A smooth-functioning hospital or healthcare center requires a proper medical billing process. In short, medical billing is a vital process. Medical physicians spend years of hard work, learning, and developing skills that contribute to building a successful healthcare practice. But still, it doesn’t get easier, medical healthcare practices face financial problems and have to keep up with the physician revenue cycle management (RCM) as well. But you can tackle your medical billing problems by outsourcing your medical billing services to a reputed organization. With our professional experience and expertise in this industry, we assure you billing in 24 hours and timely follow-ups. UControl Billing provides you with a competitive and affordable price with an improved revenue cycle and increased reimbursement rate.
What is Physician Billing?
Providing safe and quality healthcare, managing revenue cycles, increasing productivity and cash flows, all of this is no easy task. Physician billing in particular deals with the billing of healthcare procedures provided by the medical physicians and suppliers (for both inpatient and outpatient). With all the medical procedures handled by you, leave the physician billing to us! But outsourcing the physician billing services is one of the most important decisions to be made. There are various factors to be considered when making this decision.
why does the patient receive two separate bills (physician bill and the hospital bill)? Before starting the medical billing process, understanding the difference between physician billing and hospital billing is very important. First and foremost, differentiate, whether the claim falls under physician billing or hospital billing. Physician billing is also known as Professional Billing. Whereas hospital billing is also known as Institutional Billing. This medical billing depends on the place of service. The physician’s side of the bill is for the professional services provided by them. The hospital bill is for the technical or any other services provided. Below is the difference between physician billing from hospital billing.
- Physician Billing or Professional Billing:
A physician or professional billing is based on creating the medical claims for the services specifically performed by medical physicians. These physicians can be any of the following:
– ER Physicians
– Pathologists or radiologists
– Surgeons or Anesthesiologists
– Primary or special care medical physicians
These physicians can charge their professional fees, separately from the payment charged for the services provided by the hospital. Both in-patient and out-patient services can be billed under professional billing.
UControl Billing offers all types of revenue cycle management, medical coding, and medical billing services.
- Hospital Billing or Institutional Billing:
This type of billing is based on creating medical claims for the services provided by the hospital, nursing facilities including medical institutions providing any in-patient and out-patient services. These institutions include charges of medical devices, equipment, services like radiology or lab testing.
What is the Place of Service in Medical Billing?
A place of service is the location where the medical services or procedures were performed. Each location has a POS code so that the location where services were rendered can be identified in physician billing. Note that, the place of service never changes for physician billing. A POS (place of service) code is a two-digit code. For instance, according to the Centers of Medicare and Medicaid Services (CMS):
– Place of service (POS) code for Emergency Room – 23
– Place of service (POS) code for a Nursing Facility – 32
– For an Ambulance (land) – 41
– For an Ambulance (air or water) – 42
Choosing the right code when filing a medical claim is important in order to reduce the risk of denials.
Physician Billing Services for Hospitals:
Providing safe healthcare to the patients is the first responsibility of a hospital. But in order to keep the hospital inflow, managing the revenue cycle and the medical billing side of the business is also a crucial part. Functions of physician billing services for the hospitals involve:
– Filling the insurance claim
– Figuring out the co-pays (patient responsibility and the insurance carrier’s part)
– Collection of the payments
– Lastly, make sure that the insurance claims have been paid.
These billing services can be handled in-house (by hiring a medical biller specialist or a team of those) or outsourcing the medical billing services. This decision solely depends on how you want to manage your claims.
Physician Medical Billing Services:
Medical billing is slightly different for physicians belonging to various medical fields. For instance, An ER (emergency room) physician has to take care of the patient first and worry about the cash flow after. Making Emergency Physician Billing the most challenging medical billing. Another example would be medical billing for hospice patients and laboratory services.
Physician Billing for Hospice Patients:
The most important thing to understand regarding medical billing for hospice patients is what Hospice is? Hospice is a patient-based benefit that falls under Medicare. Note that, if a patient is referred to hospice, they choose to stop the treatment being done for the terminal diagnosis. The attending physician and the medical director have to authenticate and certify the medical prognosis of the patient. Which is that their life expectancy is about six months or even less than that (if the disease keeps on going at its usual course).
After the patient chooses hospice, CMS (Centers of Medicare and Medicaid) directly pays the healthcare provided by the physician (hospice provider) related to that terminal diagnosis.
Emergency Room Physician Billing:
Emergency rooms are often visited by patients for various health conditions during an emergency. This is why the healthcare physicians there are under pressure for diagnosing a number of different symptoms and patients. Emergency room billing services need special and extra care. It is called emergency room for a reason, with a high volume of patients, healthcare physicians don’t find time to convey the patient’s responsibility (financial) before or during the treatment. Now, these patients might be just one-time visitors, getting paid by them is a challenging part of emergency physician billing. With medical billing and coding challenges, eventually, your cash flow gets affected.
In outsourced medical billing services, professional and experienced vendors integrate with your hospital system and hence enhance the billing services. This is why outsourcing can be considered a better option. But why would you want to outsource? These professional vendors, like UControl Billing, have been in the industry of medical billing services. We know how to handle situations like that, get the work done, and ultimately improve the revenue cycle and increase the reimbursement rate.
Why is Medical Billing so Important?
Medical billing involves the process which ensures that the healthcare providers are compensated for the medical and professional services they provide. Now in order to get reimbursements, filing and submitting a clean medical claim is the key, or else they get rejected and result in lost payments. The revenue cycle is the key to keeping the hospital or healthcare facility running. Monitoring or dealing with medical billing as well as patient care can be very hectic for the healthcare providers which is why the cost-effective way for them is to outsource the medical billing services to a third-party medical billing company.
Benefits of Outsourcing Emergency Room physician billing services:
- Decreased errors
With a professional and well-reputed medical billing company like UControl Billing handling all your medical claims, you wouldn’t have to worry about errors. We ensure eliminating errors from your claims, streamline your workflow and maximize your reimbursement rate.
Healthcare physicians in an ER have more pressing concerns than medical claims, which is why the medical billing and cash flow suffer. With an outsourced billing services vendor, you get a team working full time, ensuring high reimbursement rates.
- Lesser Administrative Cost
Hiring an in-house source for medical billing and coding can be costly and timely. But with outsourced physician billing services to a well-reputed vendor like UControl Billing you get competitive pricing. Moreover, with an in-house source, you are stuck with a fixed cost. But with UControl Billing, you can change that. With us, your medical billing services costs are based on your monthly receipts, meaning we only get paid when you do.
- Increased reimbursement rate
With lesser errors come fewer medical claim denials, therefore higher reimbursement rate. With UControl Billing, you get increased reimbursements and proper claim tracking.
- Increased and improved revenue cycle
You get paid faster! Due to lesser claim denials and faster processing, increase your account receivables with UControl Billing.
- A number of services
UControl Billing team is highly specialized in handling all services related to medical billing, medical coding, revenue cycle management, physician billing services, front desk management, and telemedicine billing.
Physician Billing Guidelines for Laboratory Services:
Like every other billing, laboratory billing is also based on specific codes. If used wrong can result in claim denials, lost payments, and low reimbursement rates. Following are some of the documentation requirements for laboratory billing.
- All the diagnostic tests (x-rays, lab testing, and others) must be ordered by the physician currently treating the patient.
- The lab tests ordered by the physician must support and help in managing the medical condition of the patient.
- The physician must provide consultation to the patient. Note that if the tests are not ordered by the medical physician, they are considered unnecessary.
- All the tests ordered must be clearly indicated by the physician along with a signed order and an authentic patient’s medical record justifying the reason behind those tests.
- In order to avoid denials, the physician must use the right codes and modifiers.
Benefits of Improved Revenue Cycle Management (RCM):
What is a revenue cycle? It all begins with a patient appointment or consultation to the collection of payment for the services provided by the healthcare physician.
Sounds simple right? It’s not! If the revenue cycle is not managed correctly, it can result in payment delays, lesser reimbursement hence your cash flow suffers. In order to stay afloat, the medical claims should be error-free, no data duplication and the patient information should be complete and correct so that you don’t lose your revenue.
UControl Billing has everything under control! Our team of medical billers and specialists is dedicated to enhancing your efficiency and streamlining your workflows. All of this so you can provide the patients with better healthcare and not have to worry about the revenue cycle.
Following are some of the benefits of an improved revenue cycle:
- Enhanced patient experience.
With an improved revenue cycle, the administrative burden and costs on the healthcare physicians can be reduced. By outsourcing your revenue cycle management (RCM), the physicians can focus on providing the patients with better and safe medical care. An efficient and effective RCM focuses on reducing the errors from medical claims being submitted. UControl Billing provides you with an improved revenue cycle and HIPAA compliance.
- Lesser errors, fewer claim denials
Medical billing is a crucial part of any physician or hospital. This is why the medical claims should be scrubbed of errors. This is where an RCM vendor comes in! UControl Billing is a medical billing company that focuses on eliminating any errors from your medical claims, hence lesser denials.
- Fewer denials come from increased reimbursements
The faster your medical claims get submitted and approved, the faster you get paid for your services. An improved revenue cycle comes with an optimized payment collection process and a higher reimbursement rate.
- Simplified and streamlined workflow
The automated and electronic system helps streamline the workflow. It increases communication between the parties involved, fastens the process of claim submission hence timely payments. With increased revenue and a high reimbursement rate, physicians can focus more on providing better and safe healthcare to the patients in need.
Why choose UControl Billing?
UControl Billing offers a variety of medical billing services including:
– Medical billing services
– Medical Coding Services
– Revenue Cycle Management
– Telemedicine Billing
– Front Desk Management
And many more.
Following are some of the benefits of choosing UControl Billing:
– Improved revenues
– Increased reimbursements
– Streamlined workflows
– Timely follow-ups
– Billing in 24 hours
– Complete revenue cycle management
– HIPAA Compliance
UControl Billing offers you competitive and cost-effective pricing. You won’t have to stick with fixed administrative costs, instead of with UControl Billing your expenses will be based on your monthly revenues. Not only this, in case if your production drops, so does your cost of billing.