Training for Medical Billing and Coding

MEDICAL BILLING AND CODING TRAINING COURSES

medical billing for you

It's important to choose a well-rounded medical billing and coding training program at a quality school. In addition to academic knowledge, however, you'll also need plenty of real-world practice. So you should also look for a program that allows you to complete an externship in a hospital, doctor's office or other medical setting. This hands-on learning experience will be invaluable as you start your career.

Medical billing and coding training courses range from basic keyboarding to anatomy and physiology. Each course challenges you in different ways. Here is a list of common medical billing and coding courses you might see in a diploma program.

GETTING MEDICAL BILLING AND CODING TRAINING ONLINE

Medical billing and coding is a great degree to get online, since a lot of the coursework requires a good deal of memorization. Studying and testing at your own pace can be less intimidating for some students than being in a classroom.

Read some interesting pointers that may help you decide whether an online medical billing and coding degree is for you.

MEDICAL BILLING TRAINING: TIME TO COMPLETION

There are several types of medical billing and coding degrees to choose from:

• Certificate and diploma programs, which generally take nine months to one year to complete.
• Associate's degree programs last two years and provide other general education curriculum.
• Bachelor's programs are 4-year programs and also provide a general liberal arts curriculum.

MEDICAL CODING SCHOLARSHIPS & FINANCIAL AID

The American Health Information Management Association Foundation of Research and Education (FORE) offers scholarships to outstanding undergrads. You may also find medical billing and coding scholarships being offered at the schools to which you apply.

MEDICAL BILLING AND CODING TRAINING SCHOOL ACCREDITATION

Regardless of where you complete your medical billing and coding training, make sure your school is accredited by one of the following accrediting bodies if you want medical billing and coding or health information technician certification:

• Commission on Accreditation of Allied Health Education Programs (CAAHEP)
• American Health Information Management Association (AHIMA)
• Regional accrediting bodies

MEDICAL BILLING AND CODING SALARY

Once you've put in the hard work and completed your medical billing and coding training, you'll want to earn the best salary possible. A lot will depend upon location and the environment you choose, so read up on the facts by visiting our medical billing and coding salary page.

Overall Medical billing process

What is the overall Billing process?

The physician doesn’t get paid for his services immediately after they are rendered. Majority of the patients have insurance coverage and details of such coverage are provided to the physician before treatment. It is the responsibility of the physician to submit claims to the insurance company and get paid for his services. Submitting Claims and getting paid is a lengthy process and involves a lot of rules and regulatory systems and is very complicated. The physician needs to adhere to all these rules before submitting claims. This is the concept of Medical Billing. Sometimes the physician cannot provide his entire attention to this activity. He entrusts this activity to Billing Companies. This is a process of the physician providing rights to Billing Companies to bill Medical Insurance claims in order to save his time energy, and money.

After the provider renders services to the patient, the billing company will submit bills to the insurance company/ payer, using the insurance information that was last provided, as well as information about the reason for the examination, and the exact type of procedure performed.

Medical coding is the process of converting Medical terms to numeric code and it required Medical knowledge skills.

Medical billing is the process of submitting the claims and get paid behalf of provider.

I have listed the important process in Medical Billing. Each process is very important.

1. Insurance verification.

2. Demo and Charge entry process.

3. Claim submission.

4. Payment posting.

5. Action on denials or Denial management or Account receivables.

Insurance verification

Process started from here and usually front desk people are doing this process. Its a process of verifying the patients insurance details by calling insurance or through online verification. If this department works well, we could resolve more problem. We have to do this even before patient appointment.

Demo and Charge entry process

Demographic entry is nothing but capturing all the information of patients. It should be error free.

Charge-entry is one of the key departments in Medical Billing. Key department?? Yes, that's true. It is the keying-in department in Medical Billing. After receiving the super bills from the Doctor's office, it gets passed through the coding department, and then comes to the charge-entry department.

A Charge-entry person also has one other vital role to perform. That is, to look-up the codes entered in the claim, and to assign the relevant charges for those codes.

Claim submission Process

The next step after demographics and charge entry is claim generation. Claims may be paper claims or electronic claims. There are various types of forms for paper claims. The most widely used form is Health Care Finance Admin-1500 designed by the Health Care Financing Administration.

Electronic transmission of claims is the modern way of sending claims with less paper work. The most common means of transmission are through internet . The claim information is directly loaded into the insurance company's computer system or to the clearing house.

Payment Posting Process

Once the claims reach the carriers and they complete processing, they issue a check and prepare an Explanation of Benefits . The checks and the Explanation of Benefits would be sent to the pay-to address with the carrier or in the Health Care Finance Administrators.

In this processing we have accounted the money into the account as per the Explanation of Benefits. Now a days we are using Electronic payment posting also.

Action on denials or Denial management or Account Receivables

This is a most important function in the process flow of data. Unless this is taken care of, insurance balance will only be on an upward trend.

Problem in Medical Billing

•Inaccurate or lack of coding

• Incomplete claims

• Lack of supporting documentation

• Poor communication with the payer

• Not billing for services rendered

* Not being follow up AR balance claims

The person who is doing this process will be called Medical billing specialist.

Who is Medical Billing Specialist.

Medical billing Specialist is the one who is handling the below process and having well knowledge in each and every process.

* Insurance verification process

* Patient demographic and charge entry process.

* Submitting the claims by electronic as well as paper method. Tracking various claim submission report.

* Payments posting process for insurance as well as patient.

* Denial management.

* Insurance followup management.

* Insurance appeal process.

* Handling patient billing inquiries.

* Patient statement process.

* Preparing monthly reports such as revenue report and account receivable report and as per the provider requirement.

Medical Billing Specialists are in charge of reviewing patient charts and documents. They prepare and review all medical insurance claims based on the rules and regulations of insurance companies. Medical Billing Specialists also review insurance communications, payment and rejection notices to properly track all claims and payments.

Medical Billing specialist Professional

If a person is computer literate he is a fit enough candidate to take up the profession of medical billing and medical coding. However he will need to be trained and be aware of a lot of new information before he can start working effectively. He has to learn about the medical billing software and must be familiar with and master the various commands used while working with it.

Who are medical coders and how is it related to medical billing? Medical billing is a sub specialty of medical coding. Medical coding is the first step in the billing process. All patient records are maintained using the ICD-9 index system so that it is compliant with the federal rules.

A medical Biller’s most important skill includes filling up of the various medical forms correctly without any mistakes what so ever. All information required should be complete without any mistake at all. And the work will be include the following

Patient demographic entry

Insurance enrollment

Charge entry

Insurance verification

Billing and reconciling of accounts

Payment posting

Insurance authorization

Medical coding

Scheduling and rescheduling

Account receivable follow-ups and collections

Is it worth taking a medical billing program?

Usually don't spend too much cost on Medical billing program because the program will not do anything with real experience. What you learn from these kind of program will not be going to match with when you are working in the real environment. Hence just use as the start kind of program and get the real time experience even in small salary and later you can come up with more demanding one.

Problem of In House Processing of Medical Claims

Medical claims are generally very complex and have long extended details. While processing medical claims, one has to be highly critical and do efficient follow-up in order to get results. The process requires a lot of time and effort. And even after all this, there can be cases where files get lost or a small error can ruin the entire lot and everything has to be re-submitted again. Usually practice staff can be held up with lot of current work rather than submitting the claim and resubmitting the corrected claim hence it will lead to time delay on payment flow and it will affect all the relationship with in the practice. Even cost wise is also not effective when compare to outsourcing.

Advantage of Medical Billing Outsource

Medical Billing Company helps you in managing all your billing requirements proficiently. By choosing right medical billing company, you can get benefit such as improved financial strength.

Medical Billing task is very tedious and time consuming. However, billing must require more accuracy and special attention to strengthen the financial condition of clinical or hospital. You can do this task at own or assign to clinical staff but you have to be pleased with low patients satisfaction. Medical billing company can help you in supportive task. By efficient medical service, you will get highly satisfied patients.

A Medical Billing service can improve the efficiency of your billing system, reduce denials, cut down operating costs, boost reimbursements and save valuable time that can be devoted to patient care. These services are better equipped to adapt to continuously changing billing codes and industry requirements.

* Prince is low compare to doing it in house

* Dedicated Highly Skilled Professionals

* No need to maintain the hardware . Ability to perform Medical Billing remotely, using the software of your choice

* Usually Maximum reimbursements and fewer denials

* Accuracy is high when compare

* Faster transaction

Question need to ask when Medical Billing Outsourcing

1. Check with their referral and how long they are doing this business.

2. Are they HIPAA compliance

3. Where they are doing their work. If possible just visit there.

4. Data security.

5. Compare the price with others.

6. what are the reports they will provide

7. Your specialty wise question

8. Their software skills.

Services and process involved in Medical Billing

* Coding ( CPT, ICD-9, and HCPCS)

* Patient Demographics Entry

* Charge Entry – All specialties

* Payment Posting (Manual and Electronic)

* Payment Reconciliation

* Denials/rejections analysis, re-billing

* Accounts Receivable Follow-up

* Systemic A/R projects, re-billing

* Collection Agency Reporting


* Refunds

Anesthesia Billing Guideline CPT 99200, 99000,99070

Time Reporting:

Time for anesthesia procedures may be reported as is customary in the local area. Anesthesia time begins when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating room or in an equivalent area and ends when the anesthesiologist is no longer in personal attendance, that is, when the patient may be safely placed under postoperative supervision.

Physicians Services:

Physician's services rendered in the office, home, or hospital, consultation and other medical services are listed in the "Codes" section entitled Evaluation and Management Services (99200 series). "Special Services and Reporting" (99000 series) are presented in the Medicine section.

Materials Supplied by Physician:

Supplies and materials provided by the physician (eg, sterile trays, drugs) over and above those usually included with the office visit or other services rendered may be listed separately. List drugs, tray supplies, and materials provided. Identify as 99070.

Anesthesia Billing form Guidelines

Prior Authorization

Anesthesia itself does not require prior authorization; however, prior authorization may be required for the related surgical procedure or service.

Time-Based Units

During the first 4 hours of service, 15 minutes equals 1 unit. If services are provided for longer than 4 hours in one occurrence, each 10-minute period after the initial 4 hours equals 1 unit. A

period less than a unit should be rounded up to the next unit.

Example A: 5 hours or 300 minutes equals 22 units – 16 units for the first 4 hours (1 unit per each 15 minutes) and 6 units for the last hour (1 unit per each 10 minutes).

Example B: 128 minutes is billed as 9 units (8 units for the first 120 minutes and 1 additional unit for the remaining 8 minutes).

Completing the Claim Form

· Field 19: When billing a time-based code,enter the total minutes of reportable anesthesia time in Field 19.

· Field 24D: On the bottom, white half of the claim line, enter one CPT code and one physical status modifier (P1-P6). List additional modifiers when appropriate

· Field 24G:

o When using a time-based code, enter the number of reportable anesthesia time units; do not add base units or modifier units to the time units.

o When using an occurrence-based code, enter a “1” for each occurrence. The following codes are paid per occurrence: 01953, 01967, 01968, 01969, 01996, 99100, 99116, 99135 and 99140.

CPT Code 99140

Medicaid carefully monitors for the appropriate use of code 99140 and modifiers P3, P4 and P5. Providers’ in-office records must verify medical necessity of this procedure.

Code 99140 should be used only for emergency conditions. This does not include a normal delivery or use of an epidural during delivery.

Anestesia billing CPT codes

CPT anesthesia modifier codes

Anesthesia billing

Aneshtesia claims denial - Time not in system

Anesthesia services: general, local, regional, epidural:

• We do not provide separate or additional reimbursement for the usual monitoring procedures that are traditionally part of and recorded on the anesthesia record because they are considered an integral part of anesthesia services and are included in the anesthesia base unit value. Unusual forms of monitoring (eg, intra-arterial, central venous and Swan-Ganz) are not included and may be billed separately.

• We do not provide separate or additional reimbursement for local anesthesia because it is considered part of the surgical procedure or other manipulation for which it is given.

• Moderate sedation services provided by the same physician performing the diagnostic or therapeutic service that the sedation supports should be reported with CPT codes 99143-99145.

Separate or additional reimbursement for moderate sedation services submitted with codes 99143-99145 is allowed according to CPT coding guidelines and should be reported only with those procedures not listed in Appendix G of the CPT. Appendix G, Summary of CPT Codes That Include Moderate (Conscious) Sedation, lists those procedures for which conscious sedation is an inherent part of the procedure itself.

• Reimbursement consists of anesthesia base units plus anesthesia time units multiplied by a conversion factor.

• 99100: anesthesia for patient of extreme age, under one year and over seventy.

• 99116: anesthesia complicated by utilization of total body hypothermia.

• 99135: anesthesia complicated by utilization of controlled hypotension.

• 99140: anesthesia complicated by emergency conditions (specify).

• 99143: Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; under 5 years of age, first 30 minutes intraservice time

• We do not provide separate reimbursement for postoperative epidural narcotic analgesia when performed on the same date of service as epidural anesthesia, since the primary reason for the catheter insertion is for the administration of the anesthetic. However, we do provide payment for daily hospital management under CPT code 01996 on the same day as when epidural anesthesia is administered for the surgical procedure.

• We do not provide separate reimbursement to an anesthesiologist for postoperative pain consultation when performed on the same date of service as the surgical procedure because usual pain management services are considered part of postoperative care and included in the anesthesia base units.

• We reimburse postoperative patient-controlled analgesia (PCA) only as an initial consultation when performed subsequent to the day of surgery. Report initial consultation (CPT code 99252), 1 unit of service only. Report CPT code 99252 only once during a hospital admission.

• Reimbursement for a pre-operative consultation that is rendered within one to ten days prior to the date of surgery is already included in the global allowance for the administration of anesthesia. However, if an interval exceeding ten days elapses between a routine pre-operative consultation and the date of surgery, due to surgical rescheduling or cancellation, then the initial pre-operative evaluation can be reimbursed as a limited consultation.

• Bill a single epidural injection of narcotics using CPT code 62310 or 62311 and 1 unit of service.

• Bill an epidural catheter insertion for the continuous administration of narcotics using CPT code 62318 or 62319 and 1 unit of service.

• Effective 01/01/04 according to CPT 2004, CPT code 01996 to report daily hospital management of continuous epidural or subarachnoid drug administration performed after insertion of an epidural or subarachnoid catheter.

• Do not bill CPT codes 62310-62319 on the day of surgery when the epidural injection is performed primarily for the surgical anesthetic and not for the postoperative narcotic. CPT code 01996 (daily hospital management) may be billed if the record demonstrates that the anesthesiologists’ administration of the agent required patient care substantially beyond the intraoperative and normal recovery period.

• Do not bill 01996 (daily hospital management) on the same date of service as 62310 – 62319.

• Bill anesthesia for electroconvulsive therapy (ECT) with CPT code 00104. One unit of service is allowed.

• Bill for Swan-Ganz catheter insertion using CPT code 93503.

• Bill the insertion of epidural or intrathecal catheter for narcotic infusion for intractable pain due to malignant disease requiring laminectomy with CPT code 62351 and without laminectomy with CPT code 62350. 

NESTHESIA FOR OBSTETRIC SERVICES - CPT 01960, 01967 - 01969

Delivery only codes:

• CPT code 01960 for anesthesia for vaginal delivery only.

• CPT code 01961 for anesthesia for cesarean delivery only.

Labor analgesia/anesthesia for vaginal or cesarean delivery codes:

• CPT code 01967 for neuraxial labor analgesia/anesthesia for planned vaginal delivery (List separately in addition to code for primary procedure performed).

Effective 9/1/04, we allow a maximum of 20 time units for CPT code 01967.

• CPT code 01968 for anesthesia for cesarean delivery following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed). Bill CPT 01968 in conjunction with CPT code 01967

Other codes:

• CPT code 01962 for anesthesia for urgent hysterectomy following delivery.

• CPT code 01963 for anesthesia for cesarean hysterectomy without any labor analgesia/anesthesia care.

• CPT code 01964 for anesthesia for abortion procedures.

• CPT code 01969 for anesthesia for cesarean hysterectomy following neuraxial labor analgesia/anesthesia (List separately in addition to code for primary procedure performed).