By now, the importance and significance of a proper medical billing process must be quite clear. It is the backbone of a healthcare practice’s revenue cycle management. The entire payment process and revenues for services provided by the physician or provider are dependent on proper medical billing practices. Medical coding is a process comprised of translating the patient-physician encounter into alphanumeric medical codes. These codes are the common language used by healthcare facilities/providers and insurance payers for claim submissions.
However, billing and coding are two separate processes, with both being equally crucial for the reimbursements of procedures/services performed. Medical billing is commonly handled either in-house or outsourced to billing companies by healthcare providers. The billing process should be handled by professionals as they are the ones who are familiar with all the dos and don’ts of it. In simple words, proper and reliable medical billing services are what make a healthcare practice profitable.
Let’s learn why we bill healthcare services provided by physicians and who is responsible for preparing the claims.
Common responsibilities of medical billers and coders:
In the healthcare industry, people working in medical billing are the ones responsible for the proper billing process from claim preparation to submission. They are the ones who have to use the correct and specific codes for the healthcare services rendered by the physicians. The best medical billing services are essential for any healthcare practice’s proper revenues and reimbursements. A medical billing process involves three parties; patients, healthcare providers, and insurance payers.
Medical billers should be trained and with experience in various areas related to billing healthcare services. These specialists should also have knowledge of handling medical billing services for small businesses along with other kinds. Some of the most common responsibilities of a medical biller/coder include the following:
Medical billers and coders are the ones responsible for keeping up with the insurance payers’ requirements & timelines. This is why they should have access to information about the requirements and deadlines of every insurance carrier so that clean claims can be submitted in time.
HIPAA compliance is a necessity. Medical billers and coders have access to patients’ private information; this is why they must know the proper security and privacy procedures.
Medical billers and coders should be well familiar with medical billing software and which software will work best for the practice. The software can save time and improve revenues by automating the entire process. Medical billing software increases information accessibility and control over it. Not only does it automates the process, but it also allows various other tasks associated with medical billing.
Billing claims in an incorrect order can cause delays in the process, therefore, late payments. This is why medical billers and coders should be well aware to submit the claims in an accurate order.
Medical billers and coders must have an experience with billing systems so that they can reduce or eliminate medical billing errors or any other issues with the billing.
Usually, medical billers and coders don’t directly interact with the patients; however, they do work alongside various healthcare professionals.
Types of Medical Billing and coding:
In healthcare, there are two types of medical billing and coding. These types include the following:
Professional billing involves medical billing for the individual or physician’s practices. Usually, people working for a physician or individual practice are required to have knowledge about both billing and coding. Professional billing is also known as physician billing.
The responsibilities of professional billing are quite different from the institutional medical billing process.
Handling medical billing and coding for hospitals, clinics, healthcare facilities, etc., falls under institutional medical billing. This type of medical billing may also cover;
In-patient services and out-patient services like:
- Lab services
- Radiology services
- And other charges
Institutional billing is also known as hospital billing.
Types of Medical billing and coding claims:
Medical billing and coding comprise the use of various different types of insurance claims based on the type of billing (professional or hospital). Following are the types of insurance claims used by the medical biller in professional and institutional billing:
Professional billing insurance claim:
For professional billing, CMS 1500 claim form is used by the medical billers. However, CMS 1500 claim is a paper form with 837-P being the electronic version of it. In 837-P, “P” stands for professional.
Institutional billing insurance claim:
For institutional billing, the UB-04 form is used by medical billers. Similar to professional billing, 837-I is the electronic claim version of the UB-04 form. In this, the letter “I” represents the institutional billing.
Types of Medical billing and coding systems:
When it comes to medical billing, there are three different types of medical billing systems:
Closed billing system:
In medical billing, a closed billing system means that transfers aren’t allowed. This type of medical billing system focuses on a singular practice. One example of a closed medical billing system is an EMR – Electronic Medical Records for the healthcare practice. EMRs don’t allow any collaboration of records with the doctors and other healthcare facilities like urgent care, labs, etc. EMRs can only be used by the billing team or the assigned physician(s).
Open billing system:
Unlike closed billing systems, open billing systems allow transfers. These transfers can be done across healthcare physicians, professionals, healthcare practices, medical facilities, etc.
An example of an open billing system includes an EHR – Electronic Health Record. Mostly, EHRs and EMRs are mixed-up by people; however, EHRs are highly collaborative systems. Commonly used EHRs include:
- McKesson, etc.
Isolated billing system:
This is the type of medical billing system that has been completely removed from the medical practices or physicians. Isolated medical billing systems are PHRs – Personal Health Records. These medical billing systems are managed by the patients themselves and shouldn’t replace the open (EHRs) or closed (EMRs). PHRs are the kind of medical billing systems that aren’t commonly used and can’t legally replace hospital records as well.
Medical Billing Process:
The entire medical billing process comprises 10 steps with each of its own importance. These steps include:
- Patient Registration
- Confirming the financial responsibility
- Meeting with the physician (a.k.a., the encounter)
- Medical transcription
- Medical coding
- Preparing the medical claim
- Claim submission
- Monitoring adjudication
- Generating patient’s statements
- Follow-up and denial management
Common Medical billing and Coding Errors:
Medical billing is a complex process involving a number of steps, factors, and pieces of information. Documentation is the most crucial part of the medical billing process, and the use of correct code depends on it. With so many factors to be considered and so much information to work through, errors are inevitable! There are several different kinds of errors that can occur in billing a medical claim. Some of the common medical billing and coding errors include:
1. Use of incorrect code (CPT (procedure code), ICD-10 (diagnosis codes), or HCPCS Level II):
Using the correct medical code is essential for proper medical billing. Medical coding is basically a process in which billers translate patient information into specific codes.
2. Use of inappropriate modifier:
Modifiers provide additional information to the insurance payers regarding the procedures performed or medical codes used in the claim. They aren’t supposed to change the meaning of the medical code(s). Using an incorrect modifier(s) can lead to a claim being denied or rejected.
3. Overuse of a modifier:
Modifier 22 is the most incorrectly used modifier in medical billing. This modifier is for “increased procedural service,” used when a provider has to perform more work than unusual.
Unbundling is when a provider uses separate codes for an individual procedure even though a comprehensive code exists. This medical billing error is a fraudulent practice and is also considered Medicare abuse.
When a provider or biller uses a more comprehensive or expensive procedure code than the service actually performed is known as upcoding. Upcoding is also considered a fraudulent practice that results in higher revenues for the healthcare practice.
Other common medical coding errors include the following:
Using a deleted or outdated code
Not following the coding guidelines
- Not fulfilling the insurance payer’s requirements
- Late submissions
- Incomplete or inaccurate documentation
- Under coding
Outsourcing Medical Billing Services to U Control Billing:
Outsourcing billing services to third-party medical billing companies is becoming a common practice among healthcare providers. There are several benefits of outsourcing your medical billing services to a well-reputed medical billing outsourced services company.
Medical billing companies have a vast experience in the healthcare industry and are up-to-date with all the coding changes. U Control Billing offers a wide range of services for your healthcare practice, giving you the time to focus on your patients more. The aim is to help you grow financially as well as help you achieve advanced business performance.
U Control Billing doesn’t believe in “One size fits all.” We adapt based on your healthcare practice; the best part is that you don’t have to change your already existing EHRs/EMRs. Our team of highly skilled professional medical billers can work with any of your existing billing systems. And the list goes on; there are several other benefits of outsourcing your billing process to U Control Billing.
Why choose us?
U Control Billing offers:
- Maximized revenues
- Competitive Pricing
- Reduced risk of errors
- Lower expenses
- Uninterrupted service (billing in 24 hours)
- Timely follow-ups
We offer 100% privacy, discretion, and confidentiality of patients’ information.
We offer several different services for your healthcare practice:
- Revenue Cycle Management (RCM)
- Medical Billing services
- Front Office Management services
- Telemedicine Billing services
- Medical Coding services
- Medical Credentialing Services
- Medical Transcription services
By outsourcing your medical billing services to U Control Billing you get affordable or competitive pricing. Moreover, we offer two different kinds of pricing plans:
- Medical billing only
- Complete revenue cycle management (RCM)
With U Control Billing you don’t have to worry about fixed costs; your billing cost will depend on your monthly receipts. We only get paid when you get paid! If your production dips, so will your medical billing cost.
Frequently Asked Questions (FAQs)
1. What is upcoding in medical billing?
Upcoding is a common medical billing error and is also a fraudulent practice. In upcoding, the healthcare provider bills a more expensive or comprehensive code than the service actually performed. Upcoding results in higher revenues and reimbursements for the healthcare practice.
2. How do I choose a medical billing company?
When choosing a medical billing outsourced services company, consider the following factors:
- HIPAA Compliance
- Reputation in the industry
- Medical billing software awareness
3. What are the three main problems with billing in the health office?
Medical billing is a complex process involving a number of steps, factors, and information. Some of the common medical billing and coding errors include:
- Use of incorrect medical code or modifier
- Incomplete documentation
- Overuse of modifier 22
- Failing to be in compliance with NCCI edits
4. What is the biggest challenge in medical billing?
Building a proper team for medical billing is one of the biggest challenges for healthcare providers. In case medical billers on board are struggling with managing the process, ultimately, your revenues will suffer.
5. How do you optimize medical billing?
Following are some of the tips to optimize your medical billing:
- Manage the claims properly
- Reduce the medical coding errors
- Promptly manage the claim denials or rejections
- Outsource your medical billing services
A couple of years ago, I executed the effective plan of creating a Medical billing and Coding company named U Control Billing. The company aims to bring revolutionary advancements to foster medical billing and coding revenues. As an official member of HIA-LI and MGMA, I feel honored in providing networking opportunities, problem-solving, and improving the revenue management cycle.