Before we dive into what urology medical billing is, what challenges are faced by medical billers. Let’s see what urology itself even is. Urology is basically a discipline of medicine dealing with urinary tract or system-related diseases among males and females as well as the reproductive system in males.
It includes the kidney, Urethra, ureters, and Bladder. Urologic health is very important as several related health problems can happen to anyone. Urology also deals with the male reproductive parts, including the penis, testes, prostate or scrotum, etc. Urologists come across several clinical problems and can be divided into seven categories;
- Pediatric Urology (Urology condition among children)
- Urologic Oncology (Cancers in Bladder, kidney, prostate, or urinary system)
- Kidney Transplant (Renal Transplant)
- Infertility in Males
- Urinary tract stones (Calculi)
- Neurourology (Problems in the nervous system causing issues in urinary system)
What Is The Urology Medical Billing Service?
Urology itself is a complex medical area dealing with a number of conditions related to the urinary system and reproductive part among males. Urology billing gets a bit more complex than the medical field itself. As we already know, medical billing is an essential yet another complex part of healthcare. It plays a vital role in the revenue cycle and reimbursement rate of a healthcare provider. As urology also involves surgeries, medical billing becomes more complex due to the required medical services. With the increase in instruments being used, medical devices, surgical procedures, anesthesia, and other related medical services that need to be billed, add to the complexity. Like every other medical discipline, urology practice also depends on the financial well-being of the healthcare provider or practice. It includes: –
- Timely claim submission
- Clean claim submission
- Getting timely payments
- Reducing errors
- Managing the denied or rejected medical claims.
Challenges faced by Urology Billing Practices:
Like medical billing for every other healthcare service, urology billing practice also faces a number of challenges. Following the urology medical billing guidelines is essential for lesser claim denials. The challenges faced by medical billers in urology billing include;
Using the right codes: –
Using the right and updated codes is essential for submitting a clean claim, getting reimbursed, and increasing the revenues.
Missing information and incomplete documentation: –
Patient name, address, birth date, insurance information, etc., must be complete. Even minor errors or incomplete information can result in claim denials or rejections.
Not being up to date with the coding updates: –
Codes for medical procedures are updated every year, and the medical billers should be up to date regarding the changes and use the right codes.
Upcoding, under coding, or Unbundling: –
Using a code for a more complex procedure than the one actually performed is called upcoding.
Under coding happens when medical billers don’t bill for all the medical procedures or services provided.
Some medical procedures have a single code to bill, but it is known as unbundling if separate codes are used.
Urology Billing Software:
In order to maintain a high clean claim rate and increase revenues, healthcare providers must have high-end billing software to automate the billing procedure. Healthcare providers need to adapt according to technological advancements if they want their healthcare practice to be profitable.
Choosing a billing software that is HIPAA compliant and user-friendly is crucial. Along with an amazing billing software for your urology billing, your practice must also have a team of highly qualified medical billers on board with expertise in that particular billing software. They should have experience handling the software so that the denied claims can be managed. Errors can be reduced and ultimately increase revenues.
Following are the benefits of choosing the right medical billing software for urology:
- Improves the day to day operations of your practice
- Improves claim tracking, patient data, and care
- Minimize the medical billing errors
- Streamlines the claim submissions
- Improves revenue and reimbursement rate
Outsourcing Medical Billing Services:
Based on the above-mentioned challenges, healthcare services tend to lean more towards outsourcing their services to a medical billing company that oversees their billing practice. These companies like UControl Billing have a team of highly qualified and certified medical billers and coders on board. These experts work passionately to reduce errors, increase your cash flows, streamline medical billing, reduce account receivables, offer flexibility in software, and are HIPAA compliant. Following are the top three benefits of outsourcing your urology billing services:
Improved Revenue cycle:
With the outsourced medical billing services, one is handing over their medical billing to the experienced and highly qualified medical billers and coders overseeing the operations and making sure that clean claims are being submitted, managing the denials, hence faster payments higher reimbursement rate.
Lesser coding errors in medical coding:
Medical billing companies are up to date with all the changes in coding procedures, codes, and urology billing guidelines. These expert medical billers ensure that codes for the exact procedure performed are being used. For instance, urethral dilation is a common medical procedure in urology. Medical coders need to make sure that the correct code is being used for the first and the subsequent dilation.
Affordable and more efficient than in-house medical billing:
You don’t have to face fixed costs or oversee operations with outsourced medical billing. Rather you can leave the medical billing to the experts and focus on your primary cause; providing safe patient care. You will see an increase in your revenues, reimbursement rate, and lower claim denial rate with this.
Importance of Urology Billing:
Almost 10% to 20% of reimbursements in urology practice are left uncollected due to a lack of billing skills, technical knowledge, and poor practices.
According to the Guide for Third-Party Reimbursement of Facility Fees by the American Association of Accreditation of Ambulatory Surgery Facilities, the reimbursement rate of urology is the least appealing.
The cost of urology medical billing services provided by medical professionals is continuously rising; therefore, the revenues must be collected. If your practice is losing revenues, you need to assess your urology medical billing and coding process. You need to figure out the problem behind low revenues, whether it is wrong coding or improper documentation. The wrongly coded medical bills can lead to claim rejections and denials. Therefore, lost or late payments lower reimbursement rates, directly impacting the revenue cycle of your healthcare practice.
Urology medical billing can make all the difference in the bottom line of your healthcare practice. One of the major reasons behind urology healthcare services shutting down practices is the medical claim denials rate.
Scrubbing the medical claims off of any errors is crucial for submitting clean claims. Denied claims lead to wastage of time on assessing and resubmitting the claim, late payments, and hence, lower revenues.
Ways to reduce claim denials:
The good thing is that there are ways to reduce claim denials in your urology medical billing. First and foremost, the healthcare provider must assess the exact reason behind claim denials depending on the denial rate. In order to reduce the denial claim rate, follow the following steps:
- Figure out your denial rate
- Find the reason behind denied claims
- Categorize the denials
- Based on this, make a decision on hiring an in-house team of medical billers or outsourcing your medical billing services to a medical billing company.
Urology Billing Cpt Codes:
Current Procedural Terminology (Cpt) codes are the alphanumeric, five-character codes assigned to various medical procedures and services. Using these codes, medical billers convert the clinical data patient’s medical records into medical claims.
Medical billing for urology services is also billed using Cpt codes. Cpt Codes from 50010 to 53899 are used for urinary system-based surgical procedures. These codes are further divided into four categories based on the organ:
- 50010 to 50593 for surgical procedures and services are done on the kidney, including incision and excision procedures, endoscopy, repair and introduction procedures, etc.
- 50600 to 50980 for surgical procedures done on the Ureter. Including repair, endoscopy, incision, or excision procedures.
- 51020 to 52700 for surgical procedures done on the Bladder. Including removal, endoscopy, Incision, repair procedures on the Bladder.
- 53000 to 53899 for surgical procedures done on the Urethra. Including Incision, excision, repair, or manipulation procedures on the Urethra.
Frequently Asked Questions (FAQs)
What is Urology Medical Billing?
Medical billing of urology is an ever-changing, complex, and complicated area. Urology medical billing deals with medical services related to the urinary system in males and females and the male reproductive system. It includes everything from diagnosis and treatment of the related disease. For this reason, outsourcing urology medical billing to a company like UControl Billing is more efficient.
What is coding and billing Urology Medical Billing?
It involves billing the insurance payers for the medical procedures and services performed by the healthcare provider. Correct codes are essential for timely payments, lesser claim denials, and a higher reimbursement rate.
What does the Urology Medical Billing specialist do?
He specifically bills for the medical procedures from diagnosis to the treatment of diseases related to the urinary system and male reproductive system. It requires highly experienced and specialized medical billers to submit clean claims as it directly impacts the revenue cycle.
What are some of the most common urology medical billing errors?
Medical billing is a complex process and with it comes a number of errors as well. One of the most common errors is using the wrong code or the incorrect modifier for billing the medical procedure performed. Medical billers must use the correct and updated codes and complete and correct documentation to avoid errors when billing for the medical procedures and 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.