Categories
Medical Billing Guide Medical Coding Guide

The Impact of Telehealth on Medical Billing and Coding

How does telehealth affect medical coding and billing?

Telehealth services have revolutionized the healthcare industry by providing patients with access to healthcare services remotely. This trend has had a significant impact on medical coding and billing processes. In terms of coding, professionals must accurately assign telehealth codes based on the services provided during a virtual visit. This requires a clear understanding of telehealth coding guidelines to ensure proper documentation and billing.

When it comes to billing, telehealth services require specific billing procedures to ensure proper reimbursement. Understanding the nuances of telehealth billing is crucial to avoid billing errors and ensure timely payments. Effective management of the revenue cycle in telehealth settings is essential for streamlining the billing and coding processes.

Telehealth has streamlined the way medical services are provided and billed for. In the realm of coding, professionals must navigate through telehealth-specific codes such as HCPCS codes. These codes help identify the services provided via telehealth, allowing for accurate billing. On the other hand, effective billing in telehealth requires adherence to specific reimbursement guidelines to ensure that healthcare providers are compensated for the services rendered.

Revenue cycle management in telehealth settings involves overseeing the entire process from scheduling appointments to receiving payments. Professionals must ensure that telehealth services are billed correctly to prevent revenue cycle disruptions. By staying up-to-date with the latest coding and billing practices related to telehealth, healthcare facilities can optimize their revenue cycle and improve financial outcomes.

What are the reimbursement challenges in telehealth services?

Telehealth services face various reimbursement challenges, especially concerning medicare coverage. Providers need to navigate through complex medicare telehealth billing regulations to ensure compliance and maximize reimbursement. Implementing best practices in telehealth billing can help address these challenges and optimize reimbursement.

Understanding the different protocols for telehealth reimbursement is crucial for healthcare providers to capture the full value of the services provided. It’s essential to stay informed about the latest reimbursement policies and adhere to best practices to minimize claim denials and delays in payments.

Reimbursement challenges in telehealth services require healthcare providers to navigate through a complex landscape of regulations and policies. Medicare coverage for telehealth services is continually evolving, and staying updated on the latest changes is crucial for ensuring proper reimbursement. Providers need to implement best practices in telehealth billing to optimize revenue and address reimbursement challenges effectively.

Telehealth billing processes require meticulous attention to detail to avoid claim denials and ensure prompt reimbursements. That’s why PractiSynergy is here; we’ll pay attention to those little details in your medical billing and coding so you can focus on your practice.

Categories
Medical Billing Guide Medical Coding Guide Uncategorized

Innovations in Skin Grafts & What it Means for Your Practice

What is Skin Grafting and Its Evolution?

Skin grafting involves the transplantation of healthy skin from one part of the body to another to treat skin wounds or large defects. Over time, the technique of skin grafting has evolved significantly, from ancient practices to modern innovations like artificial skin and autologous skin grafts. It plays a crucial role in the treatment of severe burns and skin loss, particularly benefiting burn patients with extensive damage.

Skin grafting techniques have advanced from simple procedures to sophisticated methods, enhancing outcomes for patients. Understanding the evolution of skin grafting is essential for healthcare practitioners who perform these procedures.

Advancements in skin grafting, including the use of artificial skin, have revolutionized the way skin wounds are treated, offering new possibilities for patients with extensive skin damage, such as burn victims. As skin grafting continues to progress, its applications in medical practice expand, benefitting both patients and healthcare providers.

Understanding the Basics of Skin Grafting

Skin grafting is a surgical procedure that involves transferring skin from a healthy donor site to cover a wound or defect, crucial for burn wound treatment using either a split-thickness skin graft or a full-thickness skin graft. It aims to promote healing and improve the function of damaged skin. The donor site can vary depending on the type of skin graft used, such as a split-thickness skin graft or a full-thickness skin graft.

A split-thickness skin graft involves removing the top layers of skin, known as split-thickness skin, while a full-thickness skin graft includes the entire thickness of the skin. Each type has specific indications and applications in different clinical scenarios, such as burn injuries or reconstructive surgeries, with split-thickness skin grafts often used in the treatment of burn wounds.

Donor sites are carefully selected to minimize donor site morbidity and ensure successful grafting, often involving the use of donor skin for better outcomes. The choice of donor site depends on factors like skin quality, location, and the size of the graft needed.

Evolution of Skin Grafting Techniques

The historical development of skin grafting dates back centuries, with early techniques using simple methods to cover wounds. Over time, advancements in surgical and medical knowledge, including the development of artificial skin, have led to the refinement of skin grafting procedures.

From autologous split-thickness skin grafts to modern skin substitutes, the evolution of skin grafting techniques has significantly improved patient outcomes. Innovations like mesh grafts and pinch grafts have expanded treatment options for various skin conditions.

Understanding the historical roots of skin grafting provides valuable insights into the origins of modern practices and the continuous development of skin grafting techniques to meet the evolving needs of patients.

What it Means Your Medical Billing and Coding

While traditional autologous skin grafting is still considered the gold standard, new methods of skin harvesting and skin grafting techniques have expanded the possibilities for treatment. The use of meshed split-thickness skin grafts and other innovative approaches have allowed for the efficient coverage of large areas of damaged skin with a limited amount of donor skin. These advances in skin regeneration and skin graft donor site utilization have greatly improved the function of the skin and subcutaneous tissue in the treatment of skin injuries.

Medical billing and coding professionals like PraciSynergy must stay up-to-date on the latest skin grafts and skin replacement techniques to accurately code for these procedures. With the increasing use of meshed skin grafts and other innovative approaches, it is important to document the specific methods of skin harvesting and skin grafting used in each case to ensure proper reimbursement. As technology continues to advance in the field of skin grafts, billing, and coding practices will need to adapt to accurately reflect the complexity and cost of these procedures.

Categories
CPT Codes Medical Billing Guide Medical Coding Guide Vaccines

Understanding CPT Codes for COVID-19 Vaccines

What are CPT Codes?

Current Procedural Terminology (CPT) codes are numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical, and diagnostic services. They are used by insurers to determine the amount of reimbursement that a practitioner will receive by an insurer.

CPT Codes for COVID-19 Vaccines

The American Medical Association (AMA) has approved unique CPT codes for COVID-19 immunizations. These codes help to better track, report, and analyze data for the planning and allocation of vaccines.

As of August 14, 2023, the CPT Editorial Panel approved the addition of new product codes 91318-91322 to identify monovalent vaccine product for immunization against COVID-191. These codes are used for the Pfizer and Moderna vaccines. The existing Novavax Product Code 91304 was retained for the currently authorized vaccine product available for use in the U.S.

Here are the new CPT codes for Pfizer and Moderna’s vaccines, as well as a new administration code that applies to all COVID vaccines:

How PractiSynergy Can Help

At PractiSynergy, we understand the complexities of medical billing and coding. Our team of experts is here to help you navigate the intricacies of CPT codes for COVID-19 vaccines. We provide expert medical billing, credentialing, and medical coding to a diverse range of medical practices, providers, and facilities.

Don’t let the complexities of medical billing and coding slow down your practice. Contact PractiSynergy today and let us help you streamline your billing process, reduce administrative burdens, and improve your practice’s efficiency and profitability. Let us handle the complexities of medical billing so you can focus on what you do best – providing excellent care to your patients.

 

Categories
Medical Billing Guide Medical Coding Guide

Demystifying Medical Billing and Coding Part 2

In our last blog, we started the process of demystifying the complicated world of medical billing and coding. We’ve still got a bit more to go to fully provide a comprehensive guide to this field. But don’t worry–if this world seems to be a little too tough to understand on top of everything else going on in your life and in your practice, PractiSynergy is here for you. Instead of struggling to learn the process of medical billing and coding, we’re happy to handle it for you! Let’s dive in. 

The Significance of Coding Systems

There are three major coding systems used in the healthcare industry:

  • The International Classification of Diseases, 10th Edition (ICD-10) is used to classify diagnoses and illnesses.
  • The Current Procedural Terminology (CPT) is used to describe medical, surgical, and diagnostic services.
  • The Healthcare Common Procedure Coding System (HCPCS) is used to code services not covered by CPT, such as durable medical equipment and drugs.

Medical coding relies on standardized coding systems to ensure consistency and clarity in communication. The International Classification of Diseases, 10th Edition (ICD-10) categorizes diagnoses and illnesses, while Current Procedural Terminology (CPT) codes describe medical, surgical, and diagnostic services. Healthcare Common Procedure Coding System (HCPCS) codes cover services not included in CPT, such as medical equipment and drugs.

The Coding Process: Ensuring Accuracy

The coding process involves meticulous attention to detail. Coders collaborate closely with healthcare providers to gather accurate information about procedures and diagnoses. This information is then translated into the appropriate codes, which are submitted for billing. Accuracy in coding is paramount, as it directly influences the reimbursement process and prevents claim denials or underpayments.

Collaboration for Accurate Coding

Effective communication between medical coders and healthcare providers is essential for accurate coding. Coders seek clarifications when needed to ensure that codes accurately reflect the provided healthcare services. This collaboration guarantees that claims are submitted with precision, enhancing the chances of proper reimbursement.

The Medical Billing Process: Submission to Reimbursement

The medical billing process extends from claim submission to reimbursement. Medical billers play a crucial role in this journey by meticulously preparing and submitting claims to insurance companies. This process demands an in-depth understanding of insurance policies, proper documentation, and compliance with regulatory standards.

Challenges and Solutions in Billing and Coding

The realm of medical billing and coding isn’t without its challenges. Claim denials, coding errors, and communication breakdowns can hinder efficient revenue management. However, solutions exist. Thorough documentation, continuous training, and open communication between providers, coders, and billers can mitigate these challenges and optimize the revenue cycle.

Regulatory Compliance: Upholding Industry Standards

Adhering to industry regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and the Stark Law is paramount. Non-compliance can lead to legal repercussions and disruptions in the billing and coding process. Ensuring patient data privacy and adhering to legal standards are critical components of the revenue cycle.

The Impact of Technology

Technological advancements have revolutionized medical billing and coding. Electronic Health Records (EHR) store patient information digitally, enhancing accuracy in documentation and coding. Automated coding tools assist coders in assigning appropriate codes efficiently. However, maintaining a balance between technology and human expertise is crucial to prevent errors and ensure accurate reimbursement.

The Role of AI and Machine Learning

Artificial Intelligence (AI) and Machine Learning (ML) are reshaping the landscape of medical billing and coding. These technologies can analyze vast amounts of clinical data to assist coders in selecting the most accurate codes, reducing errors and enhancing reimbursement optimization. Additionally, predictive analytics offer insights into revenue management and potential risks, enabling proactive measures.

Preparing for the Future: Trends in Medical Billing and Coding

As the healthcare industry evolves, so does the landscape of medical billing and coding. Artificial intelligence, machine learning, and telehealth are emerging as significant influencers. AI and ML technologies promise improved accuracy in coding, while telehealth’s rise necessitates adaptation to coding practices for new service delivery models.

While technology continues to make headway in many different fields, it can never replace the human touch. At PractiSynergy, we know how to utilize these technological advances; but we also know the right questions to ask, the correct steps to take, and of course, to make relationships and connect with other people. 

As telehealth reshapes healthcare delivery, adapting coding practices becomes paramount for precise reimbursement within this evolving service. Amid these dynamic changes, the mastery of these essential processes remains pivotal for sustainable revenue management and top-tier patient care. For comprehensive medical billing and coding services that prioritize seamless payments, consider exploring PractiSynergy—a partner empowering practices to concentrate on quality care while we handle the intricacies of payments…so you don’t have to. 

Contact us today to learn more!

Categories
Medical Billing Guide Medical Coding Guide

Demystifying Medical Billing and Coding Part 1

In the intricate world of healthcare, the seamless functioning of medical billing and coding is essential for both providers and patients alike. This crucial process involves translating complex medical procedures and diagnoses into standardized codes, ensuring accurate revenue management and reimbursement for healthcare services. In this comprehensive guide, we’ll delve into the fundamental aspects of medical billing and coding, its significance, key coding systems, processes, challenges, and future trends–and how PractiSynergy fits into it all. 

What is Medical Billing and Coding & Why is it Important for Providers?

Medical billing and coding are integral parts of the healthcare revenue cycle. Medical billing and coding is the process of translating medical diagnoses and procedures into codes used in medical records and claims submitted to payers for reimbursement. It is a complex and specialized field that requires a deep understanding of medical terminology, anatomy, and disease processes. This symbiotic process ensures healthcare providers receive proper compensation for their services and contributes to efficient revenue management within the healthcare industry. By properly coding and submitting claims, providers can secure timely reimbursement, which is vital for sustaining operations, offering quality care, and investing in advanced medical technologies. This process also helps prevent revenue leakage due to errors or improper documentation.

 It sounds pretty complicated, right? On top of running an effectively functioning practice, managing staff, and of course, treating your patients, correctly getting your billing and coding done can seem like quite the feat. That’s why PractiSynergy exists–so that you can focus on what’s most important, instead of having your hands full with your payments. 

Medical Billing vs. Medical Coding

Medical billing and coding are often used interchangeably, but they represent distinct stages in the revenue cycle. Medical coders are responsible for translating complex medical information into standardized codes, while medical billers focus on submitting these coded claims to insurance companies for reimbursement. Both roles require a keen understanding of medical terminology, anatomy, and coding systems. As a medical provider, learning coding systems on top of the rest of your responsibilities is a taxing undertaking. 

Role of Medical Coders

Medical coders are akin to language translators in the healthcare world. They convert medical procedures, diagnoses, and services into codes from coding systems like ICD-10, CPT, and HCPCS. This translation process ensures that healthcare services are accurately represented, enabling efficient claim submission and accurate reimbursement.

Role of Medical Billers

On the other hand, medical billers are the liaisons between healthcare providers and insurance companies. Their responsibilities include verifying patient information, ensuring proper documentation, navigating insurance policies, and submitting claims. The precision of their work directly impacts the timeliness and accuracy of reimbursement.

Accurate coding and billing not only ensure fair compensation but also contribute to the overall sustainability and success of healthcare practices–it’s absolutely critical to the productivity and profitability of your practice. At PractiSynergy, we know how complicated this field is, and how hard it can be to get it right. That’s what we’re here for! In our next blog, we’ll continue our comprehensive guide so that you can get a better understanding of everything we do. 

Contact us today to learn more.

Categories
Medical Billing Guide

End of Public Health Emergency – Part 1 COVID Services

It’s the end of the Public Health Emergency (PHE) as we know it! Under the PHE, private and government health insurers could not apply any cost-share amounts (co-pays, co-insurance, deductibles, etc) for COVID testing, COVID vaccines, certain treatments, or anti-viral drugs such as Paxlovid. Starting May 11, 2023, however, some of these COVID-related services will be changing. 

So what do you need to be aware of?

At the end of the PHE, Medicare Beneficiaries Cost Share will be reinstated. Meaning, COVID testing (at home and otherwise, except when being treated by a doctor to rule out COVID) and COVID treatments except for oral anti-viral drugs such as Paxlovid will now be able to be applied with cost-share amounts. 

For Medicaid and CHIP, no cost share will be applied to COVID vaccines or the administration of COVID vaccines for adults and children. Additionally, until the last day of the first calendar quarter one year after the end of PHE (September 30, 2024), no cost-share amounts can be applied. 

Finally, Private Health Insurance may reinstate patient cost share and may require prior authorization to cover COVID testing and testing-related services, as well as patient cost share for vaccines and vaccine administration. Private Health Insurance will also no longer be required to reimburse out-of-network providers for COVID tests, testing-related services, vaccines, or vaccine administration. 

As we celebrate coming to the end of this Public Health Emergency brought on by the COVID-19 pandemic, we also need to remain aware of the changes that will come with it. But with PractiSynergy, you don’t need to spend your time being vigilant over these changes or focusing on getting every detail right. We handle all things medical-billing and coding so that you can spend your time on what matters most, your practice and your patients. 

Contact us today!

Categories
Medical Billing Guide

Should You Outsource Your Small Practice’s Billing?

We know that you and your practice have a lot on your plate. There’s lots to get done, and you can’t do everything! The revenue cycle is a time-consuming, complicated process, so should you outsource your billing? 

While it’s understandably tempting to want to have your part in all aspects of your practice, you’ll have to ask yourself if it’s worth sacrificing time and energy for the billing process. Will internally learning, understanding, and doing all functions of the revenue cycle contribute to a better understanding of the practice’s financial position? Here’s why you should consider letting an external company like Practisynergy take the weight of billing off of your shoulders. 

The revenue cycle is dense and complicated, and running your practice is a big task already. It would be nearly impossible for one person to be an expert on each part of the revenue cycle; verifying insurance eligibility and benefits, medical billing and coding, managing claims, denials, and accounts receivable, answering questions about medical bills, and more; taking care of each of these would be extremely difficult, especially on top of other duties. 

The cycle is also time-consuming, taking valuable time and energy from your patients. You would need to find the time to appeal claim denials, make sure your billing and patient statements are accurate, manage insurance credentialing and contracts, et cetera. With all that time dedicated, you may also need to bring on more employees to pick up the slack, especially in case of vacation or illness to keep claims going out the door.

This is a heavy burden for any one person to bear. As you’re running your practice, don’t add this weight to your load. While you stay focused on your patients, let PractiSynergy take care of your medical billing and coding. With our smooth process to transition a practice from in-house billing to us, and a model that fits your needs and increases revenue, you won’t regret switching to PractiSynergy. 

Categories
Medical Billing Guide

When to Switch Billing Companies

How do you know it’s time to start thinking about switching your billing company? When it is time, how do you know where to start? With so many questions surrounding such an important part of your practice, we’re here to lend a hand and make sure you have all the information you need to take the best steps for you, your patients, and your practice. 

How do you know it’s time to switch?

Are payments coming in slower?

Are your payments coming in at lower amounts?

Has there been an increase in patient complaints about billing?

Are claim denials and rejections increasing?

Are your Accounts Receivable creeping up?

If you’re answering yes to one or more of these questions, you may want to consider making a switch in billing companies. 

 

So you’ve decided to move forward in finding a new billing company:

Here are the key things that you’ll want to look for in a company that will be the best for your practice: 

Good references: Do other practices have good things to say about their experience?

Contact: You should be able to have a single contact person with a backup person for emergencies

Availability: Does the availability of those contact individuals match yours? Are they available during your hours of operation?

Billing options: Do they offer on-shore or off-shore billing? Your payment percent will be higher when an on-shore/local billing team is used because they are more comfortable and knowledgeable about state-specific billing guidelines

Training: You want your team to stay up to date on new developments so you don’t have to. Do they offer training opportunities to stay current?

Reports: What types of reports will you receive and how frequent will you receive them?

There are lots of different aspects that will factor into your choice of switching billing companies and which company to switch to. Whether you’re just starting this process or ready to make the change, Practisynergy is here to help with all of your medical billing and coding needs.

 

Need more advice?

Check out our “12 Questions to Ask Before Hiring a Billing Service” worksheet.

Categories
Medical Billing Guide

Am I being Scammed? – The Truth Behind Virtual Credit Cards

Did you get a piece of paper in the mail with what appears to be an outline of a credit card with numbers and a whole bit? What are these and are they legit? 

It’s no secret the internet is slowly taking over. Everything is becoming ‘optimized & automated’. After COVID, the virtual world skyrocketed as we know it. It’s no surprise credit card companies have wanted an in. These virtual credit cards advertise as a streamlined way to make purchases and keep up with payments. Much like everything else, virtuality has its pitfalls. Not everything is meant to be optimized. Have you ever been on the phone with a large company, needing assistance, but find it takes an endless amount of time to reach an actual person? Virtual robots can’t assist you the way human interaction can. 

Providers are getting buried in a sea of virtual credit cards coming from all different insurance companies – companies as large as UnitedHealthcare to small private union insurance funds. The appeal behind these virtual cards can be rooted within streamlining the process. Insurers are trying to reduce costs by outsourcing payment processing. Printing checks requires supply costs as well as people to print and handle these checks. The downfall of checks include getting lost mail. The advantage of virtual credit cards means it’s easier to track. Since the credit card isn’t tangible, the balance can’t get lost. 

Each insurer has different needs. Providers must figure out what is the best option for them – virtual credit cards, physical checks or direct deposits. All fees need to be examined as well as the time it may take if checks get lost. Some corporations find it beneficial to outsource to virtual assistance – saving them time to get back to their main job duties. The right virtual credit card can also help protect personal information and privacy. Virtual cards generate new card numbers, so that individual account numbers can stay confidential. 

Providers get dinged with fees since they have to run the cards through a merchant service provider (credit card servicer) that will deposit the funds into their bank account. If you decide a virtual credit card is not your jam. You must initial the “opt-out” of these cards and select check or direct deposit. Keep in mind some of the direct deposit options through these outsourced vendors also charge a fee.

All in all, there’s a give and take between payment options. Each individual requires different needs. And it’s important to seek counsel when choosing the best option. At PractiSynergy, we work closely with clients to give them the best option for their unique needs. To get informed about our medical coding and billing services, reach out to Katie Fergus. Call 515.412.2800 or email  katie@practisynergy.com.

Categories
Medical Billing Guide Medical Claim Adjustments

Top Three Reasons Your Claim Has Been Denied

When it comes to medical billing, the coding network can get quite tricky. There are many reasons your claim may be denied. This fault could fall on the provider or the payer. The more informed you are, the easier the claim process will operate. It’s important to cooperate with your medical coding professionals and give them the most accurate information possible to avoid a denied claim. The best way to avoid errors is to communicate efficiently.

Having a claim error can negatively impact your practice and harm revenue cycles. To achieve an optimum experience with patients, it’s important to make this process seamless and smooth. We’ve all heard the “a bad foundation builds a weak house…” analogy. Think of your medical billing system in such a way. The well-being of your business is one of your main priorities. It’s essential to maintain a strong base of medical coding to keep everything on the front lines running as it should. At PractiSynergy, our highly trained staff works closely with you to build that foundation. This way you can get back to what’s important, rather than stressing about coding errors. 

Furthermore, we’re here to divulge common errors leading to claim denials. Using our years of experience, we’ve gathered our knowledge to reveal the top three reasons we see claims get denied – and how to avoid them. 

  1. Claims not filed on time
    • Provider contracts with Insurance companies dictate how long from the date of service a claim can be filed
    • Traditional Medicare is 1 year
    • Many insurers have drastically shortened time to 90-180 days
    • You can appeal denials with proof you filed on time – these appeals also must be filed timely
  2. No Authorization or Exceeded Authorization Denials
    • Providers must know which procedures require prior authorization from the insurance company
    • Most insurers allow providers to submit for emergency authorization when procedures must be done – or allow for post-service review and authorization
    • Most insurers DO NOT allow providers to bill patients if the provider neglected to get a prior authorization
    • The authorization typically states a time frame when the procedure must be completed as well as the number of procedures or visits allowed
    • Appeals may be done if there is documentation that information received from the insurance company stated an authorization was not required.
  3. Claim errors and patient demographic errors
    • Coding errors happen – but there are ways to minimize these errors by building edits or macros into a practice management system
    • Patient intake forms – these forms are typically filled out by patients. As these forms have become electronic they tend to feed directly into the practice management system. This causes an immense amount of error since most patients do not know exactly what information they need off an insurance card or they may put a nickname that does not match the insurance database
    • All demographics need to match what insurance companies have on file or there is a high probability of claims being rejected or denied

By making sure your claims are authorized, reported on time, and fully reviewed before submission, you’re able to avoid the most common faults we see as medical billing professionals. Taking these proper precautions can help the well-being of your practice and its backend process. 

Using this data, we’ve formulated our business in a manner to avoid such errors. We ensure our clients get none of the stress and all of the cash flow. When we work together we’re able to take the stress of coding errors off your back. Get back to what you do best. It’s our passion to help you, so you can help others. To get informed about our medical coding and billing services, Call Katie at PractiSynergy or reach out via Email

Telehealth Success Guide

Fill out your contact info to download our PDF

ROI of Outsourcing Your Billing

Fill out your contact info to download our PDF

New Practice Start-up Checklist

Fill out your contact info to download our PDF

Billing Rejections Checklist

Fill out your contact info to download our PDF

12 Questions to Ask Your Billing Services

Fill out your contact info to download our PDF