Medical Billing USA

Medical billing – Patient Collections

Healthcare system in United States is under going drastic changes which are leading to new challenges for both providers and patients. Patients with financial difficulties have tough time paying their medical bills. Patient copays account for about 20% of a provider’s office revenue.

Patient collections are not something that can be ignored in medical billing.

Reminding patients defaulting payments need to be done regularly without harassing them.

Tips to improve patient collections in medical billing: –

  • Standard payment policy – Practice should have clear payment policy that is informed to patients in advance.
  • More payment options – Patients should be able to pay by cash, check, credit card or through an online payment portal.
  • Inform patients about prices – Patients should be aware of procedure costs beforehand.
  • Check your patients’ coverage before the consultation – Remind patients who are on high-deductible plans.
  • Use a Medical billing software system – Medical billing software can track patient collections process by looking up past due bills, automatically check patient insurance eligibility and has system integrated payment processing method.
  • Regular reminders – Send out patient statements on a regular basis.
  • Using a collection agency – Notification from a third-party agency prompts patients to pay their dues.

With so much work and attention to detail required for successful medical billing and ensuring proper payment from patients it is good to outsource medical billing to a reputable company. This enables providers to focus more on patient care rather than on getting reimbursed.     

Medical Billing and Telemedicine

Medical Billing and Telemedicine

Telemedicine refers to a category of services that are provided to a patient without any actual patient contact. Services are provided via a telephone, web portal or via email interactions between the patient and provider.

The Corona virus crisis has created billing requirement with telemedicine a significant issue. The guidelines for billing telemedicine are not only changing apace but also differ from payer to payer.  All the major private insurances pay telemedicine. Private insurance companies and Medicare are streamlining telemedicine policies virtually on a daily basis. Now Medicare allows telemedicine visits for new patients as well.

Simple pointers to consider when billing telemedicine:-

• Confirm that the patient’s insurance covers telemedicine. Always call and verify coverage with the patient’s insurance before their initial telemedicine visit
• Knowledge of the telemedicine guidelines for each payer. Rules and regulations differ from payer to payer and also area vice.
• Claims for covered telehealth services provided at the distant site need to be submitted using the applicable CPT or HCPCS code.
Documentation necessities for a telemedicine service are the similar as for face-to-face services. As telemedicine becomes more efficient and improves patient outcomes, more services are likely to be approved for reimbursement. In the present situation as more payers reimburse telehealth services, payment policies and criteria will be regularly amended, hence constant observation and updation is required on the telemedicine billing services.

medical billing and credentialing services

Medical Billing – Medical Credentialing a Necessity

Medical Credentialing consists of verifying the qualifications of licensed medical practitioners and assessing their background and legitimacy. Credentials are documented evidence of license, education, training, experience, or other qualifications.

Not obtaining proper credentialing can lead to lost revenues. This results to loss in medical bills for various services provided by the uncredentialed professionals. Medical credentialing process also validate a medical provider’s regulatory compliance record and malpractice history before allowing that provider to participate in a network or treat patients at a hospital or medical facility.

Medical credentialing is a vital part of the Medical Billing process without which it cannot even be completed.

Steps to follow for efficient Medical Credentialing process:

  • Confirm all documents are up to date
  • Provide adequate references
  • Begin early and pay attention to details
  • Have knowledge about the State’s Credentialing specifications.

An efficient workflow will help overcome medical credentialing problems and thus avoid money loss in handling appeals and reimbursements. SpectraMedi Medical Service Organisation provides simple and cost effective Credentialing service. Our service help Providers handle the burdensome procedures of enrollment and credentialing at a competitive price.


Medical Billing to a COVID-19 World

Catastrophic Plans in Medical Billing

What is a catastrophic plan?

Designed to have low premiums but still protect its enrollee’s from substantial medical debt if they suffer a catastrophic illness. These plans have a major role in Covid-19 crisis.

In medical billing, diagnosis and treatment of COVID-19 can be filed under catastrophic plans. These plans must cover essential health benefits (EHB) as required by the Patient Protection and Affordable Care Act (PPACA) but are typically subject to limitations. Health issuer can amend their catastrophic plans to provide pre-deductible coverage for services related to the diagnosis and treatment of COVID-19. 

Catastrophic plans help patients who can’t afford more comprehensive plans. Though expanded catastrophic plan maybe harder on medical billing systems, reimbursements to hospitals and providers will likely remain the same.

RPA in Medical Billing

Robotic Process automation (RPA) with its cost savings, speed and efficiency is slowly making its way into all industries and all types of business processes. Enterprises and service providers are adopting more tools that aid automation. RPA enhances accuracy.

Robotic Process Automation (RPA) has the perfect solution to transform revenue cycle management. It unites an organization’s systems, including electronic health records, billing, patient payment portals, and credit card processing applications. Automation in data entry and insurance claim processing results in fast and precise process completion.

Robots connect to the payer website, handle insurance aging and resubmit claims without human intervention – saving significant time and resources.RPA can help medical billing organizations when processing information as physician credentialing and enrollment as well as checking patient eligibility.

RPA is complementary to existing systems and processes, enabling health care organizations to address gaps in existing processes. Additionally, it creates a 24/7 work force which is more efficient and quicker resulting in improved collections.