What is Physician RCM?

physicians rcm

Revenue cycle management, or RCM, is an increasingly vital aspect of healthcare information technology. Physicians RCM focuses on revenue-generating processes, such as filing claims and dealing with insurance denials. When properly implemented, RCM for physicians can reduce administrative costs and significantly improve the collection of funds.

The rapid growth of the RCM industry from less than $80 billion in 2016 to more than $120 billion today demonstrates its significance. Most experts agree that its annual growth rate will remain at 12%.

Every healthcare provider wants to deliver the finest treatment possible to their patients and the community, but they must also ensure that their RCM does not interfere with their goal. Therefore, it is essential to comprehend the revenue cycle management for physicians. In this regard, the present article intends to uncover every important aspect of a physician’s RCM. These include factors related to RCM, medical billing’s function in RCM, and the benefits of a well-run RCM. So, let’s learn it all.

Physicians RCM: An Explanation

The revenue cycle is the process of tracking and collecting patient payments and fees in medical practice. The process begins with patient registration and appointment scheduling, followed by:

  • Insurance Verification
  • Co-Payment Collection
  • Medical Record Management
  • Coding of Clinical Procedures Performed
  • Charge Entry
  • Claim Submission
  • Payment Posting
  • Management of Denied Claims
  • A/R Follow-Ups
  • Collection Statement Compilation

In the US, more than 23% of all healthcare providers work in private practices. Typically, one physician or a small group of two to five physicians handle these practices. Medical practices must accomplish their collection and revenue targets to maintain business continuity. In the healthcare industry, billing and other financial procedures must constantly have committed resources handling claim management, payment follow-ups, and physicians’ RCM. The important steps include the following:

  • Claim Preparation

Before submitting a claim, you must gather more information about the patient. Typically, this occurs before the initial appointment. It is essential to confirm the patient’s eligibility and insurance coverage.

  • Claim Submission

Claim creation involves entering charges and codes. It is then sent to the patient’s insurance carrier.

  • Claim Management

The practice is responsible for managing the claim before and after receiving a response from the insurance company. Additionally, it must post any payments that must be paid.

  • Receivables Collection

It involves payment collection from the patient. This stage involves sending out bills for receiving the funds.

  • Evaluation and Analysis

The end of the process requires the billing team to extract and examine data from the RCM software.

Efficient physician RCM practices can reduce errors, increase the likelihood of invoices being paid, and prevent accounts receivable from falling too far behind.

Revenue Cycle Management for Physicians: Important Factors

The revenue cycle, a collection of front and back-office processes, functions as a chain. Even a minor hiccup in the workflow can disrupt the operation. Thus, it is vital to ensure there are none. Unified processes facilitating communication between front-office and back-office resources are necessary to improve the revenue cycle.

For a practice to be financially sound, each phase of the revenue cycle must be performed correctly. A good workflow is necessary to ensure that the provider fulfills the established income targets. Numerous factors can affect the revenue cycle and efficiency, resulting in more money collected.

Two of the most important factors involved in a physician’s RCM are discussed below:

Front Office Processes

Appointments will be difficult to schedule if the front desk staff registers patients properly. It results in missed appointments, which causes patients to wait longer. Similarly, difficulties might arise in the initial phases of the revenue cycle if insurance information cannot be confirmed or if incorrect information is entered. The front office is a crucial component of optimizing the physician’s RCM because it ensures that the workflow is optimized and processes are handled flawlessly. A scheduling system that integrates with the practice management system and ensures that patients are always checked in is required. For patients to be able to call and schedule appointments, a physician’s office must have a flawless system.

Clinical Flow and Patient Visits

An essential aspect of a revenue cycle is ensuring that patient visits and walkthroughs function optimally in the care process. During the clinical phase of the revenue cycle, visit documentation is gathered to record the specifics of the patient’s visit. The physician records the clinical notes and transmits them for further processing. In the clinical phase, errors and missed steps can negatively impact the revenue cycle. Medical billers create patient bills by utilizing clinical notes as their primary source of information. For the remainder of their duties, they rely solely on the information provided by treating physicians during patient visits. If missing information or the medical procedures matched up correctly, the bills would be correctly made, decreasing their likelihood of being reimbursed.

 

Medical Billing in RCM for Physicians: Functions

Billing is by far the essential aspect of the revenue cycle for a physician. Problems with billing, such as incorrectly inputted CPT codes that do not match the diagnosis, errors in ICD codes, patient demographics, and health information, and the absence of insurance verification, generate a broken revenue cycle.

RCM for physicians involves submitting claims for reimbursement, monitoring payments, handling claim denials, collecting past-due balances, and generating patient statements. Due to the administrative workload, most physicians’ offices already struggle with burnout and low energy. Optimization and management of the revenue cycle require ongoing attention from professional firms like Precision Hub. Due to this, most medical practices outsource billing and revenue cycle management activities to teams who can assist them in achieving their revenue objectives. RCM companies are proficient in the revenue cycle management for physicians. Their expertise and experience ensure the seamless flow of incoming funds.

Well-run Physicians RCM: Benefits

A well-planned physician RCM serves as the brain and the heart of the practice. If RCM is not implemented, there will be no money flowing through the clinic. Without that flow of funds, the clinic will be incapable of expanding and thriving. If a healthcare institution wishes to continue operations, it must make RCM a top priority as it offers numerous benefits:

1.    Boosted Revenue Performance

Better revenue performance will be one of the most significant benefits of a solid RCM. Payments will arrive more quickly, regularly, and with fewer expenses. The financial health of your practice will be improved consequently.

2.    Augmented Visibility

Increased revenue cycle visibility and transparency will allow for better examination of data. The team will be able to identify problems and devise solutions accordingly.

3.    Shortened Billing/Collection Cycle

A carefully designed and expertly implemented RCM system will reduce the time required for billing and collecting money by accurately registering, scheduling, appointing, and processing payments. It will save physicians time and money by decreasing the number of denied claims and allowing patients to pay online. Consequently, fewer claims are denied overall.

See Also: How does physician credentialing work?

Conclusion

In the current healthcare system, doctors must be able to manage the revenue cycle to offer quality care and receive adequate compensation. Precision Hub employs the best and most skilled revenue specialists to provide physicians with RCM services. We employ the most intelligent automated technology and the greatest business practices to improve the patient experience and maximize financial outcomes for physicians. Schedule your free consultation to see how we can assist you with our best physician RCM services.

Why Outsource your Medical Billing Services?

outsourcing medical billing

Apart from clinical services, the most important aspects of a medical practice are billing for medical services and managing the revenue cycle. The majority of practitioners must decide whether or not to outsource their medical billing. The answer is a definite “yes”; however, the answer to this question depends on the size, scope, market conditions, and financial situations of individual practices. Do you want to know why you should outsource your medical billing and what to look for in an outsourced medical billing company to manage your medical bills? Continue reading this post to find the answers to your questions, as this article reveals all the important aspects of outsourcing medical billing.

Outsourced Medical Billing

In today’s complicated and rapidly expanding healthcare business, outsourcing medical billing has proven to be a significant strategic advantage for medical professionals. As a result of superior systems, cutting-edge technology, economies of scale, and experienced personnel with specialized knowledge and abilities, outsourced medical billing frequently results in more cost savings and better outcomes. An outsourced medical billing firm can help you establish billing process priorities. So, outsourcing is the simplest and least time-consuming strategy to increase the profitability of your medical practice. Investing much money and time in the billing process is vital.

Keep on reading to uncover the benefits of outsourcing your billing:

Keeps Doctors Focused on Patient Care

Medical personnel can concentrate on patient care by outsourcing claim filing and payer communication. They know professionals will handle billing and other revenue cycle management (RCM) tasks. Outsourcing allows them to spend more time and effort ensuring that their care is of the highest quality. If a physician is too busy with the business side of their practice, they cannot provide their patients with adequate care.

Cuts Down Labor Costs and Billing Mistakes

The practice is responsible for hiring, onboarding, and training billing staff when billing is performed in-house. On the contrary, professional billing firm ensures that the billers they employ have the necessary skills and knowledge to submit medical claims accurately. Medical billers with the essential knowledge and experience can ensure that your claims are submitted on time and in the correct format. Thus, outsourcing reduces the number of claims denied or rejected due to billing issues.

Amps up the Revenue Cycle

The top medical billing services have a system that allows claims to be submitted on time. Timely filed claims have a greater chance of being paid more quickly—the income increases when a practice transitions to an outsourced medical billing provider. Practices lose a significant amount of money annually due to denied claims. Using an effective electronic health record system and expert medical billing services reduces the likelihood of errors. It results in fewer denied claims. Moreover, unpaid claims are maintained in the system until they are settled.

Accelerates Insurance and Payment

When a competent establishment handles medical billing, there are fewer errors, reducing the time required to receive payments and reimbursements. Customers accustomed to the faster pace of today’s digitalized environment prefer streamlined processing solutions, increasing efficiency and generating more revenue.

Adherence to the Rules and Updates

Daily implementation of new coding and billing standards helps keep the medical industry current. Those on your staff responsible for coding and billing should be aware of the most recent regulations. Internal billers should be made aware of changes to industry regulations. In addition to government regulations, public and private insurance companies frequently alter the steps and criteria that must be met to receive reimbursement. When you hire a company to handle your billing, your insurance company will rely on that company to send your bills appropriately. Companies that outsource their work ensure compliance with HIPAA regulations and insurance standards.

Outsourced Medical Billing Company

Outsourced Medical Billing Company

An outsourced billing company offers automated software, quick recovery, and follow-up. A consistent cash flow contributes to a practice’s success and growth over time. An outsourced medical billing service can help you create value for your practice by keeping billing transparency and accountability under control. You can avoid the time-consuming and tedious medical billing procedure by employing a low-cost company like Precision Hub that performs excellent service.

Outsourcing Does Not Limit Your Financial Control!

It is a common misconception that outsourcing medical billing entails handing over a practice’s finances to an unknown third party and abandoning financial management. However, this is not the case. After a contract is signed, an outsourced billing team must focus on specific KPIs. It provides a very clear image of the money-making cycle that you control. A billing company undertakes to provide information in the form of detailed performance reports depending on its activities and outcomes. So, you can handle problems with payments, delays, and other financial concerns without micromanaging.

Picking the Right Outsourced Medical Billing Firm

You must select the appropriate billing service for your practice. Several factors must be considered, including a company’s medical billing services and the rate at which insurance claims are processed. These are both essential considerations. It is also vital to choose whether monthly financial reports will be issued, their quality, the training their team receives, and how to reach the professionals who manage current accounts receivable (A/R). Considering these aspects, Precision Hub is the right choice. It provides a complete picture of the clinic’s performance. Using the drill-down function of the BI custom reports that we offer at Precision Hub, you can obtain specific data regarding the number of patients, the status of medical credentialing, and more.

See Also: How to Attain Accurate Billing Solutions

Conclusion

There are numerous advantages associated with outsourced medical billing. Healthcare providers can save considerable time and resources by outsourcing their medical billing. They can devote more time and attention to providing high-quality patient care while improving patient flow and overall satisfaction.

In medical practice, billing errors are the leading cause of revenue loss. Outsourced medical billing service can ensure that it meets certain quality standards. Outsourcing thus reduces the likelihood of costly errors and increases profits by simplifying work. Precision Hub ensures that all invoices are received on time and contain the correct information. We know the need to complete documents accurately so insurance companies can avoid delays or refuse claims. Our staff has been trained to do medical and coding activities involving patient demographics, CPT, and ICD codes with modifiers. So, book your consultation now and outsource your medical billing to Precision Hub to reap maximum benefits.

How to Attain Accurate Billing Solutions

accurate billing solutions

Are your practice’s income or reimbursements decreasing? Inaccurate billing and coding may be the source of the issue. A healthcare practice must generate revenue and maintain a healthy financial growth rate for effective operation. Coding and billing are the foundations of revenue cycle management (RCM). They ensure that doctors are paid according to the insurance company’s standards for their services.

However, when it comes to invoicing for medical services, physicians encounter numerous obstacles. If a billing mistake occurs or the error code attains, the payer might deny or reject claims for the tiniest reasons. These denials and rejections of claims impact how much doctors are compensated for their services. When practices adopt improper billing procedures, it is detrimental to the medical practice and the patients. Thus, attaining accurate billing solutions is crucial for streamlining the practice.

Today’s post is about accurate billing solutions and tips and tricks for precise billing and coding. It sheds light on avoiding coding errors and ensuring accurate billing. So, keep reading to find out how to ensure accurate billing for your practice to generate maximum revenue.

Accurate Billing Solutions

Medical billing in the modern world can be so intricate that it can take weeks or even months to complete. This is because the procedure is occasionally difficult to comprehend. The process must be constantly reassessed because it is difficult to balance the internal workflow of your practice with the expectations of your claims processing vendors and external clearinghouses.

Coding and billing are essential components of the modern medical industry. These essential tasks must be appropriately performed because they relate to the patient’s health and safety, the surgeries’ effectiveness, and timely payment. When it comes to invoicing and coding for medical services, precision is crucial. Medical coding involves familiarity with medical terminology and fundamentals of anatomy and physiology. If medical billers lack this knowledge, they may send insurance companies bills containing incorrect medical conditions or diagnoses. Underpayments or overpayments would be detrimental to the financial health of medical practices. They could face legal consequences if they were discovered to breach government regulations and private-payer laws. Medical billing and coding errors can result in substandard care and improper payment. Accurate billing ensures that patient bills are precisely analyzed and managed and that practices receive full payment.

accurate billing

Steps for Obtaining Accurate Billing

Attaining accurate billing solutions can be difficult for healthcare professionals since it entails a multitude of codes, rules, and guidelines. However, with the right approach, accurate billing is achievable. Listed below are some steps that will assist you in achieving accurate billing solutions:

  • Understand the billing codes: It is crucial to stay current with the most recent billing codes and laws, as medical billing codes are always evolving. This will guarantee that your billing is compliant and correct.
  • Utilize billing software: Investing in software for medical billing can assist in automating the process and reduce the likelihood of human error. Look for user-friendly, adaptable software that includes an error-checking mechanism.
  • Verify insurance coverage: Verify the patient’s insurance coverage before administering treatment to guarantee that the service will be covered. This will aid in preventing denied claims and reducing the chance of attaining an error code.
  • Have an effective follow-up system: It is essential to follow up on unpaid and denied claims to ensure that you receive payment for services rendered. One or more staff people be employed to review claims that have been in the system for an extended period and identify any missing information that could result in claim denial.
  • Have an efficient audit process: Regularly review and audit your billing process to identify any errors or areas for improvement.

By following these steps, you may increase the accuracy of your medical billing and ensure that you receive accurate payment for the services you render.

Attain Accurate Billing Solutions with Precision Hub

The success of any practice depends on being paid in a timely and precise manner for the services rendered, making accurate billing solutions a top priority. Precision Hub provides accurate billing services. From invoicing and payments to financial reporting, Precision Hub’s state-of-the-art technology ensures that all billing operations are carried out efficiently and accurately. With Precision Hub, you can rest assured that your billing process is in good hands, leaving you free to focus on providing the finest care to your patients.

When you outsource your billing to Precision Hub, you will get the following benefits in addition to accurate billing:

  • Competitive Pricing
  • Higher Reimbursement
  • Timely Payment
  • Faster Turnarounds
See Also: How Accurate Coding Can Save Your Revenue?

Conclusion

Coding and billing are frequently viewed as revenue-generating operations in the medical sector. Obtaining accurate billing solutions is vital, ensuring you receive timely payment for your services. The process can be complex, but by understanding the billing codes, using billing software, verifying insurance coverage, and having a good follow-up and audit process, you can improve the accuracy of your billing and reduce the risk of errors. With the right approach, you can achieve accurate billing and focus on growing your practice. By keeping these steps in mind, you can take control of your billing process and ensure that it is accurate and efficient.

Outsourcing can make it easier to keep track of things, save operating expenses, enhance speed and accuracy, and reduce the likelihood of problems occurring with costly-to-maintain in-house technology. For accurate billing, you can rely on Precision Hub, as we use cutting-edge technology to streamline and correct all aspects of the billing process. Schedule a free demo today to learn more.

How does physician credentialing work?

physician credentialing

There may need to be more than a doctorate for someone who wants to work in the healthcare industry. Despite having the necessary certifications and qualifications to open your practice or acquire your first employment at a hospital, you still need to provide proof of your credentialing to get paid for your services. You must go through the certification process for this. If you recently completed your medical education and are certified, you may wonder what the physician credentialing procedure entails.

Credentialing in the medical field is the process of confirming the submitted records that assist doctors in opening their practices. This might contain credentials for being accepted to a hospital, malpractice insurance, academic transcripts, a work history, references, and more. Credentialing process for physicians is an essential medical procedure necessary to uphold the highest levels of patient safety.

Credentialing process for physicians requires numerous stakeholders and moving pieces. All healthcare professionals, including your doctor, must demonstrate the education, training, and expertise necessary to provide patients with the best treatment possible. Healthcare oversight organizations monitor doctors’ and nurses’ work to assess complaints of poor treatment, among other things.

Both healthcare facilities that employ providers and health insurance companies who want to publish approved provider listings must continuously review all this reporting and monitoring. This article will help you learn thoroughly about the physician credentialing process, services, and how practitioners should conduct themselves appropriately.

Physician Credentialing

Physicians must be credentialed to be eligible for in-network reimbursement from insurance companies. Cash-flow catastrophes for your new provider can be caused by procrastination and careless processing. Fortunately, there are strategies to reduce credentialing problems. Here are five straightforward but effective strategies to increase your physician credentialing process a success.

  1. Start Early

Be aware that most commercial insurance contracting and credentialing will, on average, take 90 to 120 days. Don’t leave things till the last minute. Many newly established practices hiring a new provider make the mistake of starting the process one month before the desired start date. As a result, they become frustrated when they cannot receive in-network reimbursement for an additional 3–4 months while the network contract process is ongoing. Each insurance provider requires you to go through two procedures. The first is the physician credentialing procedure when they confirm your education and training before submitting your file for approval to the credentialing committee.

Based on their internal credentialing standards, approval or rejection is given. Normally, the first phase takes 90 days. The contracting procedure comes in second. The network contract is delivered to you for review and execution during the contracting procedure. You can only charge a commercial insurance company and receive in-network reimbursement once your network contract is implemented. You can only get a complete refund after your effective date because commercial plan contracts don’t offer any provisions for retroactive invoicing.

  1. Attention to Detail

Don’t put off your implementation because you submitted physician credentialing applications with inaccurate or missing information. Here are a few of the most occurring mistakes on applications for payer enrollment:

  • Incomplete work history – you must list your current practice and all former professional employment since completing medical school. All start and end dates must be in the format mm/yyyy.
  • Malpractice insurance: You must submit your most current policy and the past ten years of coverage.
  • Hospital privileges: To participate in a health plan, you must have admissions rights at a network component hospital. If not, you must have a written admitting agreement with another in-network doctor who will vouch for your commitment to admit any of your patients who need in-patient care;
  • Colleagues who fill in for you when you’re away must be disclosed. You are responsible for providing coverage for patients around-the-clock. Those who work alone should take note of this.
  • Attestations: Completely respond to all yes/no questions on each application, and when asked for more information, provide it.

Making sure your applications are accurate the first time will reduce the time your new provider must wait.

  1. Updated CAQH Profile

A crucial component of commercial insurance physician credentialing is a current CAQH profile. Make sure your CAQH profile is up to date with all your personal information, needed documents, attestations, and signature pages. Most commercial payers use CAQH to retrieve the majority of credentialing data. A complete profile will ensure the process is completed on time.

  1. New Provider

Please ensure new providers know they are accountable for completing the physician credentialing procedure for each payer in which your organization participates when hiring them. Please do not consider that asking a new provider to complete the proper physician credentialing documentation may seem inconvenient or insulting; this is their only obligation. The practice must complete the contracting and credentialing procedures with each payer before receiving payment for their professional services. The ideal scenario would be to tie the start date of a provider to the conclusion of primary payer credentialing. If a provider refuses to cooperate with credentialing, include sanctions in employment contracts.

  1. Key Payers

Knowing which payers provide 80% of your revenue can help you prioritize your physician credentialing so that those payer processes may be finished first. Until the new provider is fully certified, you can choose which patients to schedule for your new provider. It takes a long time to obtain credentials. You will cause delays in the procedure if you do not have all you need to finish it on the first submission and are fully prepared. It is excellent practice to start working with payers only after gathering all the data normally needed for the payer credentialing procedure.

Standards for Physician Credentialing

The federal Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations set the requirements for physician credentialing. Medicare and Medicaid do not pay hospitals or practices that do not adhere to the CMS’s rules and regulations. Similarly, the Joint Commission on Accreditation of Healthcare Organizations recognizes only hospitals and other healthcare facilities that adhere to set standards. Although each state has its own set of regulations, many hospital facilities adhere to the Joint Commission on Accreditation’s standards to be accepted by CMS.

Healthcare organizations also adhere to credentialing requirements issued by other bodies to increase accreditation. These groups consist of;

  • Utilization Review Accreditation Commission (URAC)
  • The National Committee for Quality Assurance (NCQA)
  • Det Norske Veritas (DNV)
  • The Accreditation Association for Ambulatory Healthcare (AAAHC)
See Also: Is There a Shortage Of Physicians And Doctors In The U.S.?

Conclusion

Physician credentialing is crucial in receiving authorization for reimbursements and payment for treating patients from various entities. Before beginning their profession, doctors must obtain their credentials. Consulting credentialing experts, such as Precision Hub, is the only way to ensure you succeed with your physician credentialing process. You can reach us by calling (888) 454-4325. Book your free demo now to see how Precision Hub can assist and navigate your healthcare personnel with the credentialing process.

How Accurate Coding Can Save Your Revenue?

accurate coding

The goal of the revenue cycle is to be paid. Now the concern is how to ensure prompt and appropriate payment. The solution may appear challenging, but it is only a matter of accurate coding.

Billing and coding for medical services are two of the most vital aspects of the revenue cycle. However, the significance of accurate billing services is only sometimes monitored, reviewed, or supported to the extent it should be. When medical coding is performed correctly, claims are error-free, payments are expedited, and the bottom line is healthy. Money can be lost if there are errors in the coding of medical invoices.

Coding accuracy is crucial when submitting a claim for services rendered to a patient’s insurance company. The profitability of medical practices is ultimately determined by the claims that patients and their insurers pay. However, medical practices may only receive payment for a few weeks or months. It is contingent upon the nature of the patient’s sickness, the diagnosis, the treatment, the selection of medical codes, and the time spent dealing with the likelihood of claim denials due to coding errors. It is essential to provide the relevant codes from the outset to receive the whole amount owing to you as quickly as possible.

Continue reading to find out why accurate coding is important and how it helps in saving revenue.

Accurate Coding

The overall cash flow of a medical practice is primarily dependent on the proficiency of its coding and billing specialists. The main objective of all healthcare workers should be to provide quality treatment to patients. However, as the number of patients increases, so does the documentation or the administrative work. A streamlined billing and accurate coding ensure that your medical practice has a constant revenue flow. By remaining current on the most recent innovations and best practices in medical billing, you can reduce the number of refused claims, thereby enhancing the overall efficiency of the process.

Benefits of Accurate Coding

Coding accuracy, essential for practice cash flow, involves comparing the number of errors with the number of codes. Official manuals and online resources for coding can help coders improve their productivity and serve as standards.

Here are a few advantages that can be attributed to the fact that billing and coding are completed accurately and promptly:

  • Decreases the Physicians’ Workload

The majority of health care and medical professionals are perpetually rushed. If they must additionally file claims, they may be overburdened with work—incorrect coding or missing required documentation results in denials, which decreases revenue. Accurate coding service by professionals ensures claim quality and precision. As a result, there will be no payment delays, and the healthcare staff will be able to focus more on the patients.

  • Prevents Medical Billing Errors

When assigning a medical code to a provider’s specific therapy, a biller must pay great attention to the specifics and search for the code that best fits the service. Even the tiniest error in assigning a code to a medical procedure can result in a payment delay or claim denial. Coding errors could be prosecuted as crimes. If you have access to efficient and accurate billing services, you will be less likely to run into a conflict.

  • Improves Patient Satisfaction

When patients visit your clinic for treatment, their primary objective is to receive the suggested therapy. However, they prefer payment methods that are simple and feasible. Most people who receive therapy are covered by insurance; therefore, they wish that their claims be paid in full without any problems. If your billing system is efficient, your patients will experience fewer problems, and your clinic will be compensated properly for its services.

  • Assists Verification Process

A competent medical billing system verifies the patient’s eligibility information in advance to prevent claims from being denied. Verification also ensures that the correct amount of money is returned. Therefore, you must have extensive knowledge of the regulations and the most recent information on how insurance payments operate. An expert biller must double-check the accuracy of the information to be efficient to ensure that when claims are submitted, there will be few denials.

  • Ensures Steady Cash Flow

For a medical practice to remain in operation, money must continue to flow in. It is only possible if a few claims are denied. A good system for coding and billing ensures that claims are accurate and complete. It ensures consistent and prompt claims payment and improves the practice’s overall health.

coding accuracy

Tips for Assuring Coding Accuracy

The following tips are useful for accurate coding and medical billing:

  1. Correct and full claims must be submitted, which entails inputting data correctly and checking claims for problems before submission.
  2. Technology must be integrated to select the appropriate codes based on the accompanying papers.
  3. EHR systems must be adjusted to the coding updates to maintain transparency and improve compliance.
  4. A coding audit must support the practice’s quality compliance activities.
  5. Documentation should be accelerated to boost coding productivity and reimbursements.

Why do you need Accurate Billing Services?

If claims are to be reimbursed on time, medical professionals must ensure that they are accurate. Even if the doctor provides the requested treatments, the claim may be denied due to insufficient documentation or improper data handling. Under-coding is an additional issue. Your coding practices could also be detrimental to the reputation of your medical practice. You may lose money and get into legal trouble if convicted of fraud. If the medical billing department is careless, the medical practice may not be able to remain open, resulting in revenue loss.

Hiring a reputable medical billing service to handle the coding and billing is the best way to ensure that the revenue cycle runs smoothly. Coding and billing tasks are unlikely to be performed in-house because they are costly and consume time that could be spent on patient care. However, medical billing companies with dedicated personnel can effectively manage these tasks with the expertise needed for accurate billing services.

Precision Hub is a reputable service that assists practices in enhancing their revenue with accurate coding and billing. Our experts at Precision Hub have helped hundreds of practices improve their revenue cycle with their expertise and knowledge.

See Also: Guide to Medical Billing and Coding Best Practices

Conclusion

Accurate coding and billing procedures are essential to the revenue cycle and should always be a top priority. It benefits the patient as well as the practice. Outsourcing to medical billing services is the most effective strategy to ensure consistent revenue. When there are patients to care for, it is impossible to keep track of administrative information and tasks, so employing individuals with sole responsibility to perform these responsibilities is a wise idea. Precision Hub is a professional medical billing company that has helped hundreds of physicians optimize their revenue cycle for years. Our team of specialized coding experts is here for your practice revenue to improve. Schedule your free demo now to learn more.

Guide to Medical Billing and Coding Best Practices

practice medical billing

Precision is crucial when it comes to medical billing and coding. Even little errors can result in a payer rejecting a claim, causing delays and lost revenues. Since coding regulations are frequently updated, healthcare experts can avoid under or over-coding or using outdated codes. Due to denials, billions of dollars are lost annually.

The practice’s medical billing can be improved with automation. Using software-driven and automated methods can aid in simplifying the already complex field of medical coding or billing. Claims processed correctly on the first attempt expedite the settlement process, resulting in faster and greater reimbursements. Providers can generate more accurate financial estimates, spend less time reworking denied claims, and inform patients more precisely of their out-of-pocket costs.

This post intends to offer guidelines for best practices for medical billing. Let’s explore important aspects of medical billing for private practice.

Coding and billing are essential components of the revenue cycle in the healthcare industry because they ensure that patients and payers pay for the services providers render. Depending on the intricacy of the services, how organizations handle claim denial management, and how a patient’s financial obligations are collected, medical billing and coding can take anywhere from a few days to many months.

Comprehending the fundamentals of medical billing and coding assists doctors and other personnel run a seamless revenue cycle. It also helps in getting compensated for the excellent treatment they provide.

Stress, rage, and other negative emotions can result from billing issues affecting patients and doctors. When a provider fails to provide the correct demographic information about a patient or verify that the patient is eligible for the treatment, expensive denied claims may occur. Errors can cause delays and additional labor when claims must be resubmitted. So, adhering to the best practices for medical billing is crucial to limit the likelihood of making errors.

Let’s examine some of the most effective approaches for your practice’s medical billing process.

Best Practices for Medical Billing

The following are the important areas to focus on for improving your practice’s medical billing process.

practice medical billing

Make Patient-Friendly Medical Billing statements

Patients are likely to find the medical billing procedure difficult to comprehend. Since industry expectations have shifted in a way that makes it essential for doctors to take a patient-centric approach to this process, you must remain accessible and make your statements patient-friendly.

Maintain a 95% Clean Claim Rate

Your clean claim rate is the proportion of your medical practice’s claims that are approved and paid on the first try. When the percentage of clean claims increases, practice will spend less time determining why claims were denied, organizing payments, and resubmitting claims.

Analyze your Payer Reimbursements

Numerous medical practices rely excessively on payers to pay the entire amount on each claim they submit. Unfortunately, this is only sometimes true. Contrary to what you may believe, underpayments occur frequently. If you invest time and money into determining whether your payments are accurate, you will minimize revenue loss and learn a great deal about how your practice handles revenue.

Ensure Accurate Claim Submission

If you double-check your claim before submitting it for the first time, you will save time editing and resubmitting it. It is estimated that up to 80% of medical invoices contain errors, which take a few weeks to resolve and resubmit and result in unpaid medical providers. You may improve the efficiency of your practice’s medical billing process by ensuring that claims are accurately filled out and eliminating typical errors, such as providing the incorrect patient or insurance information and submitting duplicate claims.

Maintain Medical Billing Regulations

It is essential to have a thorough awareness of the current standards governing the process to ensure that medical billing and coding procedures are of the greatest quality. Keeping up with the ever-changing standards enables the creation of a streamlined approach that reduces the likelihood of rejections and medical billing changes. If you remain current on medical billing regulations, your ability to generate revenue from your medical practice may improve.

Look for Improvement

Your healthcare practice will continue to expand if you discover new ways to improve your skills. Finding ways to enhance the medical billing process continuously is one strategy to maximize revenue. It is crucial because the healthcare industry is constantly evolving. It’s important to remain current on the latest medical billing laws, but it’s equally important to analyze past performance to identify areas of inefficiency and devise solutions. Using key performance indicators (KPIs) to monitor performance can help determine how precise and effective past performances were and where they could have been improved.

Medical Billing for Private Practice

Accuracy is required to ensure that medical claims are completed, sent, and paid within the allotted time frame. Having best practices improves accuracy, which in most cases results in shorter collection times and a higher claim approval rate. It is crucial to plan to investigate your current billing practices to determine if there are ways to enhance the relevant KPIs. Identify improvements that reduce billing times, increase cash flow, and make it simpler for insurance companies to approve claims.

See Also: Advance Radiology Medical Billing Guide

Conclusion

Your medical practice cannot provide quality patient care if it cannot generate sufficient revenue. Suppose you have an efficient medical billing system in place. In that case, your medical practice will remain financially stable, allowing you to focus on your primary objective, improving your patient’s health. As technology and payer expectations evolve, the practice’s medical billing processes must also evolve. If your medical practice fosters a culture of adaptability and continuous improvement, it will be able to adapt to the changes in the healthcare system.

If you are running behind on billing or can’t keep up with the current rules, consider outsourcing your billing. Medical billing companies are an excellent resource for practices that want to ensure claims are submitted in the correct format, as they are aware of the most recent billing regulations.

Precision Hub’s services help you reduce overall expenses and increase profits. The expertise of our team assists you in overcoming the obstacles associated with establishing a successful private practice. Our comprehensive and expert services enhance your practice’s medical billing process and efficiency—our service of medical billing for private practice aids in resolving the most significant billing-related issues.

Everything you need to know about ICN Number

icn number

Medical billing is a complex procedure, including numerous steps, numbers, and codes. The entire procedure is crucial to the efficient operation of medical practices since it influences the amount of money earned and repaid. Therefore, the information on the medical claim form must be comprehensive, accurate, and complete. A medical claim form contains all of the pertinent information for the insurance company on the treatment rendered. The insurance company might deny or cancel the claim if the required information is missing or incorrect. If this occurs, you must either cancel or modify the claim. Each claim sent to Medicare is assigned a tracking number known as an internal control number (ICN). You must be wondering: what is an ICN number? Continue reading this article, as it intends to discuss the ICN number in great detail. From ICN number definition to the various aspects related to this claim identifier are presented in this post.

What is an ICN Number

What is an ICN number? ICN number is a claim identifier comprising 18 digits used to track claims. The ICN identifies the claim. Depending on the system’s configuration, you can manually enter ICNs throughout the claim entry process. ICNs are visible when investigating a claim because they are shown in a banner at the top of the screen.

ICN Number Definition

An Internal Control Number (ICN) is defined as a unique tracking number assigned to a submitted medical claim for medical billing. The insurance payer assigns this number to every medical claim.

icn number definition

Importance of Control Numbers

The claim identification (ICN) number is called CCN (Claim Control Number). It is a 14-digit number provided to each Medicare claim for processing. The first five digits of the Medicare claim number show the date Medicare received the claim. The organization uses the Julian calendar. The Julian date will consist of the first two digits of the year, followed by the days of the year). The sixth digit specifies whether the claim was submitted manually (on paper) or electronically. The final number of a claim indicates whether it is a new or existing claim with modifications. The claim has been amended if the final number is more than one.

Breakdown of ICN Number

Below, we explain the significance of each digit (from 1 to 13) in the 17-digit ICN number.

  • The first two digits indicate how the claim was submitted (electronically or manually)
  • The third and fourth digits in the ICN indicate the year the claim was initially submitted.
  • The fifth, sixth and seventh digits indicate the year in which the claim was submitted.
  • The Medicare contractor provided the numbers 8 through 13 in an unprecedented manner.
  • The digits from eighth to thirteenth are the ones (a unique set of numbers) that the Medicare contractor provided

Considering the example of the following claim number: 1119100351480.

  • The third and fourth digits are 1 and 9, respectively. This indicates that the claim was received in the year 2019.
  • The fifth, sixth and seventh digits are 100, representing that the claim was received on the 100th day.

Medicare received the claim on April 10, 2019, as identified from the above ICN number.

It is essential to pay specific attention to the claims and the American National Standards Institute regulations (ANSI). The claim comments are placed at the end of the first line in the “MOA” field. The meaning of each code is specified at the bottom of the remittance. The ANSI codes are listed directly below the group code at the bottom of each line item (CO, PR, or OA). At the bottom of the remittance advice is a series of explanations. Both the ANSI code and the Group code are referred on this series. The codes will explain why a claim was paid or denied and any other relevant claim information.

ICN number is extremely important in medical billing. Before a claim deemed invalid, modified, or replaced can be sent again, it must have an ICN number. Insurance payers will utilize the ICN number associated with the claim to identify it uniquely.

The number is on the payer’s explanation of benefits so that claims can be monitored. If a claim was modified and resubmitted, and the payer requires the ICN from the posted explanation of benefits, you may be required to file the claim as a Replacement for a Prior Claim. Alternatively, if the claim is invalid, you may be required to resubmit it as a Void/Cancel Prior Claim. You must consult with your payer to determine what is required.

See Also: CPT Code 99465 – Delivery/birthing Room Resuscitation

Conclusion

In medical billing, ICN stands for Internal Control Number. Every submitted medical claim receives this unique tracking number from the insurance payer. A veteran’s ICN is a 17-digit number that is both unique and distinct. The claim is invalid if it lacks an ICN number. Outsourcing medical billing is one of the greatest ways to ensure that the billing process is done without errors. The major benefits of outsourcing medical billing include a lower error rate, lower expenses (compared to in-house medical billing), increased revenues and reimbursements, and a greater emphasis on providing patients with safe, high-quality care.

Precision Hub is one of the leading medical billing companies that work with you to optimize billing and coding procedures. We strive to make healthcare more efficient, transparent, and effective for everyone by delivering organized workflows and tech-enabled solutions that result in improved claim acceptance, more growth, and quicker reimbursements. Book your free demo with us today and find out how we can assist you in enhancing your practice’s revenue.

Why Are Patient Statements Necessary for Improving RCM Practice?

patient statement services

Due to the current healthcare system, hospitals spend a lot of time and money on patient statements. To achieve this objective, most healthcare organizations hire full-time employees whose sole responsibility is to process patient statements. Sending medical invoices to patients, supervising their printing, and handling other logistics comprises patient statement services. On the other hand, some individuals opt to have other technology companies execute the procedure by offering patient statement services to increase its success and efficiency.

After receiving the patient’s statement, the physician must overcome hurdles to persuade the patient to go to the next level. In the next sections, we will discuss why patient statement services are important for practices. So, continue reading to get a deeper understanding of billing statement service.

Patient Statement Services for RCM Practice

A patient statement is a medical bill delivered to the patient via standard mail or the Internet. If you provide medical services, you spend a significant amount on mailing patient statements. You may even employ administrative staff whose primary responsibility is medical billing.

Patient statement services can improve how the patient statement is presented and help the patient comprehend what they must do to pay their bills so that office costs can be effectively handled.

The cost of the patient statement paper can accumulate. For instance, it would be incredibly costly for your organization if you want to remember a patient and send them a paper invoice, and you have 63 patients. In addition, if medical practices wish to save money, they must migrate to electronic statements. To ensure that providers receive as much payment as possible, they must improve how they provide patient statements.

Since there are so many health insurance plans with large deductibles, patients are even less likely to pay their portion of the payment. Therefore, service providers must enhance how they educate patients on their duties. One way they can accomplish this is by maintaining current patient statements with the assistance of billing statement services. If physicians can improve the quality of patient statements, they will see more patients pay their bills on time, which benefits the practice’s CM.

Importance of Patient Statements

Patient-friendly billing methods must be used to enhance RCM in medical offices. Suppose doctors create billing statements that are simpler, shorter, more accurate, and easier for consumers to comprehend. In that case, their reputation will likely improve, and they will receive more referrals and positive evaluations.

Healthcare organizations are compensated depending on what patients pay, which is the most crucial reason for patient statements’ importance. After the appointment, the front desk relays pertinent information to the health insurance provider. The insurance company will evaluate each treatment and therapy to determine which charges are covered. Moreover, patient statements are also necessary for patients to comprehend payment procedures.

Finding patient balances, running custom reports, maintaining records, and creating and mailing patient statements can be time-consuming and unpleasant for the medical provider and office personnel. Patient statement services make this procedure simpler and more effective by removing inherent difficulties.

Patient statement services reduce administrative costs and increase the revenue from patients. Billing statement services involve generating easily-understood patient statements and mailing them to patients while maintaining correct records to comply with requirements.

Tips to Improve Patient Statements

Tips to Improve Patient Statements

Improve your practice RCM by advancing patient statements through these tips:

  • Make it accessible

Ensure that your organization’s name and logo are prominently displayed on the patient statement enclosed in the envelope. This will prevent your patients from discarding the statement inadvertently. You might use colorful writing to attract the patient’s attention and make it easier for them to recognize instantly that this is a medical bill.

Most bill payments are made online, and the accompanying statements are accessible online. It is reasonable that medical providers offer written patient statements, but they must also provide alternative access ways. Patients with digital information access are more involved in their healthcare. This will pay for their medical expenditures.

  • Create a safe method of paying with a credit card

Frequently, a patient’s daily payments are made online, and most invoices are paid using a credit card or debit card. Traditionally, credit card coupons for patients were included at the bottom of printed patient bills. However, this exposes the consumer’s banking information to fraud. When individuals often used credit card coupons, their information was more likely to be stolen while it was being delivered. Although providers must still be prepared to offer a quick and easy alternative, patients can continue to pay with credit cards. This can be achieved by allowing patients to purchase via your patient portal. Patients can use their credit cards to make secure online payments if a doctor employs the right technologies. This increases the frequency with which you receive on-time payments. On your patient statement, you should see all of your payment options.

  • Make sure to clear away clutter

Your patient refuses to pay despite receiving a paper copy of their bill in the mail because they need help understanding it. People not accustomed to receiving medical bills may find it difficult to interpret the information. Bringing the patient’s financial obligations to their attention will help to resolve the issue. Providers should emphasize the patient’s financial responsibility. If there is clarity regarding who is responsible for paying the bill, it will be easier to collect payment from patients.

  • Keep in mind the importance of specifics or details

Providing patients with as many opportunities as possible to comprehend the items on their medical bills is the most effective way to reduce the number of difficult patient collections. Patients are more likely to make payments on time if their patient statement is unambiguous and they know the exact amount they must pay. Inform your patients about payment plans, alternate payment methods, and late payment penalties. When your patient has difficulty paying their medical bills due to unanticipated medical expenses, informing them about their bill will offer them peace of mind.

See Also: Best Practices When Outsourcing Revenue Cycle Management

Conclusion

There are numerous reasons why patient statement services are essential. Nonetheless, they constitute an indispensable component of practice RCM. Practices can benefit greatly from the assistance of billing statement services in collecting more money from patients and managing the revenue cycle.

Patient statement services assist physicians in determining how to manage their finances. Physicians must adhere to industry best practices to collect patient balances without confusing patients.

In case you are struggling with the billing process, Precision Hub is here to help you out. Our team of experts makes the entire billing procedure simple and efficient. Let us handle billing and statements so you can focus on your specialty, providing quality treatment. To know more about our valuable services, book your demo.

Denial Management Services for Emergency Medicine Physicians

denials management services

Denials of medical billing are a common and frustrating problem that many practices and organizations face. Medical billing denials are annoying for emergency medicine physicians and significantly impact an emergency center’s efficiency and profitability. Although many efforts have been made concerning denials management services, medical billing denials remain a widespread issue.

The present post intends to discuss important aspects of denial management services for emergency medicine physicians. Let’s investigate the complex realm of medical billing denials to determine why they occur and what are effective denial management solutions.

Denials Management Services

Emergency room billing is a major issue for physicians. It entails submitting insurance claims for various medical procedures performed by a doctor. Any error in medical bills or insurance claims, regardless of how minor, may result in claim denials, which can be detrimental to the practice’s capacity to generate revenue. Thus, a professional medical billing firm must handle emergency room billing to prevent the complications associated with emergency billing services. Denial management services are necessary in this regard.

Denial Management determines where the claim is incorrect or has issues. You should resubmit the claim as soon as you determine what went wrong and have taken the necessary corrective action. The number of denied or rejected claims will decrease with the proper denial management services. It is a systematic approach that seeks to identify and resolve the causes of denied medical claims. It reduces the likelihood that future claims will be denied and increases the likelihood that practices are paid on time and have a healthy cash flow.

Why do Emergency Medicine Physicians Need Denial Management Services?

Physicians are under great pressure when many patients are in the emergency room. They are frequently understaffed but are expected to diagnose patients swiftly and thoroughly. The regulations for recording information in an emergency department are significantly more stringent than in other medical fields.

Emergency department treatment can exacerbate the problem because it typically involves multiple types of medical care, including primary care, surgery, pain management, diagnostics and laboratories, and much more. In such a high-stress environment, it is absurd to expect doctors and personnel to complete paperwork flawlessly. They should seek professional assistance or denial management services.

Precision Hub can assist physicians on the back end while attempting to correct billing errors, preventing future errors on the front end. Our team of multitalented individuals works diligently and effectively so that the staff in the emergency room may focus on the patients.

Denial Management Solution

Denial Management Solution

Emergency physicians should be able to provide high-quality care in the emergency room at a reasonable cost, and payers should be required to pay highly trained emergency physicians. However, this is only the case in some circumstances.

Some denial management solutions in this regard include the following:

Identifying the Issue

It is important to identify why a provider denied a claim to avoid similar situations in the future. Some employees need to know how the claims denial procedure works or how complicated it can be. Therefore, it is the organization’s responsibility to inform patients about the procedure that will be used to process their claims.

Leveraging the Technology

It is difficult to keep track of every denied claim without a well-organized system, which creates a backlog that causes great difficulty. Utilizing technology to manage denied claims is the most effective course of action and is integral to denials management services. Technology is becoming increasingly vital for hospitals to monitor their claims. It facilitates processing older claims and ensures that new claims are properly tracked.

Conducting Meetings

To be more explicit, practices should modify their intake systems, so uninsured patients’ claims are not processed. A key step is developing an intervention strategy that allows staff to discuss payment options with individuals who lack adequate health insurance. It may only be practicable once coverage is established and may even be against best practices. However, it should begin as soon as the patient is stable.

During a brief post-care meeting, the patient is informed that their insurance has expired. You could discuss a payment plan if there are no alternative options for acquiring insurance.

If the patient has the correct insurance policy on file, the practice may be required to balance-bill them if there is no means to meet with them after they have received care or if the opportunity to meet has gone. It is something that many businesses would prefer not to undertake. Nonetheless, it should attract the patient’s attention and, if feasible, encourage them to review their current insurance if they have one.

Creating Systems

Ultimately, the two most important things that must be done to reduce emergency room denials are to create systems that immediately flag expired coverage and establish a procedure to locate available insurance. For this strategy to be successful, the individuals responsible for intake must be highly educated and highly motivated. With their advanced systems, denial management services help run a smooth revenue cycle.

Appealing Denials

When a claim is denied, it is crucial to determine why it was denied. Healthcare providers can recover the money they may have previously lost through appeals. When appealing denied claims, the healthcare professional must understand how the patient’s coverage-benefit plan and payer contracts operate.

All pertinent information must be submitted on time, so physicians do not have to submit additional paperwork. Your letter to the insurance company should be concise and detailed enough to expedite the appeals process. Additionally, the letter should include the supporting documents.

See Also: What should you know about Denial Code CO 50?

Conclusion

Denial management is determining the most effective strategies to reduce the number of denied claims and increase the proportion of claims paid on time. Streamlining the denial management process is a top priority for revenue cycle specialists because it increases revenue and improves patient satisfaction. Denial management services are of utmost significance to improve revenue. Outsourcing your denial management helps you in saving your revenue. Moreover, outsourcing lets you focus on other crucial aspects of patient care.

Precision Hub has been providing thousands of clients with expert denials management services. We have an experienced team of insurance specialists and project managers who can meet your needs. By adhering to the best practices for handling emergency denials, we guarantee that the reimbursement process runs as smoothly as possible. We protect the confidentiality of your information. We guarantee that your project will be completed on time and reasonably priced. Book a demo now with us if you require assistance with denial management.

CPT Code 99465 – Delivery/birthing Room Resuscitation

cpt code 99465

CPT code 99465 is used for billing the procedure performed on newborns in the delivery room. The American Medical Association (AMA) maintained two codes for billing delivery-related procedures for newborns. These newborn CPT codes include 99464 and 99465 under the “Delivery/Birthing Room Attendance and Resuscitation Services category.”

The medical coding method uses multiple codes to determine the newborn’s health status soon after birth. These codes depend on various factors, such as the baby’s health, the location where the service was performed, etc. It is essential to stay current and adhere to neonatal coding guidelines to ensure accurate medical billing and coding.

Today’s post is all about CPT code 99465. Various aspects related to the newborn CPT codes, including 99464 and 99465, are highlighted in this post. So, read on to familiarize yourself with these codes performed in the delivery or birthing room.

CPT Code 99465

The CPT code 99465 is billed to get the payment if the other physician was present during delivery and performed resuscitation. Billing CPT code 99465 requires proper documentation to demonstrate whether or not the infant was in distress.

CPT 99465 Description

The code description for CPT 99465 is Delivery/birthing room resuscitation, provision of positive pressure ventilation, and chest compressions in the presence of acute inadequate ventilation and cardiac output.

Resuscitation of the newborn is the procedure of providing:

  • Ventilation or breathing
  • Chest compression

The services rendered as part of the Attendance at delivery (CPT 99464) code include the following:

  • Obtaining fetal and maternal histories
  • Examining labor records and mother’s charts
  • Providing the care needed for the newborn’s health

Attendance at delivery does not consist of endotracheal intubation (31500). In case newborn resuscitation is performed, then 99464 is not billed. Instead, the CPT code 99465 is billed for the procedure of newborn resuscitation.

Newborn CPT Codes

Newborn CPT Codes

In the Current Procedural Terminology (CPT) system, being present at the birth of a baby and being present at the birth of a baby requiring resuscitation each has unique codes.

CPT 99464 represents being present for the birth (where requested by the delivering physician) and ensuring the newborn’s immediate stability.

CPT 99465 represents resuscitation in the delivery room, involving chest compressions or ventilation in the case of acute inadequate ventilation or cardiac output.

Both codes are similar; however, CPT 99464 cannot be billed alongside 99465. The primary distinction between these two newborn CPT codes is whether resuscitation was attempted.

The primary distinction between the two codes is whether the patient has been stabilized or revived. Attendance at delivery (99464) includes the use of blow-by oxygen or continuous positive airway pressure (CPAP) if positive-pressure ventilation (PPV) is unavailable.

One of the most notable differences between CPAP and PPV is the timing of therapy administration.

PPV should be utilized if the infant’s heart rate is below 100 beats per minute and is fighting to breathe or has apnea. It involves using a mask, an inflating bag, or a resuscitator with a T-piece to provide air to the newborn. This procedure allows the lungs to exchange more air with the outside air.

Newborns with a heart rate of more than 100 beats per minute, difficulty breathing, or cyanosis can be treated with supplemental oxygen and CPAP. CPAP therapy should be utilized if any of the following conditions exist:

  • Respiratory distress syndrome
  • Atelectasis
  • Respiratory acidosis
  • Apnea of prematurity

Even if the other physician arrives a few seconds or minutes later than anticipated, the CPT code 99464 should not be utilized, per AAPC regulations. In this instance, a code for critical or neonatal care that is more accurate or specific must be utilized. For CPT code 99464 to be applicable, the accompanying physician must be in the operating room at the delivery time. The CPT code 99464 should only be billed if the physician who delivered the infant specifically requested a pediatrician. This is one of the most crucial things to know. In addition, the paperwork must indicate that the OB requested the page so that the pediatrician may be present in the surgery room.

For the use of an AAD, there must be a medical need that is backed by evidence. If the practice or provider requires pediatricians to be in the operating room during deliveries or C-sections, their presence is not a medical requirement. The infant must be distressed and stabilized immediately after birth to qualify for CPT 99464.

The following are included in the stabilization of the newborn:

  • Stimulation
  • Initial drying
  • Apgar (Appearance, Pulse, Grimace, Activity, and Respiration)
  • Suctioning
  • Visual inspection
  • Blow up
  • CPAP
  • Discussion with OB and parents

Billing CPT Code 99465

Billing CPT Code 99465

CPT 99465 is for resuscitation, and for billing this code, either one of the below two procedures must be performed:

  • Positive pressure ventilation (PPV)
  • Cardiopulmonary Resuscitation (CPR)

Resuscitation is the act of combining the following:

  • CPR
  • Mask and bag usage
  • Ventilation and intubation

For billing of CPT code 99465, the newborn must be in distress, which must be evidenced through documentation. Any of the following is used for the documentation purpose depending on the medical condition of the newborn:

  • Acute inadequate cardiac output or ventilation
  • Acute respiratory failure or distress
  • Any other cardiopulmonary distress

The CPT code 99465 may only be billed to get the payment if the other physician was present during delivery and performed resuscitation. Effective billing of this CPT code requires proper documentation to demonstrate whether or not the newborn was in distress. It is important to remember that resuscitation and AAD (attendance at delivery) are different services that cannot be billed on the same day.

See Also: All You Want to Know About custom CPT codes for Orthotics.

Conclusion

The Current Procedural Terminology (CPT) system has various codes for newborns, including 99464 and 99465. CPT 99464 requires attending the birth when requested by the doctor in charge of the delivery and guaranteeing the baby’s immediate stability. CPT code 99465 is for resuscitation. In the labor room, resuscitation comprises chest compressions or ventilation in the event of a sudden loss of breathing or heart activity. Despite their similarity, you cannot simultaneously bill for CPT codes 99464 and 99465. The primary difference between these two neonatal CPT codes is whether or not resuscitation was attempted. So, these two codes cannot be billed on the same day.

Do not let coding or billing affect your practice’s revenue. Rely on the professionals at Precision Hub to provide you with billing services that are precise and efficient. Schedule your free demo today to learn more.