Monday 21 October 2013

How to Work from Home Doing Medical Billing and Coding

Medical billing and coding professionals are a guild of individuals who can often arrange to work from the comfort of their homes. Working from home can eliminate expensive commuting costs, provide for more time with family, and generally help an individual to streamline life goals and manage a work/life balance. If you are interested in figuring out how to work from home doing medical billing and coding, here are some of the most popular steps in securing this sort of employment.

Fulfill education requirements. In addition to a high school degree or equivalent, medical career individuals such as billers and coders often start with an associate's degree from an accredited school of higher education. Many follow this with a bachelor's degree, or even a master's, or engage in other kinds of continuing education that can prove extremely useful at any stage in a medical billing and coding career.

Build the skills to prove yourself as a medical billing and coding professional. Another key step in securing work in this industry is to prove that you have the expertise to handle complex medical documents.
    • Learn the medical coding conventions and master them. Universal coding practices like ICD-9 or ICD 10 diagnostic classifications and CPT or procedure codes can be partially learned from an entry-level role in medical administration. Get a good grasp of these coding standards to start building your career.
    • Understand the uses of forms such as UB40 and HCFA billing documents, explanation of benefits documents, and other sorts of documents involved in medical billing and coding. This knowledge will also help you advance your career in this field.

Friday 18 October 2013

Healthcare Training Conferences - Establish Medical Necessity with CMS’ Documentation Guidelines

It is the responsibility of CMS to administer Medicare and other federally mandated healthcare programs throughout the United States. Medicare prohibits payment for services and items deemed by local Medicare Carriers as not medically reasonable and necessary for the diagnosis or treatment of an illness or injury, so here documentation is essential for claims to be paid.

There are a couple of points that a physician needs to ensure like only tests that are medically necessary in diagnosing or treating their patients should be asked for, correct ICD-9 codes to be used for patient files and test request forms, advance beneficiary notes to be signed by patients in case service gets denied.

Thursday 17 October 2013

Healthcare Training Conferences - Dermatology Coding Guidelines under ICD-10

With the introduction of ICD-10, that will have revised dermatology coding guidelines, dermatology billing will be more accurate and it will be easier to file clean claims. The procedure that is performed in the office determines the amount that needs to be charged by an outpatient dermatology practice. All the charges are related to specific procedure codes as complex procedures draw high reimbursement. This again is related to the practice and professional resources that are used to provide the service. The ICD-9 codes for dermatology are matched to the corresponding procedure code that implies medical necessity under the present reimbursement system.

But it has been seen for a long time that the required specificity to accurately report medical necessity lacks in ICD-9. Often, physicians assign Volume 2 codes without referring to the volume 1 codes, which usually happens to be an unspecified code, and the claim gets paid without any obstacles. But this doesn’t mean that it is a clean claim.

So when a coder or biller who is certified reviews the record, one can find a more appropriate code to describe the condition. Since ICD-9 has only 13,000 codes, most of the codes that are reported often turn out to be unspecified. But the new ICD-10 contains 68,0000 codes that will help to describe medical conditions specifically. This will help to determine medical necessity that will help in proper reimbursement.

For instance, under ICD-9 code 708.9 is used to report urticaria that has the medical description of “unspecified”. But with ICD-10 there will be separate procedure specific codes to describe the exact condition. For instance, L50.0 with the description: reaction to food, drugs or inhalants.  But if solar urticaria needs to be reported then L56.2 will be used.

Although this information will be contained in every medical record, only a professional biller or coder will be able to decode ICD-10 to assign the accurate codes for every documented diagnosis. If correct codes are assigned to bill, it will result in maximized reimbursement.

If you are looking for online medical coding training conferences, AudioEducator is the place where you can choose a wide range webinars for dermatology coding guidelines and medicare guidelines to stay compliant.

ICD 10 - Frequently asked question

1.  Q: What is ICD-10? 
A: ICD-10 is the International Classification of Diseases, version 10.  (ICD is the international standard for diagnostic classifications.) The current version, ICD-9, was adopted in 1979.

2.  Q: What changes are occurring in the ICD-10 version? 
A: The changes will impact ICD-9-CM diagnosis codes and ICD-9-CM procedure codes.  The changes are as follows:
** The diagnosis codes (ICD-9) are currently three to five digits that are alphanumeric in nature and combine to make around 14,000 unique diagnosis codes being used today. For ICD-10, the diagnosis codes will be seven digits that are alphanumeric in nature and combine to make around 68,000 unique diagnosis codes
** Currently, ICD-9 procedure codes are three to four digits that are numeric in nature and  combine  to  make  about  4,000  unique  procedure  codes.    For  ICD-10-PC  S (inpatient), the procedure codes will be 7 alphanumeric in nature and combine to make around 72,000 unique procedure codes.

3.  Q: What is the primary purpose of this change? 
A: The primary purpose of the change to ICD-10 is to improve clinical communication.  It allows for the capture of data about signs, symptoms, risk factors and comorbidities and better describes the clinical issues overall. It will also enable the United States to exchange information across country borders.

4.  Q: What is CarePlus’ plan for ICD-10 acceptance? 
A:  CarePlus  will  accept  ICD-9  codes  on  claims  w/  date  of  service  (DOS),  or  discharge  dates  of September 30, 2014 or prior.  CarePlus will accept ICD-10 codes on claims w/ DOS, or discharge dates of October 1, 2014 or after.

5.  Q: Do you plan to be ready to process ICD-10 codes submitted on claims forms by Oct 1, 2013? 
A: CarePlus will go live with the ICD-10 codes effective October 1, 2014.

6.  Q: How long will support for both ICD-9 and ICD-10 coding be provided? 
A:  CarePlus  will  process  correctly  coded  transactions  within  the  date  ranges  specified  in  the  answers above until the volume of ICD-9 submissions is diminished.

7.  Q: When will CarePlus begin testing transactions? 
A: CarePlus will begin testing ICD-10 transactions in the second quarter of 2014.
 
8.  Q: Do you have a communication plan and schedule for customers to keep them informed? 

A: The ICD-10 Program team is currently working on a communication plan and schedule with testing partners, trading partners, providers and internal departments.

9.  Q:  Will  your  claims  adjudication  processing  vary  by  contract  type  (e.g.,  hospital, professional provider, and/or ancillary services)? 
A: CarePlus does not foresee any issues with claims processing with the change to ICD-10.  Testing will begin in early 2013 to mitigate any such issues.

10. Q:  Will  CarePlus  purchase  any  new  technology  as  part  of  its  preparation  for  ICD-10 implementation? 
A: CarePlus is remediating the systems that are currently in place for claims reimbursement. 

11. Q: Will CarePlus be using GEMS as part of its process, or for creating files coming in or out? 
A:  CarePlus will process transactions in its “native” format and will not be using GEMS to crosswalk ICD-9 codes and ICD-10 codes for inbound or outbound v5010A1 transactions.

12. Q: Will there be any changes in payment with the change to ICD-10? 
A: CarePlus’ plan is to be reimbursement neutral. There should be no change to the way a claim is paid with  ICD-10  and  ICD-9  codes  unless  an  MS-DRG  change  has  taken  place  or  a  contract  has  been rewritten to incorporate a change of reimbursement.
 
13. Q: What claim-processing issues does CarePlus anticipate with the preparation for ICD-10? 

A:  CarePlus is investing in remediation of systems and processes to support the ICD-10 requirements. CarePlus  does  not  foresee  any  issues  with  claims  processing  with  the  change  to  ICD-10,  although rejection due to misuse of new codes is possible. Testing will begin in early 2013 to mitigate any such issues.

14. Q: What key information should providers to keep in mind as they develop their own ICD-
10 implementation plans? 

A:  CarePlus  suggests  that  providers  stay  up-to-date  on  any  changes  by  CMS  regarding  the  ICD-10 implementation.  This  can  be  done  by  monitoring  the  CMS  website.  If  providers  have  questions  or concerns, they may contact their CarePlus provider associate.

Websites offering additional information on 5010 and ICD 10 are:
** http://www.cms.gov/ICD10/Downloads/Sept132010_ICD10_5010Final.pdf
** http://www.himss.org/ASP/topics_FocusDynamic.asp?faid=220 

CD-10-CM Codes

See https://www.cms.gov/Medicare/Coverage/ CoverageGenInfo/ICD10.html for individual Change Requests (CRs) and coding translations for ICD-10

Who Is Covered

Certain Medicare beneficiaries who fall into at least one of the following categories:

• Women determined by their physician or qualified non-physician practitioner (NPP) to be estrogen deficient and at clinical risk for osteoporosis;

• Individuals with vertebral abnormalities;

• Individuals getting (or expecting to get) glucocorticoid therapy for more than 3 months;

• Individuals with primary hyperparathyroidism; or

• Individuals being monitored to assess response to U.S. Food and Drug Administration (FDA)-approved osteoporosis drug therapy

Frequency

• Every 2 years; or

• More frequently if medically necessary Beneficiary Pays

• Copayment/coinsurance waived

• Deductible waived

Tuesday 15 October 2013

Medical Billing and Coding Program



Have you been looking for a Medical Billing and Coding School?

Medicalbillingforyou
Medical billing and coding offers a variety of opportunities for individuals who are filled with curiosity and welcome the challenge of finding correct answers to tough questions. So if you’re analytical and self-motivated, you should investigate a future in medical billing and coding.
When you earn your Certificate or Associate degree in Medical Billing and Coding, you can develop the specialized skills needed to maintain accurate and organized medical documentation. This includes patient records that track data about medical history, symptoms, X-ray and laboratory tests, medications and treatments.
The Medical Billing program at Carrington College and Carrington College California is focused on helping you to develop the specialized skills, knowledge and discipline that can prepare you for an entry-level position in this growing field. Our dynamic curriculum provides:

Healthcare Training Conferences - CPT Code changes for Molecular Pathology

This year there has been considerable code changes in every practice that has taken the healthcare industry by storm. Molecular pathology too underwent significant changes and new CPT codes. But many payers as well as CMS did not have fee schedule payments. This will be done April onwards and failing to meet the terms of the new changes can lead to delay in claim processing and claim rejection.

Some of the 2013 CPT code changes include medical lab procedures that deal with analysis of nucleic acids that detects variants in genes that indicates germline or somatic disease or tests for histocompatibility antigens. It does not include diseases causing infections or in situ hybridization analyses that are only found in Microbiology and anatomic pathology section.

Some of the deleted codes include stacking codes 83890 – 83914, 88384-88386 that are array based evaluation codes, a few genetic testing modifiers.  A new code 81479 is to be used for unlisted molecular pathology procedure. Some Tier 1 molecular pathology codes like 81200-81383 are relevant to few biomarkers. Tier 2 molecular pathology codes in the range 81400-81408 are used to refer groups of biomarkers that will need the same level of interpretive and technical resources that is necessary to finish the test.

If one is reporting a particular biomarker and not providing the complete descriptor that is there in the parenthetical CPT examples will be considered to be sufficient. But sometimes it will be important to provide the abbreviated information that will be essential to identify the service that has been provided.

For instance, The CPT code 81404 indicates “level 5” biomarker tests. CPT has identified an huge list of biomarkers that needs to be reported using code 81404. While billing for “frataxin” reporting it as FXN will be sufficient.

When a particular biomarker that has been tested is not represented by a Tier 1 code as well as not listed in Tier 2 codes, then it is best to report the test as “unlisted” using molecular pathology code 81479.  However, it needs to have a description in the narrative or remarks section when this code is used.

If descriptions are provided for Tier 2 and unlisted codes it will immensely affect in claims being processed on time and failing this will only result in claim denial or delay in processing of claim.
If you are looking for online medical coding training conferences, AudioEducator is the place where you can choose a wide range webinars that provide training on 2013 CPT code changes and you can get familiar with the 2013 ICD 9 code changes and stay compliant.


Friday 11 October 2013

Healthcare Training Conferences - Ensure Compliant Documentation through HIPAA Training To Survive HIPAA Audits



A number of trials have been conducted in a year for HIPAA Compliance Audit program and these audits were also a trial for the entities where they were conducted. Now plans are being made to revive this new HIPAA audit program in Fiscal Year 2014, after the US Department of Health and Human Services has evaluated it.

The set of rules used for the 2012 HIPAA audits by the HHS contractors have been published by USDHHS, making it easier to understand the exact way to prepare for the audits and implement HIPAA Compliance training. Audits are applicable for any health care covered entity as they need to understand the adequate information that they are required to provide and ways to avoid compliance related issues resulting in penalty.

Tuesday 8 October 2013

Medical Billing and Coding Training - Understand E/M coding guidelines for 1995 and 1997 to ensure a compliant orthopedic practice

Insurance carriers closely scrutinize services related to Evaluation and Management as documenting these services requires one to follow innumerable guidelines. The two basic guidelines of 1995 and 1997 have a huge impact on the way claims are being reported that effects reimbursement too.

It is important to have extensive medical billing and coding training to understand the documentation requirements to file error-free claims.
Example: In orthopedic practice, if one has to bill for a comprehensive exam, according to the 95 guideline what body area or organ does one need to address. Can body areas and organ systems be mixed when elements for the exam will be counted.

Monday 7 October 2013

Medical Billing and Coding Training - Ensure A Smooth Transition To ICD-10 For Radiology By Preparing For The Documentation Changes Now



According to experts, every practice must start preparing themselves for the ICD-10 transition next year. To make this learning process hassle-free new strategies need to be introduced as performing, testing, planning and training will take great time and effort.

Amongst all the other things, radiologists need to understand the condition of the patient to correctly report it for coding and billing. ICD-10 will be a lot more detailed than ICD-9 codes so after the physician examines a patient and sends the report to the radiologist, who will in turn have a better understanding of the patient condition. This also means that for accurate billing radiologists need the history of the patient to make billing, dictation, and billing smooth and error-free.

Also, document specification is another aspect that will be required in ICD-10 for radiology. Moreover, coding will vary based on whether the procedure is outpatient or inpatient. For inpatient exams and procedures ICD-10 PCS codes are to be used. But since one exam can be performed on the same patient twice, for instance: as inpatient and then as outpatient, the report codes need to be different to mark the difference. There are also three specific sections in ICD-10 for radiology, so radiologists need to accurately pinpoint the images and the type of imaging that is being performed.

Friday 4 October 2013

Medical Billing and Coding Training - Follow These Tips To Build A Rewarding Career In Medical Coding And Billing

A career in medical coding and medical billing is quickly emerging to be the most sought after one. A medical coder is a general or specialty specific trained SME who uses ICD-9-CM, ICD-10-CM, CPT®codes, or HCPCS codes to report services performed by doctors or healthcare providers to patients. The service imparted gets documented in the patient’s medical record and after reviewing it the medical coder assigns appropriate codes and medical biller claims reimbursement in the form of invoices.

Doctors and healthcare providers depend greatly on medical coders and billers. But one needs to be highly knowledgeable and build a solid foundation to ensure a rewarding career or business. Here are a few tips that one has to keep in mind when starting your career:

Medical Billing and Coding Training - Understand what to do beyond ASC Coding and Billing For Maximum Reimbursement

Learn some basic tricks to make reimbursement quick and easy and ensure you don’t leave money on the table or face denials. Follow these recommendations from industry experts to improve profits for ambulatory surgery center.


  • It is advisable to be on good terms with commercial payers. Investing in good relations over the years will ensure easy reimbursements even during difficult years. Being familiar makes your interactions and negotiations easy, honest and friendly.
  • When any claim gets denied, one needs to be aggressive about it and question for reasons about its denial. According to experts, electronic claim rejection reports must be reviewed daily for ASC coding and billing error and help understand the reason for claim rejection as this leads to loss in revenue.

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