While third-party health insurance agencies like the New Hampshire Blue Cross and Blue Shield Anthem exist for beneficiaries opting for Medicare’s Part C and D, why would anyone want to choose paying more for something the government offers at a lesser price?

Medical Billing and Coding Process:

Anyone who has ever been hospitalized and has filed a claim for Medicare or Medicaid services should know how troublesome it can be. As wonderful and beneficial these social health insurance coverage can be, the process of them actually being wonderful and beneficial could take from a few days to a few months, depending on the nature of the claim. Imagine having to go through illness and disease, and processing an insurance claim at the same time.

Granted, health insurance like Medicare cannot help it when certain claims take too long to be processed. The reason for this is because as a government-funded and backed program, it caters to a whole multitude of people who essentially file claims at the same time. Imagine the staggering amount of paper and electronic forms that get submitted to Medicare carrier offices daily, and the reason for the delay seems clear.

Faster Processing with the New Hampshire Blue Cross and Blue Shield:

Fortunately, third-party insurance companies like Anthem can process these claims faster than if a beneficiary were to file a claim to the government or original Medicare program. This is because third-party agencies will get a substantially smaller bulk of claims as not all qualified beneficiaries opt to choose a third-party health insurance.

Furthermore, agencies like the New Hampshire Blue Cross and Blue Shield have affiliated pharmacies and physicians who all provide Medicare and Medicaid coverage. Should their beneficiary member seek treatment or prescribed medications from their affiliates, the process of medical billing and coding gets easier, as the interaction between the medical provider and the insurance agency is faster than it would be if the medical provider were to interact with a government-issued carrier.

For medical providers, opting to be affiliated with a third-party insurance agency can also prove to be more beneficial, especially when it comes to the process of coding medical bills. Medical bills can be so confusing that there are separate Medical biller to do the job. For a physician filing a medical bill under the government-centered Medicare, he or she will most probably complete the taxing medical coding and billing process. If he or she is affiliated with a third-party agency, he or she might not have to, as the agency will probably have a Medical biller on staff.

Though it might be true that going for a third-party option for Medicare and Medicaid will be more expensive, it can provide faster, smoother, and better handling with the troublesome coding, filing, and processing of medical bills.

Click Here to visit the New Hampshire BCBS website for more information.

Outsource Management Group was originally born in March of 2003 in a small home office in Bloomington, Indiana. As the business began to quickly outgrow this office, it was moved into a much larger 1,200 square foot facility on 17th Street in early 2004.

This move allowed the business to continue providing physicians with excellent results and grow it’s client base by 10 times, as well as increasing the billing staff by 6 times. As the client base and staff continued to grow, it became apparent in 2011 that the business had outgrown this facility and would need to move it’s operations to a larger facility accommodate it’s clients.

On October 14th of 2011, Outsource Management Group moved it’s entire operation to it’s current, 4,500 square foot facility near IU Health Bloomington Hospital and continues to provide unprecedented service to providers nationwide.

Fueled by the professional drive and determination of its co-founders, CEO Melissa Clark and Operations Manager Kathryn Disney, Outsource Management Group has grown over 2,000% since 2003 and has the proven ability and dedicated professional staff to handle all of your management needs.

With extensive editing and audits being performed on all electronic claims prior to their transmission to carriers, the percentage of suspension/rejections is very low, thus fueling the growth and subsequent need for the new facility. Additionally, Outsource Management Group realizes the importance of working the aging report and rest assured Insurance companies are contacted as early as two weeks after submission to ensure quick reimbursement to the physicians.

Contact us for information about our operations or provider services

The only part of an evaluation and management visit that the physician or nurse practitioner must complete for medical billing purposes is the history of present illness or the reason for the visit.

By allowing your administrative staff to complete some of the patient documentation, a practice can save time and money as it frees up the pediatricians and nurse practitioners to have more time for the actual servicing of the patients.

Another great way to save your practice time and money is to outsource your medical billing. Your medical billing partner will make sure your pediatric practice gets the maximum return and if you’re not using a medical billing company, you could be losing almost 30% of your medical billing revenue by simply not knowing how to get the maximum reimbursements that your practice is allowed for services rendered and general errors that occur when practices file their own claims.

Look into expanding the duties of your administrative staff and consider outsourcing your medical billing – the winners will be your patients and your practice!

Learn the rules of the carrier and take the time to bill under the NPP provider number and statistics show that over three-fourths of the health plans billed would reimburse at an average rate of 85%. While this isn’t a full reimbursement, it is far better than not receiving anything in return for your services rendered.

There are two main rules for using this type of billing. The patient’s physician or another affiliated physician must be available in the office during the time the services were rendered. Also, shared visits apply where the patient sees both the physician and the NPP.

Each individual carrier has their own policies in place for the credentialing and reimbursement to NPPs. Find out what the patient’s insurance plan covers up front before you compile your medical billing.

When you combine calling the carrier and getting the hard-line of what exactly is covered and what is not along with medical necessity of services rendered, you will have an air tight medical billing claim.

If you make a mistake and bill the carrier for the evaluation and a unit of service for the reevaluation, your claim will be denied based on incorrect coding no matter how much medical documentation you provide showing the necessity of the reevaluation of the patient.

Keeping up with the fast paced changes of the medical billing industry are what your medical billing partner does best! They stay on top of the current changes as well as the coming coding changes that will directly affect your practice so your staff knows the proper codings to use for patient services rendered and when to begin using them.

Your medical billing partner can also help you eliminate errors in your medical billing by knowing the correct way to use the codes and bundle claims to get your practice the maximum returns allowed on your medical billing claims.

Outsourcing is just smart business. Your error rate will fall on the average from nearly 30% of your medical billing claims to less than 1% and your claims will also be reimbursed nearly 2 weeks faster than self-filed medical billing claims.

The best company to handle your medical billing isn’t necessarily located around the corner from your practice or even in the same town. Thanks to the power of the Internet, secure Internet connections, and advances in software and computer networks that allow for secure transmission of sensitive data, the process of finding a medical billing company to handle your needs is just a mouse click away.

This will free up your staff immensely as they will no longer have to spend long hours at the copy machine getting claims ready to send in. Your claims will be transmitted computer to computer via secure network transmissions and you can get real-time information on your patient accounts at anytime. Furthermore, outsourcing your medical billing will insure that all your claims are properly coded and documented properly. Your medical billing partner can devote 100% of their time to handling your coding and claims. That way your cash flow is steady and you can concentrate on growing your practice.

-If a surgeon mentions single layer closure in his or her operative report, it is a simple repair. Simple repairs involve superficial wounds that involve “primarily epidermis, or dermis or subcutaneous tissues without significant involvement of deeper structures” according to the CPT. Surgeons will refer to these types of repairs as single layer closures.

- If a surgeon mentions “layered closure” in his or her operative report, then you probably have an intermediate repair. Intermediate repairs are more extensive, involving “one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin closure” according to the CPT.

-If a surgeon mentions a repair to the depth of muscle, or deeper, then it is complex. Complex repairs will involve more than just a layered closure, and may include extensive undermining, stents, or retention sutures.

Remember that it is not a good idea to guess. If the operative report does not provide you with enough sufficient detail to determine, beyond a doubt, the level of wound repair, then check with the operating surgeon to see what level of wound repair was involved in the procedure in question.

In some cases, you will come across two removals that are very similar, but different. For example, if a pediatrician removes an extra digit from a newborn’s hand, and also removes a skin tag from the newborn, the removal of an extra digit and the removal of a skin tag fall under the same CPT code but fall into different ICD-9 codes.

For these two procedures, you should report 11200 (11200 is the removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions). This code identifies “the use of scissors or any sharp methods, ligature strangulation, electrosurgical destruction, or any combination of the treatment methods including electrosurgical techniques or the use of chemicals” according to the notes on skin tag removal from the CPT.

It is important to remember that, although the pediatrician has performed two removals on the newborn patient, you should only bill code 11200 one time. This is because the code 11200 is removal of up to and including fifteen lesions from any area. Two ICD-9 codes should be used, from the 740-759 section, which is Congenital anomalies.

In cases such as this, you should report 755.01 (which is Polydactyly of fingers) for the extra digit or accessory finger. The skin tag diagnosis should be listed as 757.39, which is ‘Other specified anomalies of skin; other’ which includes as an example, “accessory skin tags, congenital.”

This should provide you with a simple solution to a seemingly difficult medical billing problem.

The source to find consolidated HCPCS medical billing codes is no longer in the Centers for Medicare & Medicaid Services’ Skilled Nursing Facility Help File. Since September 25, 2005, CMS has tried to steer medical billing staff members away from this file. Now, however, it is more important to do so.

A new website has been created specifically for consolidated medical billing updates. The web address is www.cms.hhs.gov/providers/snf.pps/snffi/. This is where individuals can find the 2006 Annual and quarterly updates as well. This website will be kept more current and up to date than the old CMS Skilled Nursing Facility Help File. Your medical billing department can even print off the files in an Excel or PDF format. CMS wants the medical billing HCPCS codes to be used correctly, so they wanted the best resource as possible for reference.

When training your medical billing staff members, knowledge retention and memorization is not always the most important element. If you don’t know the answer to a problem or question, sometimes the best knowledge is knowing where to find that information. You will never know the answer to every medical billing question, but you should always know where to find the answer.

Be sure your medical billing staff use all available resources before they submit claims to payers. Accurate claims mean correct and timely reimbursement for your services. The introduction of the new HCPCS website makes accuracy in medical billing easier to obtain.

Fluorescence Chain Reaction is a brand new lab test that checks human DNA. The amazing aspect of this test is the short amount of time needed to retrieve results. This method takes less than five minutes to produce accurate information.

Although insurance payers may be more familiar with the old DNA medical billing, this new procedure is growing in popularity. In the past, medical billing was submitted for a DNA test that required DNA amplification. This amplification is a highly complex process and requires skilled technicians. With Fluorescence Chain Reaction, this is not the case.

Be sure the medical billing for your lab has the most current coding information available. When choosing the right medical billing code, you should always choose the specific code that describes your service. Never choose a medical billing code that just sort of describes the service. Sometimes with new procedures there is not yet a medical billing code assigned. In that case, always use an unlisted procedure code and attach clinic notes.

The benefit of using the Fluorescence Chain Reaction test not only decreases wait time for results, but also for medical billing reimbursement. The quicker you get results, the quicker you can get paid for those results. Also, physicians will be more likely to refer patients to your lab if your results come back quickly. Medical billing for everyone improves with new technology and innovative procedures.