both billing and coding, even if an eventual position only emphasizes one discipline over the other– as would likely be the case in large patient care facilities where medical claim volumes are high.

Are Medical Coding Online Jobs a Scam?

The tremendous growth of the medical coding industry and need for trained coders has unfortunately led to some medical coding online scams. In addition to fraudulent coding schools that act like “diploma mills,” online coding job scams are prevalent as well. Individuals who wish to find online medical coding jobs should do research and educate themselves for typical fraudulent behavior.

The lure for most people is the opportunity to work from home. Who would not jump at a listing for a medical coding job that offers plentiful work with flexible hours in the comfort of their own home? The truth is that while work-at-home jobs for medical coders do exist, they are not as plentiful as the many websites out there would like you to believe. Moreover, it takes medical coding course work and several years of experience in the field to be able to do medical coding at home properly and efficiently.

Signs of Fraud

How Can I Increase My Odds of Landing a Medical Coding Job?

Securing your perfect job requires skills to stand out in a crowd of candidates. It takes more than a full resume and a good handshake to land the medical coding job that you are looking for. Besides tweaking your cover letter and honing your interviewing skills, there are many actions you can take to make sure you rise to the top of the candidate pool. Learning about computer software and technology, getting the proper training and experience, obtaining certification and applying for an association membership are a few of the most important things to consider.

Befriend Your Computer

Learning how to work with computers can seem intimidating, but it is not impossible. Start by taking some classes in computer skills and technology. A medical coding job consists of a lot of computer work. Many people know how to work a computer, but not many know how to operate the particular software that a medical coding job requires. The Bureau of Labor Statistics states in its Occupational Outlook Handbook that medical records and health information technicians “that demonstrate a strong understanding of technology and computer software will be in particularly high demand” in the future of the field.

What are the Different Types of Medical Billing and Coding Jobs Available to Me?

All medical billing and coding jobs do not fall under one title or type. Generally, medical billing involves billing for goods and services rendered at health care facilities, while medical coding involves assigning numeric codes to patients’ diseases and conditions for the purposes of filling out insurance forms.

Medical billing and coding jobs vary by a number of different factors including:

1. experience
2. specialized knowledge
3. customer contact
4. work environment and
5. field: medical or insurance.

Variations in Medical Billing and Coding Jobs

Within medical billing and coding jobs, individuals may work in multiple areas or they may work exclusively in one area such as:

What is the Medical Billing and Coding Job Market Looking Like for 2012?

Today’s weakened economy and job outlook have not held much promise for many Americans seeking employment. The medical billing and coding job outlook, however, is one bright spot that promises continued job growth in the near future.

Current Statistics

According to the United States Department of Labor’s Bureau of Labor Statistics, as of 2008, medical billers and coders made up about 172,500 jobs in the U.S. The average annual job growth rate for an industry is between seven and 13 percent. However, the medical billing and coding job outlook is expected to increase by 20 percent or more between 2008 and 2018. That would increase the number of people employed doing this type of work to 207,600. The states with the highest level of employment in medical billing and coding are:

1. California (17,340 jobs)
2. Texas (14,710 jobs)

Medical Billing Jobs 2012

• What is the Medical Billing and Coding Job Market Looking Like in 2011? - The job market for medical billers and coders in 2011 is strong, especially as the US continues to climb out of the recession that began in 2008. Overall healthcare spending will continue to grow, and health records will become increasingly electronic, which opens opportunities for freshly trained professionals.
• What is the Medical Billing and Coding Job Market Looking Like for 2012? - The medical billing and coding job market should continue to improve in 2012, given the rising costs of healthcare and an aging population. Since ICD-10 implementation is scheduled for October of 2013, those with training in the new code set will become increasingly valuable as 2012 progresses.
• What are the Different Types of Medical Billing and Coding Jobs Available to Me? - There are plenty of job titles available to medical billers and coders aside from "coder" and "biller." You could work as an administrative assistant, auditor, compliance officer, manager, educator, product developer or consultant, just as examples.

Is Medical Billing and Coding for You?

According to Bethany Despot, a medical billing and coding student studying at Northern Michigan University,

"I would recommend medical billing and coding to people who can learn new things. If you don’t like stress, I wouldn’t take this job. You do deal with angry patients sometimes, which they’re teaching us to do in our classes. If you’re prone to mistakes I wouldn’t take this job either, because a mistake could potentially cost a patient their life, not only you your job."

But one important final thought before we continue with our expansive guide to medical billing and coding - a note on work from home jobs. More and more people are looking to work from home, and medical billing is often considered to be a career that allows one to do so. However, according to a 2008 AAPC survey, two-thirds of medical billers are not permitted to work from home. On the other hand, this statistic also reveals that one third of medical coders are allowed to work from home at least some of the time.

Medical Billing and Coding Education

Medical Billing and Coding Education

Online medical billing and coding courses are the perfect solution to continuing education requirements for young MBAC professionals. Many careers require individuals to obtain CEUs, or continuing education units in order to stay certified. According to the AAPC, 26.3 percent of the medical billers and coders surveyed in 2008 paid between $101 and $250 out-of-pocket for CEUs, professional membership fees and other resources. Nineteen percent paid between $251 and $500, and 15.2 percent paid more than $500 every year. However, 71 percent of the respondents also either "strongly agreed" or "agreed" with the statement, "My employer pays for CEUs to keep my knowledge current." So, when looking for a job, it may be helpful to find out if the employer will pay for your ongoing education.

What are Some of the Best Techniques for Finding Medical Billing Jobs?

Medical billing jobs are an integral part of the health information management and health information technology fields. Because there are so many medical billing job scams advertised, particularly on the Internet, job seekers must proceed with caution and hone their job search techniques using only credible resources.

Generally speaking, persistent networking and research are the overriding key techniques needed forfinding legitimate entry level medical billing jobs. More specific examples of job hunting techniques for finding medical billing jobs include:

1. joining an accredited certifying organization
2. taking advantage of government employment programs, and
3. volunteering your services.

Join an Accredited Certifying Organization

What is Medical Billing and Coding?

First things first - don't make the mistake of thinking that medical billing and coding are the same thing. In fact, medical billing is a subspecialty of medical coding. So, a medical biller will prepare reimbursement requests on the behalf of medical care providers and facilities to make sure that insurance companies pay them back for providing services. While this might seem as simple as sending the insurance company a bill, it's not - hence the need for coding specialists.

Mistakes in the medical billing and coding industry can be disastrous - the difference between patients getting the treatment they need and having to pay for whatever treatments they can afford. What's more, medical billers and coders have a huge financial impact on both the

Medical billing and coding 1

Medical billing and coding. Sounds simple, right? Well, with thousands and thousands of codes - each tailored to fit multiple diagnoses, symptoms, treatments, and medications, medical billing and coding can quickly become far from easy. One of the major draws to this career path is the lighter education requirements when compared to other careers in medicine and the flexibility of both schedule and work environment that many medical billers and coders enjoy. On MedicalBillingandCoding.org, you will find all of the information that you need to do the following 

• Select an accredited medical billing and coding school.
• Obtain the skills necessary to become a medical billing or coding specialist.
• Choose the certification you need to find a job.
• Find the employers in your area that pay the most and hire most frequently.

Is medical billing and coding the right career choice for you? According to Pam Lounsbery, a certified medical biller and coder in Michigan,

"If you don't like to read carefully and don't have a very good memory, I would not suggest you go into this field. There is so much to pay attention to and to remember."

But if memorization and attentiveness happen to be two skills that you have or would like to develop, medical billing and coding might be the perfect choice for a rewarding and challenging career.

Petition Demands Privacy for Electronic Health Records

Petition Demands Privacy for Electronic Health Records
By M.L. Baker
Ziff-Davis Media
10/28/2005 3:52:00

PMHealth information technology legislation is swirling around Capitol Hill this week, and there's no shortage of recommendations of how it should be done.

Privacy advocacy groups began circulating a petition Thursday to bar employers from viewing patients' health information and giving patients control over who can see what medical information.

The heads of the two advocacy groups who wrote the petition say that, designed properly, electronic health records can protect privacy better than their paper counterparts.

Electronic Health Record (EHR) - Exception Relating to Electronic Prescribing Information

Exception Relating to Electronic Prescribing Information

CMS's regulatory proposal creates an exception to the physician self-referral prohibition in the Stark law for certain arrangements in which a physician receives necessary non-monetary remuneration that is used solely to receive and transmit electronic prescription drug information.

CMS's proposed rule protects the donation of qualifying electronic prescribing technology when the donation is made by hospitals to members of their medical staffs, by group practices to their physician members, and by prescription drug plan sponsors and Medicare advantage organizations to physicians. CMS is considering whether to limit the aggregate fair market value of all items and services provided to a physician from a single donor. CMS believes a monetary limit is appropriate and reasonable to minimize the potential for fraud and abuse, and is soliciting public comment on the amount of the cap.

The proposed exception would protect only items or services that are "necessary" to conduct electronic prescription drug transactions. This might include, for example, hardware, software, broadband or wireless Internet connectivity, training, information technology support services, and other items and services used in connection with the transmission or receipt of electronic prescribing information. CMS believes the exception would allow a hospital to provide a physician with a hand-held device capable of transmitting electronic prescribing information, even though the physician may already have a desktop
computer that could also be used to send the same information. However, the proposed rule would require the physician to certify that items and services provided are not technically or functionally equivalent to those that the physician already possesses or has already obtained.

In addition, to be eligible for the exception, the items and services must be "used solely" for the transmission or receipt of electronic prescribing information. However, CMS is proposing to create an additional exception to protect the provision of hardware and connectivity service that are used for more than one function, so long as a substantial use of the item or service is to receive or transmit electronic prescription information. CMS is soliciting comments on methodologies for quantifying or ensuring that a substantial use of hardware and connectivity services is for the receipt or transmission of electronic prescribing information.

Exception Relating to Electronic Health Records

Electronic Health Record (EHR)

The use of e-prescribing and electronic health records is accelerating 

On October 11, 2005, the Centers for Medicare and Medicaid Services ("CMS") and the Health and Human Services Office of Inspector General ("OIG") published separate, but parallel, proposed rules representing a unified effort to advance the goal of widespread adoption of electronic health records technologies by hospitals, physicians, and other health care providers. These proposed rules are in accordance with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ("MMA"), which directed the Secretary of HHS, in consultation with the Attorney General, to create an exception to the Stark law and a safe harbor under the Anti-Kickback Statute to protect certain arrangements involving the provision of non-monetary remuneration (consisting of items and services in the form of hardware, software, or information technology and training services) that is necessary and used solely to receive and transmit electronic prescription drug information.

Medical Billing and Coding

PPO (Preferred Provider Organization)

A combination of traditional fee-for-service and an HMO. When use the doctors and hospitals that are part of the PPO, you can have a larger part of your medical bills covered. can use other doctors, but at a high expensive. 

Maximum Out-of-Pocket Expenses

The most money you will be required pay a year for deductibles and coinsurance. It is fixed by the insurance company, in addition with  regular premiums. 

 

Managed Care

It is to manage costs, use, and quality of the health care system. All HMOs and PPOs, and many fee-for-service plans, have managed care. 

 

HMO (Health Maintenance Organization)

Patient Demographic sheet

Patient Demographics sheet contains all the basic information about an individual or patient.  Patient demographics have been classified into five major headings


Patient Information
Patient employer information
Patient guarantor information
Physician information
Insurance information. 


Patient Information consists

Account #

Patient Name 

            It is entered as Last name, First Name, Middle Initial format

Patient Date of Birth 

           It is entered in the MM/DD/YYYY or MMDDYYYY as per the Billing

Sex

Superbill or charge sheets

Superbill or charge sheet contains the service details, physician details etc.,

It contains

*Facility Name (Location Name)
*Facility Address (Location Address)
*Facility Phone number (Location phone number)
*DOS (Date of Service)
*Attending physician Name
*Referring physician Name
*CPT (Current procedural Terminology)
*Dx (Diagnosis)
*Patient Copay details

*Mode of payment

CHARGEPAD

ChargePad is a mobile charge capture application developed for Anesthesiologists. The application was developed to allow physicians to capture the Anesthesia Charge Record via a Windows Mobile phone or PDA and submit later electronically for billing.

• ChargePad produces the charges that interface with patient demographic information captured by your facility.

• ChargePad captures the same information currently documented on your anesthesia charge ticket.

• ChargePad installs directly onto your PDA-Phone so charges are synchronized following each patient.

• ChargePad allows charges to be held as pending for follow-up at a later time.

• ChargePad captures “Start and Stop Times” of patient cases with the click of a button for accurate time capture, eliminating the compliance risk of rounding case times.

• ChargePad easily handles case hand-offs.

• ChargePad provides drop-down lists as guides through procedure selection, providing all the same information found on a paper charge-sheet/super-bill.

• ChargePad delivers completed charges for more accurate billing.

• ChargePad reporting provides confidence that all charges are being captured and billed.

• ChargePad captures case charges immediately; decreasing delays in claims submissions and days in A/R, ultimately increasing your profitability.



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Modifiers | PreAuthorization / Prior Authorization

A modifier indicates that a procedure was altered but its not changed its definition.


Modifiers may be used as follows:

A service or procedure has both a professional and technical component

A service or procedure was performed by more than one physician

A service or procedure has been increased or reduced

Only part of a service was performed

An additional service was performed

A bilateral procedure was performed more than once

              Unusual events occurred 


Modifier 21 - Prolonged Evaluation and Management Services (Deleted, please use CPT 99354- 99357) 

Modifier 22 -  Unusual Procedural Services

Pace of Services list for healthcare billing

Code(s)	Place of Service Name
01	Pharmacy
02	Unassigned
03	School
04	Homeless Shelter
05	Indian Health Service Free-standing Facility
06	Indian Health Service Provider-based Facility
07	Tribal 638 Free-standing Facility
08	Tribal 638 Provider-based Facility
09-10	Prison/ Correctional Facility
11	Office Visit
12	Home Visit
13	Assisted Living Facility
14	Group Home *
15	Mobile Unit
16	Temporary Lodging
17-19	Unassigned
20	Urgent Care Facility
21	Inpatient Hospital Visit

Medicare common denials

Denial Code (Remarks):  PR 1
Denial reason: Deductible amount
Denial Action: Billed to secondary insurance/patient

Denial Code (Remarks):  PR 2

Denial reason: Coinsurance amount

Denial Action: Billed to secondary insurance/patient

Denial Code (Remarks):  PR 3

Denial reason: Copay amount

Denial Action: Billed to secondary insurance/patient

Denial Code (Remarks):  CO 4

Denial reason: The procedure code is inconsistent with the modifier used or a required modifier is missing.

Denial Action: Use appropriate modifier with respective of procedure

Denial Code (Remarks):  CO 5

Denial reason: The procedure code/bill type is inconsistent with the place of service.

Denial Action: Correct the Place of service or correct the procedure with respect of place of service.

Denial Code (Remarks):  CO 6

Denial reason: The procedure/revenue code is inconsistent with the patient's age.

Denial Action: Correct the procedure code with respect of patient's age

Denial Code (Remarks):  CO 7

Denial reason: The procedure/revenue code is inconsistent with the patient's gender.

Denial Action: Correct the procedure code with respect of patient's gender (Sex-Male/Female)

Denial Code (Remarks):  CO 9

Denial reason: The diagnosis is inconsistent with the patient's age.

Denial Action: : Correct the diagnosis code with respect of patient's age

Denial Code (Remarks):  CO 10

Denial reason:The diagnosis is inconsistent with the patient's gender.

Denial Action: : Correct the diagnosis code with respect of patient's gender (Sex-Male/Female)

Denial Code (Remarks):  CO 11

Denial reason: The diagnosis is inconsistent with the procedure.

Denial Action: : Correct the diagnosis code.

Workflow process in Medical Billing

The following details provides the workflow of Medical billing process.

1.  The doctor sees the patient. After seen the patient, Dr front office person send the all information pertaining to the patient which includes Patient Demographics (Face sheet), super bills/charge sheets, insurance verification data and a copy of the insurance card to Indian Billing office via FTP/fax .

2.   In Billing office, Scanning department retrieves the files and prints them and ties up with the control log for number of files and pages. 

4.   Illegible /missing documents are identified and a mail is sent to the Billing office for rescanning.

6.Coding and pre-coding of the super bill/charge sheet and demographics for insurance, doctors, modifiers, CPT and diagnosis are done wherever required.

7. The claims data entry operator creates a charge, according to the billing rules pertaining to the specific carriers and locations .All charges are accomplished within the agreed turnaround time with the client.

8. Charges are verified by audit department for accuracy and compliance with rules.

9. Claims are filed and information sent to the Transmission department.

10. Transmission department prepares a list of claims that go out on paper and through the electronic media. Once claims are transmitted electronically, confirmation reports are obtained from clearing house and filed after verification. Paper claims are printed and attachments done if required and put into envelopes and sent to the US for postage and mailing.

11. Clearing house transmission rejections/errors are analyzed and take corrective action and again transmit the claims to clearing house

12. Once recieve the EOB( Expalnation of Benefits-Payments),  Cash applied team receives the cash files and post the payment in the respective accounts. This would helps to reconcile the deposits at the end of each month. while psoting the EOBS, Overpayments are immediately identified and sene the information to Dr office to refund the amount into the respective insurances. 

13. All rejected/denied claims,  research the reason for denial with remark codes in the EOB’s or Explanation of Benefits received and take appropriate action to resolving the issue. 

14. AR analysts are the key to any group. They record the processing time of each insurance companies and identify all claims falling above the processing time. Then the claims are researched for completeness and accuracy and insurance carriers are called if required. AR analysts are responsible for the cash collection and resolving all problems to enable the account to have clean AR. 

15. Insurance Calling team, calls to the insurance companies to identify the  reasons for non-payment of the claims.Calling details are passed on to the AR Analysts for resolution. Calling team works during the American Time zones.

16. Patient calling team calls up the patients to confirm receipt of bill and when they are going to pay. Based on client’s approvals budget plans and discounts for immediate payments are also undertaken.

A Note on Methodology

The size of a billing organization can range from a few staff to hundreds of employees, with employees added as the number of claims processed grows. 

Cost factors include the number of claims, average number of pages per claim, average processing time per claim, average payroll costs, and the percentage of claims that must be processed in paper or hardcopy format, including those received electronically but printed for compilation. All of these variables and more have been taken into account in our study. 

Savings percentages are derived from Laserfiche’s 20-year history and experience with over 25,000 installations worldwide. In this white paper, we present results for the following types of organizations as represented by our customers:

•Single-facility billing departments: 75,000 claims processed annually.
•Multi-facility billing departments: 225,000 claims processed annually.
•Third-party billing organizations: 750,000+ claims processed annually.

An ROI calculator is available upon request. With this tool, you can plug in your own variables and calculate the savings your organization will realize by implementing digital document management technology.

A number of steps are required to generate and file a medical claim from a patient encounter, including documentation compilation, quality control, financial verification, coding, billing input and claim processing. 

Often, these steps involve one or more staff members, and this simple list belies the complexity and effort involved in each of these steps. The work processes involved in generating and filing a claim can be dramatically streamlined with document management. These benefits are further enhanced by implementing an electronic document workflow process to automatically guide the file through the required stages.

Claim Processing Efficiencies

Source documentation can vary from a single encounter form to a multi-page file of supporting records. Portions arrive at different times and in a variety of formats that include paper, electronic documents and electronic data files. 

And documents may be received in a variety of ways, including physical delivery, fax, e-mail, CDs and FTP site uploads. In fact, without a digital document management system, the most effective way to compile and review the disparate documentation is often to print everything received electronically, which wastes time and resources.


Providers that have implemented an EMR/EHR application can send an electronic data file, which in effect transfers the printing and paper costs to the billing organization. The mail room becomes the initial record assembly area, where documentation is sorted into patient batches and folders are created and labeled. 

Documents are then routed to the first step or staff in the workflow process, which is typically quality control. Too often, duplicate files are received, which doesn’t just double the cost of compilation, but also requires staff to identify them as duplicates and then delete them. 

Defining Workflow

Workflow, a term that originated in the mid-eighties, has many definitions. For this study, we define workflow as a computer-assisted (or automated) organizational process. An organizational process is a collection of activities related to a specific commitment, adding value to a product or service of the organization. 

Workflow is often used synonymously with reengineering, but workflow automation and business process reengineering are not the same thing. Workflow automation is a software technology that provides a means of automating a business process. Reengineering is the act of analyzing the business processes of a company or practice and changing them with the goal of improvement. 

Thus, business organizations can automate business processes using workflow software without reengineering them. Likewise, businesses can reengineer business processes without work- flow automation.

Workflow is also not the same as workflow automation.

Any application that can route a document so that it flows (like e-mail) from one user to another can claim to be workflow. True workflow automation includes an array of essential features that go far beyond the simple routing of documents and depends on two critical factors, (1) automating manual process steps and (2) distributing information to the workgroup, in this case, to the physician and his or her staff. 

An automated workflow system has the following characteristics:

• Tasks These are activities that must be completed to achieve a business goal. The CPR (computer-based patient record) and workflow system in this study are task-based.

• People Tasks are performed in a specific order by specific people (i.e., nurses, physicians) based on business roles.

• Roles Roles are defined independent of the people or the processes that fill them; for example, the CPR defines a nurse’s role as different from a physician’s role in the physician’s office.

• Processes Processes are the sequences of steps to be performed based on business conditions. Workflow automation may mirror existing processes or call for redesigning processes to eliminate redundancies and bottlenecks and to account for simultaneity. 

Since redesigning processes involves an examination of why people do what they do and often requires changing the way people do their work, it may foster fear, uncertainty, politics, and resistance to change.

• Practices Practices are what actually happen in organizations. Only by capturing the practices is it possible to truly automate businesses.

• Policies Policies are formal written statements of how certain processes are handled. In most physician practices, policies are unwritten and must be remembered by the person assigned to the task.

2011 CPT updates in interventional cardiology

33620 Application of right and left pulmonary artery bands (eg, hybrid approach stage 1)

33621 Transthoracic insertion of catheter for stent placement with catheter removal and closure (eg, hybrid approach stage 1)

33622 Reconstruction of complex cardiac anomaly (eg, single ventricle or hypoplastic left heart) with palliation of single ventricle with aortic outflow obstruction and aortic arch hypoplasia, creation of cavopulmonary anastomosis, and removal of right and left pulmonary bands (eg, hybrid approach stage 2, Norwood, bidirectional Glenn, pulmonary artery debanding)

Provider Enrollment, Chain, and Ownership System (PECOS)

Providers and suppliers must have Internet Explorer version 5.5 or higher and have the most recent version of Adobe Acrobat Reader before initiating an enrollment action using Internet-based PECOS.

The Internet-based Provider Enrollment, Chain and Ownership System (Internet-based PECOS) can be used in lieu of the Medicare enrollment application (i.e., paper CMS-855) to:

• Submit an initial Medicare enrollment application
• View or change your enrollment information
• Track your enrollment application through the web submission process
• Add or change a reassignment of benefits
• Submit changes to existing Medicare enrollment information
• Reactivate an existing enrollment record
• Withdraw from the Medicare Program

Advantages of Internet-based PECOS

• Faster than paper-based enrollment (45 day processing time in most cases, vs. 60 days for paper)
• Tailored application process means you only supply information relevant to YOUR application
• Gives you more control over your enrollment information, including reassignments
• Easy to check and update your information for accuracy
• Less staff time and administrative costs to complete and submit enrollment to Medicare

2011 CPT changes in Interventional cardiology

1. 93451 - RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
2. 93452 - L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
3. 93453 - R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
4. 93454 - CATH PLMT & NJX CORONARY ART ANGIO IMG S&I
5. 93455 - CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
6. 93456 - CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
7. 93457 - CATH PLMT R HRT/ARTS/GRFTS W/NJX&ANGIO IMG S&I
8. 93458 - CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
9. 93459 - CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
10. 93460 - R & L HRT CATH WINJX HRT ART& L VENTR IMG S&I
11. 93461 - R&L HRT CATH W/INJEC HRT ART/GRFT&L VENT IMG S&I
12. 93462 - LEFT HEART CATH BY TRANSEPTAL PUNCTURE
13. 93463 - MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
14. 93464 - PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASURE
15. 93563 - NJX SEL HRT ART CONGENITAL HRT CATH W/S&I
16. 93564 - NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I
17. 93565 - NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I
18. 93566 - NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I
19. 93567 - NJX SUPRAVALV AORTOG HRT CATH W/S&I
20. 93568 - NJX PULMONARY ANGIO HRT CATH W/S&I
21. 95800 - SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
22. 95801 - SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANAL
23. 96446 - CHEMOTX ADMN PRTL CAVITY PORT/CATH

How to Bill Chiropractic Diagnosis Codes For Medicare ?

Billing chiropractic services for a Medicare patient can seem complicated due to the number of rules that are specific to the chiropractic profession. In this article, we will focus on how to bill diagnosis codes correctly.

For chiropractic claims, since Medicare only covers spinal manipulation for the correction of a subluxation, we must begin by having a diagnosis of subluxation in the first position (primary) of the diagnosis codes.

On a HCFA claim form, this is Box 21D.

The only "approved" primary diagnosis codes (ICD-9) that Medicare will accept for chiropractic claims are as follows:

-- 739.0 Nonallopathic lesions of the head region not elsewhere classified
-- 739.1 Nonallopathic lesions of the cervical region not elsewhere classified
-- 739.2 Nonallopathic lesions of the thoracic region not elsewhere classified
-- 739.3 Nonallopathic lesions of the lumbar region not elsewhere classified
-- 739.4 Nonallopathic lesions of the sacral region not elsewhere classified
-- 739.5 Nonallopathic lesions of the pelvic region not elsewhere classified

A word about terminology. Some chiropractors and code books refer to these diagnoses as subluxations, segmental dysfunction or use similar terms. For example, 739.1 may be listed as cervical subluxation in some coding books or reference materials. Regardless of how you "name" the diagnosis, these codes in the list above are the only primary codes that apply to chiropractic services in the Medicare program.

The use of these codes does not guarantee reimbursement, however, because the patient's medical record must document that CMS coverage criteria (medical necessity) has been met.

Cardiology Billing - Big Changes in 2009

If your are not aware and prepared for the 2009 cardiology billing and coding changes you may be leaving a lot of money uncollected. The 2009 coding and billing changes are the most significant for cardiology that have been seen since the mid 1990s.

While the average physician will see slightly over a 1% increase in Medicare fees, Cardiologists will see a 2% reduction in fees. This is mainly the result of lower payments for office-based imaging. Cardiologist that have a higher than average use of imaging services will see decreases in their Medicare fees far in excess of 2%, while other cardiologists may be able to achieve an increase in Medicare fees.

Here are examples of some of the upcoming changes:

A Look at Medical Billing Services | Medical Billing Business Plans 2012

Medical billing services cover a wide range of activities but the main goal of any medical biller is to process physician super-bills (treatment description) and file claims with insurance companies to ensure that their clients are paid the proper amount in a timely fashion.
A typical medical billing business, working independently from a hospital or clinic, uses medical billing software to input clients’ new billing data and send it to the appropriate insurer, while also adhering to all the appropriate laws and standards. Medical billing services also include answering patient and insurance company questions and concerns, and follow-up in the case of overdue payments. Using the medical billing software at their disposal, medical billing companies often generate reports for their clients so they can see a cash flow analysis and discover what insurance contracts are making them money and which ones are not.
Medical billing services combine the skills of interpersonal communication, bookkeeping, office and computer skills, with basic medical knowledge to provide clients with an accurate and efficient method to be reimbursed for their services.
Other medical billing services can be to provide information to a client on how to more effectively manage their practice. Physicians and hospital/clinic staff often find themselves at odds with one another over billing issues, especially when it comes to how to process billing information. Medical billing businesses sometimes offer training to teach hospital and clinic employees how to more efficiently and correctly process claims and follow-up on collections. 

Medical Billing Business Plans

Medical billing is a leading business related to the health care industry. Medical billing business plans help you achieve your goals in the new business sector of medical billing. Like any other businesses, proper planning leads to a winning situation. To start a medical billing service, either in a small office or a cooperative business with other medical services, you should do a plenty of research to create a detailed business plan. Medical billing business plans guide you throughout the billing business to evaluate the medical practices that fall within your target market segment.

Medical Billing Careers

Today medical billing careers and jobs are very exciting and are in great demand allover the world. A medical billing career is the right option for service minded job seekers who wish to help patients. Top colleges and universities with medical billing career training programs offer you challenging jobs in medical billing careers. With the advent of modern technology, there has been a great demand for work from home medical billing careers.
Medical billing and coding specialists are generally employed in clinics, hospitals, insurance companies, consulting firms, medical coding and billing services firms, governmental agencies and computer software companies. The basic function of a medical billing and coding specialist is to assign codes to diagnoses and procedures. This ensures correct transformation of information between the insurance and the medical facilities.

Medical Billing Outsourcing 2012

The medical treatment business has changed significantly in the past few years. It presents many administrative difficulties during the preparation of insurance policy procedures and dealing with complicated claim forms. To avoid these complexities, doctors look out for outside help, and hire representatives to advise them, attend insurance company seminars, and provide them with regular financial reports. This is called medical billing outsourcing. It has become a thriving business in the modern age.
Very often, it is impossible to post in-house staffs for preparing medical billing, because they may not have in-depth knowledge and time to handle claims. So, most healthcare providers resort to medical billing outsourcing which involve the hiring of billing professionals. They act as consultants for doctors, and assist them in handling all medical billing needs, coding practices, and preparation of fee structure. A good outsourcing project is as a sure method of maximizing the average earning of a doctor than employing an in-house staff. The earlier doctor consultant system has been replaced by online medical billing outsourcing today.
Medical billing outsourcing assists doctors in saving money through payroll generation, equipment reduction, elimination of postage, and with software support. Outsourcing to a professional billing company frees you from administration problems. In the USA, a number of leading medical billing outsourcing companies offer assistance to your medical billing needs. These companies are equipped with a network of medical billing outsourcing experts and a number of medical billing tools on the Internet. The host company serves you with free database, clearinghouse set up and practice, and other online benefits.

TYPES OF PAYORS

1. Medicare
2. Medicaid
3. Blue Cross and Blue Shield
4. Commercial Insurance
5. Managed care Organizations
6. Worker’s Compensation
7. No-Fault
8. TRICARE

HOSPITALS | CARE EXTENDED AT HOSPITALS

A Hospital today is a center for professional health care provided by physicians and nurses
Hospitals are generally classified as General Hospital, Specialized Hospital, and Medical Centers.
Acute Care Hospitals: Provides intensive care to patients on a short-term basis. This could also include overnight stay. (Children’s, Adult, and Specialty hospitals)
Chronic Care Hospitals: Provides care on a long term basis. The care provided is not as intensive as that of an Acute Care Unit. (Skilled nursing, Rehabilitative hospital 

CARE EXTENDED AT HOSPITALS 

 Inpatient: A person who is admitted to the hospital so that he may receive care overnight.
Outpatient: A person who receives hospital services but does not need to receive care overnight; outpatients are not admitted but can be under observation for some hours.

PRIMARY CARE PHYSICIAN

Primary Care Physician in general term is a family doctor or the doctor one who is visited by the patient first for any kind of health problem. Primary care physicians are also called Gate Keepers, as they are the ones who are contacted first by the patient.
PCP is also called referring doctor

Ordering Physician: Ordering Physician is a physician who orders for non-physician services for the patient such as diagnostic laboratory tests, clinical laboratory tests, pharmaceutical services, and durable medical equipment
Unique Physician Identification Number (UPIN).
FACILITY PROVIDERS
Following are the most common facility providers:
1 Hospitals
2 Ambulatory Surgery Center (ASC)
3 Skilled Nursing Facility (SNF)
4 Home Health
5 Hospice

SERVICES OFFERED BY NURSING FACILITIES

Nursing and Rehabilitative Services
These skills include conducting treatments injections speech therapy, dental services, dietary consultation, laboratory and x-ray services, and a pharmaceutical dispensary.
Personal Care: These services include help in walking, getting in and out of bed, bathing, toileting, dressing, eating, and preparing special diets as prescribed by a physician
Residential Services: These include general supervision and a protective environment, such as room and board
Medical Care: Each patient in a nursing facility is under the care of a physician, who visits periodically and is responsible for the patient's overall plan of care. Every nursing facility has at least one physician on staff or on call to handle emergencies.
HHO Home Health agencies are organizations, which are engaged in providing services (medical and non-medical) to patients and their families in their home

PARTICIPANTS IN US HEALTHCARE SYSTEM

1. Patients
2. Providers
3. Payors
4. Suppliers
5. Researchers
6. Business Associates
Patient: Patient is also called beneficiary: person who has a medical condition (illness or diseases) and gets in contact with the medical provider for healthcare services.
Medicaid: A state administered federal and state funded insurance plan for low-income people who have limited or no insurance.
Medicare: Health insurance program for people age 65 and older. Medicare covers some people under age 65 who have disabilities or end-stage renal disease (ESRD).
Medicare + Choice: Medicare HMO insurance plan that pays for preventive and other healthcare from designated doctors and hospitals.
Medicare Part A: Usually referred to as Hospital Insurance, it helps pay for inpatient care in hospitals and hospices, as well as some skilled nursing costs.
Medicare Part B: Helps pay for doctor services, outpatient care, and other medical services not paid for by Medicare Part A.
Medigap: Medicare Supplement Insurance that pays for some services not covered by Medicare A or B, including deductible and coinsurance amounts.
Non-Covered Charges: Charges for medical services denied or excluded by your insurance. You may be billed for these charges.