Everything You Need To Know About Chronic Care Management

chronic care management

In the United States, there are currently one in three adults suffers from at least one chronic illness. Whereas, one in four adults suffers from two or more chronic conditions. With ineffective management, these statistics are likely to worsen and may even increase to four or more chronic illnesses per person, depending on their health. In light of the increasing exposure to risk factors, the immediate persisting problem of chronic conditions will only become more prevalent if proper healthcare management is not set up.

The risk factors of general chronic conditions, such as COPD include, but are not limited to, tobacco use, lack of physical activity in recent generations, and medical advances that tend to minimize mortality without improving the patient’s health condition. In 2005, the Chronic Care Management Healthcare system was initiated to deal with these pressing issues and provide optimal healthcare services along with safer living conditions. Let us have a look at what chronic care management is.

What is Chronic Care Management in Healthcare?

Chronic care management involved the means to ensure better health and care for individuals. This includes timely reimbursement of the services provided by healthcare professionals. Chronic care management or CCM services in healthcare apply to patients with two or more chronic conditions, putting them at a greater risk of functional decline, exacerbation, or even death.

After reaching a diagnosis for the provision of chronic care management, the clinic or hospital staff is required to go over the extensive electronic health record of their patients to facilitate optimum care. This may include the patient’s current conditions, allergies, medical history, past care providers, and medications prescribed. The increased efficiency in the healthcare system owing to CCM services aid in reducing overall health costs.

What is a CCM-eligible Chronic Condition?

According to the chronic care management guidelines 2020 issued by the Centers for Medicare and Medicaid Services (CMS), your condition can only qualify the eligibility criteria if your condition is chronic, that is, expected to last at least 12 months, or until the death of the patient. Out of the many medical conditions that qualify for chronic care management services, here are a few of the most common ones:

  • Multiple sclerosis
  • Lupus
  • HIV/AIDS
  • Hypertension
  • Heart disease
  • Diabetes
  • Depression
  • Dementia
  • Cardiovascular disease
  • Cancer
  • Autism
  • Asthma
  • Arthritis
  • Alzheimer’s disease

Who Can Bill For CCM Services?

The billing of chronic care management services plays an extremely critical role in the efficiency of the healthcare system at a medical facility. It is important that the CCM billing is restricted to certain personnel to ensure quality services. Critical Access Hospitals or CAHs, Rural Health Clinics or RHCs, and Federally Qualified Health Centers or FQHCs can offer CCM amongst healthcare facilities. The billing procedure of CCM services is restricted to the following personnel.

  • Certified Nurse Midwives
  • Clinical Nurse Specialists
  • Nurse Practitioners
  • Physicians- generally primary care
  • Physician Assistants
  • Non-Physician providers (NPPs).

Chronic care management service billing only applies in cases where the healthcare provider has had an in-person visit, obtained written or verbal consent from the patient, and constructed a comprehensive care plan in the hospital’s EHR or electronic health record.

How do identify patients that would benefit from Chronic Care Management?

Once you have learned what chronic care management is, you may be wondering where to put it to use. It is best to find patients that benefit from your CCM services to ensure efficient and quality care provision at your healthcare facility. While identifying patients who are eligible to receive CCM services is a quite daunting process, it does make things easier in the future.

There is no specific way to decide which of your patients are eligible to receive billing under chronic care management services and which are not. The eligibility criteria need to be tailored according to the practices carried out at your practice. Some practices may be using their electronic health records to decide which patient qualifies for CCM, while others may use an AWV (Annual Wellness Visit) or IPPE (Initial Preventive Physical Exam).

Billing Codes for Chronic Care Management

The service period per every chronic care management is one month. As a practitioner, you are required to submit your claim at the end of each service period or after you have completed the minimum required service time. After ensuring that your patient qualifies for CCM services, establishing a comprehensive care plan, and receiving explicit consent, you may forward their service claims for reimbursements.

The only way to file a claim is via CPT codes. There is a separate CPT code for each service to maintain transparency and efficiency and minimize room for errors. The following CPT codes are the ones most commonly associated with chronic care management.

  • CPT 99490 codes for the first 20 minutes of non-complex chronic care management per the one-month service time. These services code for the time spent treating the patient by the clinical staff as directed by the physician or any other healthcare professional.
  • CPT 99491 codes for non-complex chronic care management services that extend to a total of at least 30 minutes per one-month service time. Services coded under this CPT are required to be provided in person by a physician or any other qualified healthcare professional.
  • CPT 99439 codes for additional care that exceeds the 20 to 30-minute time allotment. For every additional 20-minute non-complex CCM addition to the total time, healthcare systems use HCPCS G2058. It can be used up to three times, making a total of 60-minute additional time.
  • CPT 99487 codes for complex chronic care management services that amount to up to 60 minutes of total clinical staff time per one-month service time. The services offered under this code work significantly to revise or install a comprehensive care plan via a range of moderate to highly complex decision-making.
  • CPT 99489 codes for an additional 30-minute time increment of complex chronic care management provided to the patient per the one-month service time.

Why Should You Provide CCM To Your Patient?

The process of chronic care management does not just benefit the provider. Instead, its benefits extend to the patient and reduce room for billing errors. Timely billing and reimbursements using the CCM services allow your clinic or hospital staff to focus better on their job. This means that the patients will receive a better, more focused, carefully coordinated, and highly equipped team of healthcare professionals that will work simultaneously to cater to their health problems.

The implementation of comprehensive care plans tailored specifically to cater to the patient’s needs help in maintaining better track progress of the patient’s health goals. While timely reimbursements seem like the greatest advantage of resorting to CCM services, they improve your practice efficiency, and hence, patient satisfaction and compliance.

See Also: What To Know About Medical Billing Errors And Patient Rights

Conclusion

Shortly, we may see dynamic growth in tech-enabled Chronic Care Management Healthcare companies. The partnerships between such outsourced CCM service providers and physicians/health practitioners will aid in increasing the effectiveness of the revenue stream system in healthcare.

We understand that comprehending the key concepts of working in a chronic care management system can be a lot. With Precision Hub, streamline your claims management process in the best way possible and you will never have to worry about errors in your CCM services again!

Why is Verification of Benefits Essential for Medical Practices?

medical insurance verification

Introduction

The first and most important medical billing and coding stage is determining whether a patient has insurance. As the complexity of health care increases, practices must pay greater attention to the accuracy of patients’ coverage, benefits, deductibles, and co-payments. Therefore, medical professionals must thoroughly understand the Verification of the Benefits for Medical Practices approach and its significance in healthcare.

Today’s blog post discusses the importance of verifying a patient’s insurance status during medical billing. The post highlights the benefits of medical insurance verification. Moreover, the post also presents an overview of the insurance verification process in medical billing.

Medical Insurance Verification

Physicians must have extensive knowledge of their current coverage to get payment from patients. They must verify and explain their benefits and collect payment when services are rendered. Checking a patient’s eligibility enables medical offices to submit the correct claims.

Verification of benefits is one of the procedures involved in the invoicing process for medical services. It involves contacting the patient’s insurance company to confirm their health care coverage. Medical insurance verification is required to ensure that claim reimbursement is not contaminated. Many insurance claims are denied because the policy does not cover the services. Medical personnel and healthcare organizations frequently have difficulty verifying claims because they are so occupied with patient care. As this is their best alternative, they would be wise to utilize the services of outsourcing businesses to verify their insurance coverage.

Benefit verification services provided by reliable medical billing organizations like Precision Hub can help medical service providers lessen the likelihood of not being paid or having their claims denied. It is possible to maintain an efficient billing process. Accelerating the payment and collection processes can improve a healthcare facility’s accounts receivable cycle.

Insurance Verification Process in Medical Billing

As part of the insurance verification procedure, the healthcare provider must contact the patient’s insurance company to determine the patient’s health benefits. The medical insurance verification process would occur before a patient receives medical care. Insurance providers may not pay your clinic’s claims if it is not completed, and the patient may be responsible for unexpected expenses. Both of these could harm the reputation of your firm.

Typically, the following procedures are required to complete the verification of benefits:

  • Obtaining schedules from the hospitals and confirming coverage with the appropriate insurance provider
  • Obtaining approval for each procedure before performing it
  • Checking information on eligibility and benefits, such as when the coverage begins and ends, co-payment amounts, and more
  • Including the most recent and accurate data in the invoicing system

Significance of Insurance Verification Process in Medical Billing

Insurance providers may not pay claims submitted by your clinic if you fail to perform the medical insurance verification. Failure to do so could harm your practice’s reputation and revenue.

Medical insurance verification offers the following benefits:

1. Raises Cash Flow

It is crucial to maintain precision in determining insurance eligibility. It results in a greater number of clean claims, accelerating claim approval and shortening the billing cycle. If you don’t investigate it further, it could result in claim denials and bad debts, which would be detrimental to your practice.

2. Minimizes Claim Denials and Rejections

Rejection or denial of claims is commonplace in the healthcare industry. However, insurance coverage verification improvements may not significantly impact the frequency of denied claims. Since insurance information changes frequently, keeping up with the laws and remaining one step ahead can facilitate medical billing. It assists by decreasing the likelihood of claims being rejected, billing errors occurring, and reimbursement delays.

3. Enhances Patient Satisfaction

Over 90% of your patients will inquire if they are required to make the initial payment. Therefore, your staff’s primary responsibility is to contact the insurance carrier before beginning treatment or providing services. Your patients should be able to obtain immediate responses to any inquiries they have regarding their eligibility for insurance coverage. You should also be ready to inform them of the costs associated with services not covered by their insurance. Thus, they can prepare their budget and any other necessary arrangements.

Consequently, your patients will believe that you are extremely trustworthy and that they have not been charged for anything they don’t know. Additionally, it increases both revenue and patient satisfaction.

Best Practices for Medical Insurance Verification

Consider the following tips for the medical insurance verification process:

  • Choose the appropriate way of verification, depending on your knowledge.
  • During the medical insurance verification process, front office employees should ask the appropriate questions.
  • All information, including the information on insurance cards, must be kept secure.
  • Even if the patient claims their insurance has not changed, a copy of their card should be requested.
  • You can verify the accuracy of the card’s information by phoning the insurance company.
  • Check and recheck the patient’s medical record to ensure that the information is accurate. Inform the patient as quickly as possible of any out-of-pocket expenses.
  • Maintain a written policy on patient payment and provide it to them.
See Also: Stay Coding Compliant with Medical Audits

Conclusion

Medical insurance verification is crucial for the profitability of your practice. Incorrectly verifying a patient’s insurance coverage before providing care might result in a payment delay or denial, which can negatively impact a practice’s bottom line. You can prevent this costly error by verifying the patient’s eligibility before each appointment. The patient’s eligibility must be checked accurately and on time for the healthcare practitioners to understand the pertinent information completely.

The most crucial stage in medical practice is verifying the patient’s insurance coverage. This stage entails confirming a patient’s eligibility for coverage under their insurance plan before the service date. Even though you should not ignore the verification of benefits for medical practice, practices cannot immediately verify benefits and react to requests while caring for patients. Due to this, many doctors and nurses delegate the process of validating their patients’ insurance coverage to a reputable medical billing organization. Precision Hub is one of those services that provide expert assistance for validating benefits. They have a team of experts in eligibility verification and RCM dedicated to helping you increase your revenue and profitability. So, book your consultation now.

Medicare billing Guidelines for Skin Substitute Grafts

medicare billing guidelines for skin substitutes

Introduction

Wound care is a business that must adhere to strict rules and regulations. It requires adherence to Medicare billing guidelines for skin substitutes.

The specialty electronic medical record (EMR) information is critical to demonstrating that the practice adheres to clinical, financial, and operational guidelines. The documentation process begins when a patient calls to schedule a service.

Medical necessity and insurance coverage are verified and recorded in the system. Medical necessity rules vary by payer, but most payers follow the rules established by Medicaid Services. These regulations are referred to as Local Coverage Decisions (LCDs). Cellular and tissue-based products (CTPs) should be used based on how the patient appears clinically, as indicated by the LCD.

Are you tired of this complex process of billing for skin substitutes? Do you need a checklist providing important Medicare billing guidelines for skin substitutes? If yes, then continue reading.

The below Medicare billing guidelines for skin substitutes cover different aspects of medical billing in the grafting or wound healing process. Let’s find out all the important points of Medicare guidelines for skin substitutes.

Medicare Billing Guidelines for Skin Substitutes

According to the Current Procedural Terminology (CPT), skin substitute grafts consist of the following:

  • Non-autologous skin, which includes dermal/epidermal and cellular/acellular components
  • Grafts of both types, including the homograft and allograft
  • Non-human skin substitute grafts are known as xenograft
  • Biological products for skin growth capable of forming scaffolding (sheet)

It is unnecessary to report skin substitute graft codes when using gel, ointment, liquid, or foam (non-graft dressings) to treat wounds or when injecting skin replacements.

Claims for skin replacement grafts must include the applicable CPT code required by Medicare billing guidelines for skin substitutes. If the requested service for the CPT cannot be fulfilled or denied, the requested service for the skin substitute cannot be fulfilled.

It is improper to utilize wound dressing codes that do not involve grafts or injected skin substitutes with skin replacement surgery codes, as these codes are not associated with these treatments. According to Medicare billing guidelines for skin substitutes, if a product is deemed medically necessary, it will be included in one of the other regular management procedures and will not be charged separately.

When billing for Part B pharmaceuticals and biologicals, the Medicare billing guidelines for skin substitutes require the usage of a JW modifier. It must be used to identify unused drugs or biologicals from single-use vials or packages that should be discarded. The amount to be discarded must be indicated on a separate claim line and billed with the JW modifier. Any discarded medicine or biological must be documented in the patient’s medical record.

When a product is supplied in numerous sizes, payers assume that the patient will choose the size that offers the greatest comfort level while minimizing product waste.

When a biological/drug is discarded, the quantity administered and discarded must be precisely documented in the patient’s medical record. The record must include the date, time, discarded amount, and reason.

To discard a piece of a single-use package, you will be compensated for that portion. The information provided above in medical records must be presented clearly and concisely per the Medicare billing guidelines for skin substitutes.

Billing Process for Skin Substitutes

As per the skin substitutes Medicare requirement, before beginning treatment with a specialized wound care product, all wounds must be recorded (per the policy’s documentation criteria), and a comprehensive treatment plan must be developed.

  • Prior authorization is advisable before providing a skin substitute graft. The payor will examine the product, dose, and medical need.
  • Payment allowance limits for biologicals not in the ASP Pricing File or NOC pricing, i.e., Not Otherwise Classified File, are based on Wholesale Acquisition Cost (WAC). The payment allowance limit is 95%. 106% of the WAC for the lowest-priced brand or the WAC for the generic with the median price, whichever is smaller, is the maximum price allowed. When CMS does not include a drug’s price in the ASP pricing file, it is up to the Medicare Administrative Contractors (MACs) to establish payment-allowed limitations.
  • The WAC of Allograft and Dermal Matrix has been published and is accessible online. Before sending in invoice papers by hand, providers should be able to point MACs to the published WAC.
  • Providers must provide the product name, NDC/UPC/HRIC, WAC or invoice price, and HCPCS code when billing for a skin substitution graft.
  • Verifying that the right number of units has been entered in the “24G” field is crucial. For instance, because different skin replacement grafts are paid per centimeter squared, a whole 4 cm by 4 cm graft needs the reporting of 16 billing units.

Medicare guidelines for skin substitutes: Required Documentation

Billing for skin substitutes as per Medicare requires complete documentation. These requirements are listed below:

  • All paperwork must be kept in the patient’s medical record and provided to the contractor upon request.
  • Every record page must be easy to read and contain accurate information about the patient (e.g., complete name, dates of service). The paperwork must include a legible signature from either a doctor or a practitioner who is not a doctor but is responsible for the patient’s care.
  • The medical record must include evidence that the chosen ICD-10-CM code should be used. The service provided must be described in the CPT/HCPCS code that is sent.

Documentation in the pre-service record must explain why the wound has not healed following standard wound care treatments for more than four weeks. It also needs to describe the individual therapies that have not been successful. The record should include an up-to-date list of medications, a review of any pertinent medical issues that have arisen since the previous wound examination, a description of the planned skin replacement surgery, and the selection of the skin replacement graft product. Additionally, the potential risks and problems of the procedure should be evaluated and documented.

Medicare guidelines for skin substitutes: Required Conditions

Meeting the following conditions is essential for the coverage of the skin substitute’s application for the patient:

  • Neuropathic foot ulcer as a result of diabetes for more than four weeks
  • Venous stasis ulcer for more than one month
  • Foot ulcer that failed to respond to the measures for a more than one month
  • Full-thickness or partial ulcers
  • Measurement of the ulcer’s initial size, size of ulcer at the treatment beginning, and size following the management

In all the above cases, it is required that the ulcer must be without any infection or other condition like osteomyelitis.

See Also: What To Know About Medical Billing Errors And Patient Rights

Conclusion

The Medicare billing guidelines for skin substitutes encompass all the necessary steps, from prior authorization to medical necessity.

Billing for skin substitutes requires important consideration for authorization, allowance limit, coding and modifier details, and discarding the excess product. Billing experts at Precision Hub are here for your assistance in this complex billing process for skin substitutes. Contact us now to resolve any difficulty with graft billing.

Revenue Cycle Management (RCM) Strategies to Improve Practice Revenue

revenue cycle management strategies

Introduction

The Revenue Cycle Management (RCM) strategies implemented by your medical practice will determine, influence, and transform its revenue. It includes how claims are handled, how patients pay, and how internal billing functions. If these techniques are not used, it may be difficult for clinicians to maintain a high proportion of clean claims and accurate billing. Using RCM strategies help maintain the regular income of your medical business and generate a steady income stream. Therefore, providers should consider the possibilities and techniques to generate additional revenue for their practices by employing RCM strategies.

Continue reading this post to learn about revenue cycle management best practices. This article reveals the revenue cycle management strategies. These strategies help in improving revenue cycle management.

Revenue Cycle Management Strategies

The below revenue cycle management strategies are important for improving the revenue.

  1. Difficult Patients

Since high-deductible health plans are gaining popularity, customers bear a greater portion of their health care expenses. It can be difficult for physicians, especially small-practice owners with limited financial resources, to receive payment from patients for their services. If you do not receive payment from patients at the time of service, the likelihood of getting the money back decreases weekly. The effective way to get payment from such difficult patients is to ensure they are eligible for all their benefits and programs. Before each visit, you must have a current report on each patient’s insurance coverage. You can use the eligibility and benefits report to determine whether or not your insurance will cover the scheduled treatments, how much your copayment will be, and whether or not you have any remaining deductibles. Before a patient arrives for a consultation, you can discuss their out-of-pocket expenses and payment options. It will need less money and time, and you will receive more patient payments in less time.

  1. Clean Claims

A clean claim contains no incorrect or missing patient or insurance information. Your success rate for clean claims should ideally exceed 95%. When an insurance company receives as many error-free claims as possible, it increases the likelihood that the claim will be processed on the first attempt, which expedites payment. Your claim could be denied for various reasons, including incorrect insurance information, incorrect DOS, incorrect patient information, incorrect billing information, non-payable diagnosis codes, incorrect NPI, etc. It would be best if you streamlined the front-desk duties to increase the number of clean claims. It will require obtaining and validating patient and insurance information before the planned appointment. You can compare patient data and insurance information if you create an account on each payer’s provider portal. It is among the important revenue cycle management strategies that will ensure that your claim is as error-free as possible. You can access this data with a single click when using billing or clearinghouse software from certain businesses. By streamlining all billing activities before submitting a claim, achieving a clean claim rate of greater than 95% is simple.

  1. Billing Software

Tailored billing software helps in improving revenue cycle management. It is crucial to choose tailored software. The billing software that does not offer tailored solutions cannot meet the prerequisites of specialty-wise medical billing. Contrarily, specialty-specific software helps providers access tailored billing tools. These include claim filing and coding tools that help optimize the practice’s revenue. An important beneficial feature of such software is that it notifies diagnosis codes that are non-billable, leading to claim denial. With timely notification, the software reduces the chance of denied claims; thus, it helps in improving RCM.

  1. Patient Scheduling

Improving patient scheduling is among the most important revenue cycle management strategies. It plays a significant part in improving the revenue of the medical practice. When patients miss their appointments, the practice’s finances are severely impacted. If providers can reduce the number of patients who miss their appointments, they will be able to bill for more completed services, provide more follow-up treatment, and spend less time waiting for no-shows. Using high-quality integrated practice management software and a patient portal can improve scheduling. Providers can improve the number of appointments they schedule and significantly impact the profitability of their medical practices by utilizing the appropriate software.

  1. Multiple Payment Options

You must accept various patient payment methods to be paid on time. Patients need the ability to pay their medical costs online or over the phone. If this option is unavailable, patients are more likely to forget to pay their medical bills or not pay them at all, negatively impacting your practice’s revenue. Another strategy is to keep their credit card details for recurring payments like copayments or deductibles. The most effective method for collecting payment from a patient is to give them a cost estimate before the visit and request payment at the time.

Revenue Cycle Management Best Practices

Following are the revenue cycle management best practices that help in improving the revenue of your practice:

Patient relationship management: Better patient relationship management is crucial for healthcare practices to maximize RCM. If the staff goes above and beyond to ensure patient satisfaction and cultivates positive relationships with them, patients are more likely to remain loyal to the practice. It is among the revenue cycle management strategies that help in increasing revenue. Many patients find the process of paying medical bills to be difficult. The more a patient discusses this issue with the staff, the more probable it is that the patient will pay the provider.

Eligibility and Prior Authorization: You can collect more money from patients if you inquire beforehand about their copayments and deductibles and provide many payment options. The first step to effective RCM is ensuring that the patient has insurance at the time of enrollment. Prior authorization and coverage requirements are becoming more stringently enforced by insurance companies. Prior authorizations and eligibility checks can be performed automatically to help optimize clinical procedures, accelerate the revenue cycle, and reduce the time front office personnel spend on this task.

Timely Filing of Claims: Numerous healthcare organizations do not always submit their claims on time, missing the filing deadlines. In the event of missed deadlines, claims cannot be paid, and therapeutic services must be wiped off. It is essential to implement procedures to guarantee that deadlines are reached.

See Also: What Is Coding and Revenue Cycle Management?

Conclusion

By employing Revenue cycle management strategies, a practice can generate more revenue, but it requires a team effort, not just the efforts of a single physician. Your receptionists, billers, and medical coders should all be able to assist you in the same manner. You can also hire Precision Hub (PH) expert services to manage your billing requirement.

At Precision Hub, we will handle all your responsibilities so that you can concentrate on caring for your patients. These include insurance coverage reports, prior authorizations, payment posting, denial management, and accounts receivable management.

Contact us and learn how we may assist you with RCM procedures and increase the profitability of your practice.

What should you know about Denial Code CO 50?

co 50 denial code

Introduction

Suppose a payer issues a CO 50 denial code or rejection on a claim. In that case, it indicates that they have decided not to pay for the service or procedure because they do not believe it was medically needed to be carried out. It is the sixth most frequent reason Medicare claims are denied.

CMS reports that approximately 30% of claims are lost, disregarded, or denied. In a world where payment is already complex, claim denials significantly impact the revenue cycle and are a major concern for hospitals.

You must be aware that each payer’s policy on medical necessity is unique and constantly changing. Additionally, “medical necessity” might vary greatly depending on who pays. While Medicare and the American Medical Association (AMA) serve as the basis for the criteria, it is crucial to remember that each state has its definition of what is medically required. Therefore, it is essential to comprehend medical necessity.

This post explores CO 50 denial code. The post highlights CO 50 denial reasons and intends to present solutions for denial code CO 50.

CO 50 Denial Code

The procedures are not considered medically necessary by the insurer; hence they are not covered. If the procedure code does not match the diagnosis code billed under the LCD/NCD guidelines, the insurance company will deny the claim with the CO 50 denial code. It indicates that the services are not covered because the payer does not believe they are medically necessary.

The lack of medical necessity means that the diagnosis code may not satisfy the NCD or LCD requirements for demonstrating medical necessity.

Local Coverage Determination (LCD) is defined by Section 1862(a)(1)(A) of the Social Security Act as a decision made by a fiscal intermediary (FI) or carrier regarding whether or not to cover a certain service for the entire FI or carrier. This decision is justified under Section 522 of the Benefits Improvement and Protection Act (BIPA).

Denial code CO 50 is issued because the correct diagnosis code for the procedure was not used. If the coding staff is knowledgeable and proficient with payer policies, contracts, local coverage determination (LCD) codes, and national coverage determination (NCD) codes, claims are less likely to be denied. Detailed documentation and effective communication from the clinical team will also be beneficial.

CO 50 Denial Reason

Healthcare services are medically essential if a clinician uses good clinical judgment to prevent, evaluate, diagnose, or treat an illness, injury, disease, or its symptoms. Medicaid and private insurance payers each have their requirements regarding medically essential materials, treatments, and services. These rules might be found in the payer’s payment policy or clinical guidelines. A claim submitted to the payer under CO 50 may be denied for various reasons.

Some of the CO 50 denial reasons are:

  • The item’s LCD may show it requires a certain diagnosis code or modifier code
  • Absence of a development letter seeking additional evidence to support the billed service within the allotted time frame
  • The item being billed for is medically unessential
  • The payer’s allocated time for hospital service has been exceeded

A “medical necessity” denial may mean that a practice must engage in many activities. The practice’s insurance agreement will outline its obligations.

denial code co 50

Solutions for Denial Code CO 50

According to the explanation in the CO 50 rejection code, the services at issue are not covered by the payer’s policies because the payer has not determined that they are medically required for the patient. So, it is critical to determine if the given diagnosis code meets LCD/NCD standards for billing and payment.

According to the LCD/NCD standards, if the diagnosis code on the bill cannot be paid, we must resubmit the claim using the correct diagnosis code. You have the legal right to contest the claim if the issued diagnostic code was based on LCD and supported the provided proof.

It is possible to appeal a claim that has been rejected with CO 50 denial code. Here is what must be done to rectify CO 50 denial code:

  1. Determine the precise reason for the denial: If you receive a CO 50 denial code, you should investigate further, contact the payer, and determine exactly why you have not been paid.
  2. Be prepared with your Claim Number: Remember that you cannot simply use the original claim number; you must include additional information to indicate that this is a corrected claim. It will prevent the claim from being returned to you as a duplicate.
  3. Record the data: It is crucial to note facts such as the date, the call’s reference number, and the individual you speak with when working with payers. Thus, you can utilize your skills if you need to make many phone calls to contest the claim.
  4. Follow-up: Even if you resubmit a rejected claim due to a CO 50, you should follow up at least once every month. You should never allow the claim to get lost in the shuffle.
  5. Send out letters requesting assistance: Include the claim number, the patient’s name, the date of service, the provider’s number, and your member ID when appealing a claim. Keep it brief and concise, and add any supporting evidence for your allegations. If you ensure everything is correct the first time, your appeal will not be denied.

It is essential to take the following measures to prevent CO 50 denial code:

  • Examine the patient’s medical history to determine if there are any indications of a treatable condition.
  • Check the corresponding LCD for modifier conditions.
  • Respond to development-related letters by the date specified in each letter.
  • Verify that all questions on the Certificate of Medical Necessity meet the policy requirements.
  • Suppose a supplier is aware that a beneficiary will not be able to receive the equipment. In that case, they can get an ABN (Advance Beneficiary Notice of Noncoverage) before delivering the equipment.
See Also: Medical Coding vs. Medical Billing: What’s the Difference?

Conclusion

CO 50 denial code is assigned when a procedure code is invoiced with an incompatible diagnosis and the ICD-10 code(s) provided are not covered by an LCD or NCD. Since the payer does not consider this a “medical necessity,” these services are not covered. The word “medical necessity” ensures that services rendered for diagnosing or treating sickness or damage are reasonable and necessary.

CO 50 is a common denial code. You are now aware of the CO 50 denial code and what to do if it arises. However, if you need any assistance with denial management, Precision Hub is here for you.

Precision Hub helps your practice increase profitability by improving operational efficiency. We are a group of certified billing and coding specialists who can assist you in boosting the productivity and efficacy of your practice. Contact Precision Hub immediately to learn more about how we may help you decrease the number of denied claims and enhance your practice’s revenue.

Stay Coding Compliant with Medical Audits

coding compliance audits

Introduction

Accurate medical coding has a significant role in overall care quality and management of healthcare information. Coding audits are critical for ensuring that healthcare providers or organizations follow proper procedures and policies to achieve superior medical coding.

Coding compliance audits help reveal the inaccuracy issues in the medical billing or coding process. These issues could be fraudulent billing or outdated codes. Coding compliance audit provides quality assurance for helping the organization in the proper obtainment of reimbursement and in maintaining regulatory compliance.

Continue reading to learn more about coding compliance audits. This article explores the benefits of a coding compliance audit. Let’s learn the importance of having compliant coding.

Coding Compliance Audits

A coding compliance audit examines how coding is performed in a medical office. It consists of examining patients’ medical records. Audits of medical records examine the doctor’s selection and entry of procedure and diagnosis codes to ensure they are comprehensive and accurate. During a medical audit, the following are examined:

  • Correct use of CPT codes
  • Correct location of patient care
  • Absence or incorrect use of modifiers
  • Incorrect diagnoses, accurate documentation
  • Presence or absence of any bundling or clustering concerns

The failure to conduct coding compliance audits leads to serious consequences, including lost revenue and being exposed to compliance risk. A coding compliance audit helps reveal the issues. It, in turn, helps the providers to improve their procedures and policies.

Benefits of Coding Compliance Audits

Compliance is one of the fundamental reasons for doing a code audit. Medical coding and billing must comply with payer policies, including Medicare, Medicaid, and commercial payer policies. The company will face serious financial and reputational penalties if fraudulent billing is uncovered. Audits of medical coding not only show errors and places for improvement but also give information on the correct coding procedures already in use. Coding compliance audits offer numerous benefits, including the following:

  1. Compliance Improvement, Frauds Reduction

Compliance issues and fraudulent billing practices are significant issues in the healthcare industry. Most likely, billing errors or fraud causes incorrect payments. Some of the most common causes of incorrect payments include:

  • Wrong coding
  • Lack of documentation
  • Absence of medical necessity

Upcoding and billing for unnecessary treatments and invoicing for services that were never performed or missed appointments by patients are the most prevalent types of fraud. Medical coding audits can uncover incorrect billing practices that may have resulted from error or fraud. Healthcare organizations can adjust their billing practices and employee training to prevent more billing errors and fraud. Ultimately, compliant coding will reduce the risk for healthcare organizations and may prevent them from incurring costly fines.

Compliance Improvement

  1. Revenue Protection

When coding errors occur, healthcare organizations incur financial losses. Claims could be denied or rejected if the coding is incorrect. When a payer investigates and processes a claim, only to find that it is not payable, the claim is denied. It can occur if coding errors are discovered after the claim has been processed or if it does not adhere to the provider-payer contract. Since there are so many errors, rejected claims do not even make it to the payer review stage. It will take time to remedy errors on a claim and resubmit it for payment, regardless of whether the first claim was accepted or denied.

Sometimes, claims with incorrect coding will still be processed by the payer. When claims are under-coded, healthcare organizations lose money, and when they are over-coded, they risk incurring regulatory fines. Medical coding audits will uncover flaws in the practice’s coding procedure that result in financial losses. Healthcare organizations might alter their coding practices to prevent losing additional funds.

  1. Accuracy Improvement

An important element in medical coding is accuracy which is critical for avoiding compliance consequences. Accuracy is also essential for overall care quality as it significantly impacts risk adjustment and quality reporting of the problems and the provided service. Issues like wrong documentation affect the coding quality, which coding audits can identify early.

  1. Claim Rejection Reduction

Regular audits help maintain medical coding accuracy and ensure they are free of mistakes—accurate coding results in fewer claim denials and rejections. Incorrect diagnosis codes, wrong procedures, and insufficient documentation are the major reasons for claim denials. All these issues are uncovered in coding compliance audits. Hence, compliant coding helps in the timely identification and resolution of the issue to reduce the likelihood of claim rejection.

Claim Rejection Reduction

Frequency of Conducting Coding Compliance Audits

The frequency of medical coding audits is based on various factors, including the organization’s size, the pace of personnel turnover, and changes in regulatory standards. An external code audit should be conducted at least once a year, although many healthcare facilities choose to conduct them monthly to maximize their benefits.

Monthly coding compliance audits enable healthcare organizations to detect errors more frequently, allowing them to recover more money and correct errors that cost them money. Medical coders can use the knowledge gathered from monthly audits to prevent common errors and keep updated on the most current regulatory requirements. In addition, the results of monthly audits can be an excellent teaching tool for novice coders.

Annual audits examine the coding of the whole year. However, organizations may need to alter their operations more frequently than annually. When healthcare organizations have access to the results of monthly audits, they can better identify areas where clinical documentation can be enhanced, enhancing the coding process overall. The sooner incorrect information and lost revenue are discovered, the greater the return on investment.

See Also: Why Should You Hire A Medical Billing Company?

Conclusion

Coding audits look at how procedure and diagnosis codes were chosen and written by the doctor to ensure they are complete and correct. Coding compliance audits offer numerous benefits. Precision Hub assists physicians with accurate coding. Our coding audit services are designed to assist you in meeting various industry requirements.

Precision Hub is one of the most successful service providers facilitating payment for businesses. We assist practices with coding compliance audits by adhering to the most current coding standards and best practices. We have the skills and resources necessary to conduct an audit of your medical coding operations. We assist you in increasing revenue and safeguarding your organization against fraud and regulatory issues.

Medical Coding vs. Medical Billing: What’s the Difference?

medical billing vs medical coding

Introduction

Despite the widespread misconception that medical coding and medical billing are identical, these two tasks are distinct in significant respects. To be successful, individuals in both industries must possess comparable skills. Nevertheless, how they achieve their objectives and the routes they travel to get there are vastly distinct.

Most individuals are uninformed of the difference between medical billing and medical coding. There is a degree of overlap between these two skill sets, as both positions entail encoding medical data into standard codes so that vital medical information can be transferred across individuals. A medical coder’s job is to provide the most comprehensive description possible of a medical visit. It is the responsibility of medical billers to provide accurate and timely reimbursement based on the used codes. A medical coder’s job is to provide the most comprehensive description possible of a medical visit.

The present post explores Medical billing vs. Medical coding. It identifies the difference between medical billing and coding. Moreover, the post also highlights the benefits of medical billing and coding services.

Medical billing vs medical coding

Medical Billing Vs. Medical Coding

Before discussing medical billing vs. medical coding, we must understand the meanings of billing and coding in the medical field.

Medical Billing Services: Medical billing involves the preparation and submission of medical claims on behalf of patients to insurance companies and government organizations in exchange for payment for services rendered to patients.

Medical Coding Services: Coding in medicine focuses on each patient’s health records. Correct coding reduces the likelihood that incorrect diagnoses or notes will be recorded. Medical billers must communicate with patients and insurance companies to submit claims.

Medical Billing vs. Medical Coding: Medical billers typically have more client-related responsibilities than medical coders. In contrast, medical coders typically collaborate with others in the healthcare industry to appropriately classify the services and products provided to patients.

Difference Between Medical Billing and Coding

Medical billing vs. medical coding: Medical billing and coding encompass a variety of duties, including patient registration, claim payment, and provider payment. It requires the collaboration of billers, coders, insurance companies, patients, and healthcare personnel to complete the process. Billers and coders ensure that the healthcare revenue cycle operates as efficiently as possible.

Let’s explore medical billing vs. medical coding.

Medical billing vs. medical coding involves submitting and following up on insurance claims so that healthcare practitioners can be compensated for their services. In contrast, medical coding is the process of translating various medical treatments into computer-understandable codes. Billing and coding for medical services are essential components of healthcare administration. They collaborate to ensure that patients receive the necessary care and that providers are compensated for their services. Unlike medical billing, which focuses primarily on the patient, medical coding concerns how insurance companies will reimburse for medical care rendered.

Medical coders must first translate how patients were treated into a computer-comprehensible language. ICD-10 and CPT codes are the two most prevalent types of medical codes. When medical billers submit insurance claims and add payments to patient accounts, they follow coders’ instructions. For claims to be reimbursed, the correct medical information is required. Billers collaborate with insurance companies to resolve issues with denied or rejected claims, finalize case facts, and send billing statements.

The following table shows the differences between medical billing and coding services:

Medical Billing vs. Medical Coding

Medical Billing

Medical Coding

Primarily entails entering information into a billing program using specialized software.

Categorize a patient’s care by consulting with physicians, registered nurses, and other health care experts

Providing insurance companies with proof of an insurance claim

Adding standard codes such as CPT, HCPCS, and ICD-10 to patient data to appropriately capture the services rendered

Maintaining contact with patients, healthcare providers, and insurance companies to ensure claims are paid.

Recording/Storing information into the Electronic Health Records (EHR) and Electronic Medical Records (EMR) software used in hospitals and private practices

Taking care of billing and managing payments for accounts

Including procedure codes on the surgical records utilized during the operation

Investigating claims that have been denied or rejected

Performing audits of medical charts if a claim is rejected

Ensuring that insurance companies compensate both patients and providers

Maintaining a level of familiarity with the most recent iterations of coding standards and federal laws

Determining whether or not medical coders have correctly classified patients’ services and products using the standard healthcare codes

Examining the medical records as well as histories of patients to guarantee that coding appropriately reflects a patient’s treatment

 

Benefits of Medical Billing vs. Medical Coding

Benefits of Medical Coding Service

Medical coding is quite similar to the process of translation. Coders transform medical reports from physicians into codes. The reports contain information including:

  • Patient’s condition,
  • Doctor’s diagnosis
  • Prescription
  • Any operations/procedures performed on the patient

These codes are a crucial component of the medical claim. Coders are responsible for ensuring that insurance firms receive accurate and comprehensive data. Below are the reasons why medical coding is vital:

  • Less past-due days in accounts receivable
  • Eliminating back billing, which can be costly
  • Fewer rejections when claims are clear
  • Accuracy above 98%
  • Capacity to generate customer-specific reports

Benefits of Medical Coding Service

Benefits of Medical Billing Service

Most practices know that medical billing services and revenue cycle management can assist cut costs and improving income by utilizing electronic eligibility verification and other benefits. Some of the most important benefits of medical billing are as follows:

  • Enhanced cash flow due to increased client revenue
  • Expedited claims processing
  • More time to concentrate on one’s primary abilities and achieve more
  • The practice’s overhead expenses dropped
See Also: How To Improve Medical Coding Quality

Conclusion

The post articulates medical billing vs. medical coding. People frequently believe that medical billing and medical coding are the same services. In contrast, medical billing and medical coding are two quite distinct professions. There are several significant differences between medical billing and coding.

Even though both of these services involve patients’ medical data, medical coders are the ones who examine the records and assign the correct codes based on what the medical staff says. After that, medical billers utilize specialized software to insert all necessary medical codes. Coders and billers work to ensure the correct amount is billed to the patient’s insurance carrier.

Precision Hub has been assisting customers with their medical coding and billing issues. Proficient medical billers and CPT-certified coders at Precision Hub can manage any volume of work and complete it on time to provide clients with the best possible medical billing and coding services. If you employ our services, we guarantee that your claims will be more accurate, you will have fewer denials, and your income will increase.

If you require assistance with any aspect of medical coding or billing, please do not hesitate to contact us; we will do all possible to assist you.

Tips for Effective Contract Negotiation for Physician Practices

negotiating physician contracts

Introduction

A significant shift has occurred in the medical profession, and insurance companies are becoming more willing to negotiate payment rates with physicians. Insurance companies realize that small to mid-size groups (one to ten physicians) are the “bread and butter” of their network that they have ignored for far too long. So, it is necessary to know each aspect of negotiating physician contracts.

Insurers realize that if they ignore this network segment, physicians in this area will be forced to join larger groups to negotiate higher reimbursement rates. Payers are eager to communicate with physicians, but you must be prepared when discussing your pay rates to avoid complications. There are many aspects of negotiating physician contracts that you must know.

Commercial payers do not usually reward physicians who adhere to their networks with high pay. In the majority of practices, the physician handles negotiations. Doctors who manage their practices and have worked with various payers for years may be unaware that they have greater negotiating power than they believe. Effective physician contract negotiations require certain steps to be considered. This article presents tips for successfully negotiating physician contracts. Continue reading to find out how to negotiate a physician contract.

What to consider before physician contract negotiations?

  • Identify reimbursement issues

Compare the insurance coverage offered by each insurer to your most commonly invoiced CPT codes. When developing a report on usage, collecting and analyzing data that illustrates where discrepancies exist is advantageous. Record in a spreadsheet the frequency with which a regularly used CPT code was billed to a specific payer and the amount paid for it. The remainder is then divided by the current payment amounts. You may determine when you will begin to generate a profit by adding your physician reimbursement and overhead costs and dividing by the number of codes for which the payer will pay weighted average costs. You should better understand which contracts require the most care and which companies impose the greatest financial restrictions. It is a prerequisite for successfully negotiating physician contracts.

Identify reimbursement issues

  • Define your goals

With the identification of reimbursement issues, you have actual numbers to support your claims while negotiating physician contracts. It would be best to define optimal, minimum, and intermediate objective goals. The optimal represents the ideal terms, whereas the target indicates your desired position after the negotiation. With access to all this information, you will be in a much stronger position to negotiate with payers and reject any mistaken ideas they propose.

  • Avoid Terms

Avoid including “evergreen” terms in contracts. These clauses renew the agreement for an additional year unless a notice of termination is provided within a particular period. Include an “exit” clause, especially for ninety days, if you are getting into a contract with a new payer or one with whom you have had previous troubles.

  • Consider the timeliness

Another important consideration for negotiating physician contracts is timeliness. Certain payers issue retroactive denials, leading to refund requests for old claims. Verify if the contract states that payments older than 120 days will not be taken unless there is an issue with the claim.

Tips for negotiating physician contracts

1. Study the Current Contract

Get copies of the contracts and pricing lists and schedule for thorough study. Reviewing current contracts helps identify and correct payment disparities below the agreed-upon rate. It can be accomplished by comparing the actual rate to the contractual rate.

2. Review Payment Models

If you are not currently a member of an accountable care organization (ACO) or clinically integrated network (CIN), you should strongly consider joining one of these organizations. It will help in learning the practice’s different aspects, including the payment models. The payment systems continue to evolve. It is of the utmost importance that practices can adapt and evolve in a way that will ensure the survival of the organization.

3. Use Quality Data

The provision of quality data and cost statistics help demonstrate the care you offer. You can use this data to your advantage when negotiating physician contracts. Having these high-quality independent practices as part of the network benefits the payer.

4. Show Your Worth

You must first show the payer how valuable you are relative to others in your profession. Is your medical office, for instance, the only one in the area offering longer office hours and telemedicine visits on the weekends? Are you the sole primary care doctor within five miles of your practice? Do your research before negotiating the contract. It is straightforward to acquire the information by visiting a payer’s website and inputting your ZIP code to determine the number of doctors in your area.

5. Escalator Clause Incorporation

An escalator clause, a contract provision, guarantees a given payment increase over a specified period. For instance, a medical practice may agree to a three-year contract with automatic one-percent-per-year increments for each year.

6. Investigate the source of payment

It is important to analyze payment sources for negotiating physician contracts. Speaking with other doctors in your area about their contracted rates may help you determine what yours are. This data will be used to establish standards for payment rates, rejection rates, and other metrics.

Investigate the source of payment

7. Exemptions for regularly utilized services

Negotiating at a higher rate for the regularly used service is suggested. Your practice may be able to negotiate greater prices for office visits alone. It will be beneficial for maximizing the revenue.

8. Include Service Types in the Price List

Many physicians deliver COVID-19 vaccines and conduct lab testing, but the codes for these services may not be reflected on their fee schedules at the negotiated and contracted rate. Instead, they have often compensated a smaller share of the charges. You will be paid more for a similar service if you include these services in your price schedule. Include these services in your price list to negotiate a physician contract.

See Also: How To Improve The Patient Registration Process To Enhance Patient Experience

Final Verdict!

It is wise to hire a specialist to handle physician contract negotiations. It is in your best interest to pay a trustworthy consulting firm. A reputable consulting firm has the knowledge, skills, and connections to secure you better prices.

A third party’s participation in the negotiation process can be advantageous. Working with a respected third-party billing business can help you negotiate rates and conditions by providing you with a history of clean, reimbursable claims that fulfill the requirements of all payers, including CMS and private payers. It is an effective approach for negotiating physician contracts.

The experts at Precision Hub have access to cutting-edge revenue management tools and have worked with various payers to achieve their goals. Don’t hesitate to contact us so we may assist you in satisfying the reimbursement contract’s requirements.

What To Know About Medical Billing Errors And Patient Rights

medical billing errors patient rights

If you are a medical provider, you should know your patient’s rights when it comes to medical billing. In 2010, Medicare paid $6.7 billion in claims that were not appropriately coded or billed. The proper billing of services is vital for two reasons – patients get billed for the services provided to them, and your doctor’s office gets paid. Incorrect medical billing can cause problems for your practice, including making your practice look incompetent.

Medical Billing Errors and Patient Rights

If you want to prevent medical billing errors, it’s important to pay attention to details. Double-check your patients’ personal information, check for erroneous codes, and be careful with insurance details.

This article will go over some of the most common medical billing errors and provide solutions for preventing them. These mistakes are caused by a variety of different factors. By paying attention to details, checking for inconsistencies in your records, and using the correct codes, you can prevent many costly errors and improve your medical billing.

  • Unbundling

Unbundling in medical billing may occur due to a mix-up in the coding of a procedure. It is when multiple CPT codes are used for different parts of a single procedure. This may be the result of a miscommunication or a deliberate attempt to increase the payment for a procedure. Unbundling can be a problem if the billing service provider fails to review its records carefully to identify all instances of unbundling.

Using the most comprehensive code for a procedure is the best way to report this error. HCPCS, also known as the Healthcare Common Procedure Coding System, is a comprehensive coding system used to describe medical services. Using a single HCPCS/CPT code to report a group of procedures is known as unbundling.

Unbundling

However, providers should not bill separate CPT codes for the same procedure, unless the services were performed separately. This is known as “double billing/dipping”, and it is considered unethical for a health care provider to bill patients separately for procedures that are performed together.

While unbundling medical billing codes can be difficult to detect, you can readily recognize it from the fragmented billing and coding of each component of a service where one code was appropriate. As a patient, you have the right to demand a copy of your medical bills.

In many cases, unbundling errors are difficult to identify without the help of a whistleblower. Unbundling is also difficult to detect because people receiving healthcare are not necessarily familiar with the complex terminology used for medical billing and coding.

A recent False Claims Act lawsuit against Duke University resulted in the university paying $1 million in settlement for charges of false claims and wrongful billing. It was found that Duke had improperly billed for anesthesia and cardiac services by unbundling the claims. These types of unethical billing practices can expose providers to criminal and civil liability.

In addition to medical billing errors, patients should be aware of double billing, which occurs when a bill is submitted multiple times. It is not uncommon for providers to double bill, and patients should, therefore, check their bills carefully for possible medical billing errors or fraudulent practices.

  • Upcoding

If you believe that you have been a victim of upcoding, you may want to learn more about your legal rights and options. While upcoding is often the result of fraudulent billing, it can also be the result of clerical error or misunderstanding. As a result, it can be difficult to prove a healthcare provider’s guilt, even if the case is minor or insignificant.

Fraudulent upcoding costs health payers a lot of money, which they then pass on to consumers. Health insurance companies often raise premiums to cover the increased costs. The process can also result in duplication of orders for medications, lab work, and hospital room fees.

For example, a doctor may order a five-minute nurse consultation, but bill for a 45-minute doctor examination. This would constitute upcoding and a violation of patient rights. If you suspect you have been a victim of upcoding, call the customer service line and report the problem.

Similarly, report any fraudulent practices to the state Medicaid office. Action will be taken under the False Claims Act to lay severe penalties against healthcare providers, as well as significant fines. However, you can help ensure that upcoding is a rare occurrence by taking the time to review your billing processes.

On the other side of the fence, outsourcing services or hiring experienced professionals can help you ensure that your medical billing is accurate. Upcoding can also happen due to fragmentation and unbundling. While Medicare and Medicaid have lower reimbursement rates for the same procedures, providers are often unbundled and charged separately.

  • Incorrect Use of Modifiers

Using the wrong modifiers on claims is a serious billing error that can cause non-compliance, fraud, and even payment issues. When a modifier is used incorrectly, it can affect the payment for the service or procedure.

Additionally, the incorrect placement of modifiers can lead to medical documentation requests. It is important to make sure that the documentation contains the appropriate information and is comprehensive enough to adequately describe the service or procedure.

When using modifiers in medical billing, you should keep in mind that not all payers follow the same standards. It is vital to know the modifier policy for each payer to ensure proper claims adjudication. The correct use of modifiers in claims will also help reduce the risk of NCCI edits. Modifiers should always be placed in the first modifier position. By following these guidelines, you can be assured of the proper adjudication of your claims.

Correctly using modifiers is critical for accurate medical billing. If you are not careful with modifiers, you will be accused of billing for services you did not provide. Incorrect use of modifiers can also lead to denied claims and revenue leakage.

As a provider, it is imperative that you follow all the guidelines and the rules for using modifiers. This will ensure that you avoid the potential financial impact of incorrect modifier use.

Misuse of modifiers can be a major contributor to erroneous medical bills. If a diagnosis code is used improperly, it can cause the services to be rendered incorrectly. For example, a patient may receive an MRI on the wrong knee due to a missing two-digit modifier.

Incorrect use of modifiers may lead to payment delays. If a patient is not provided with the correct service, the provider could be held liable for the cost of the procedure.

Patient Rights

  • Patients’ Right to a Patient Advocate

A patient advocate is a valuable resource to patients and their families. They will be able to negotiate with the insurance company, provider, and hospital on your behalf to get your bills corrected. He or she can also help you dispute your bills with your insurance company.

These professionals will help you obtain a better understanding of your medical bills, including upcoding, unbundling, and balance billing. In the event that you are not sure about what to do, a patient’s advocate will come to the rescue by helping you make an informed decision.

A patient advocate will listen to your concerns and complaints, help you understand medical bills and your hospital’s policies, and navigate the medical billing process. They will also help you find local services and explain your insurance coverage. They will typically work with your medical team to resolve any issues.

Patients’ right to a patient advocate is protected under federal and state law. They have the right to receive a copy of their bills and will be able to contact their advocates for help with any issues that arise.

Generally speaking, patients have the right to receive a full explanation of their bill, an explanation of why they were transferred from one hospital to another, and a mechanism to keep them informed about their ongoing health care needs.

In addition, they have the right to request an interpreter if necessary, or to have someone with them who can translate the bill for them. However, it’s important to note that these rights can sometimes conflict with legal requirements.

The patient’s right to a patient advocate is a powerful tool that can help you fight for your rights when it comes to healthcare billing. These rights are part of the Patient’s Bill of Rights and can help protect you in many ways.

See Also: Improving Pain Management Services For Patients

Conclusion

Incorrect medical bills affect everyone – providers, payers, and patients. Billing errors delay payment, affect cash flow, and result in overcharges.

Although most extra costs are paid by insurance companies, patients can be directly affected by an inaccurate bill. By working together to address these issues, providers and payers can improve the quality of healthcare and help prevent medical billing errors.

In addition to advocating for better healthcare and supporting innovative technologies, patients can also examine their medical bills for errors and speak for their patient rights. Even though mistakes are inevitable, medical billing professionals must take steps to avoid them and protect patients.

If you are looking for a tailored billing and collection service for your practice, Precision Hub offers complete solutions for medical billing, coding, and claims management. We help you to deliver patient-centric care by avoiding these headaches and focusing on growing your practice.

For more information, please get in touch with Precision Hub Manager today!