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.

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.

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.

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.