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Patient care is one of the most important elements for a Chiropractor. Patients are what make a practice survive and gives a Chiropractor a purpose. Without patients Chiropractors would have no reason to practice. Now imagine if a Chiropractor who doesn’t take good care of his or her patient and didn’t take every step possible to ensure their safety and health. Billing services don’t just provide software that can make things easier for Chiropractors, but provide software and a service that aids Chiropractors in making their patients as comfortable and taken care of as possible. Through billing services, Chiropractors’ lives are made easier and therefore they can put all of their attention on patients. They don’t have to worry about correctly written SOAP notes, claims, audits or not being able to track patients because billing services can aid in easing all of these worries for Chiropractors.

Great patient care can also help with revenues for a practice. When a patient is taken care of and knows that they will continue to be taken care of, they will come back again and again. Revenues can only go up from there. A good relationship between a doctor and a patient can also lead to referrals which also means a rise in revenues. Patients want to feel that their Chiropractor truly cares about them and their well being. Patients don’t want to be treated as just numbers so with the software that billing services provide, they are not just a number in the system. Billing services use software to keep up with a patient in every way.

This software can account for each visit from a patient to a Chiropractor’s practice, their next appointment, if they need to schedule another appointment, procedures that have been performed on the patient, etc. Unfortunately not every Chiropractor in the business cares enough about each patient to take the time with them. Billing services gives Chiropractors the leeway to take their time with each patient and get to know them and know their face. The software alone can allow Chiropractors to put their patients at ease because a patient knows that with a billing service behind a practice, they are using updated technology that is reliable. When patients are at ease, a Chiropractor is at ease and will do his or her job even better than before.

Patient care is something that is always on a Chiropractors mind, but thorough and complete patient care can be overlooked by some. Chiropractors have heavy and hectic schedules and can not always be the kind of doctor who can take the time and effort with each patient. With the help of a billing service and their software, there is no excuse for a Chiropractor not taking good care of a patient.

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If you are in the market for a new medical billing software package you more than likely have considered an online medical billing software solution. These solutions are becoming more and more common as traditional client server application become 100% web based solutions. Before you make a commitment to a complete online billing or practice management solution you need to consider the pros and cons. You are essentially selecting a platform that the core of your practice relies on for cash flow. In this article we will go over the pros and cons of online medical billing solutions.

The Pro’s For Using Online Billing Software

No doubt you have experience with the traditional software delivery model. In this model, you need a server and local network where you connect to your server and your medical billing and practice management database. In this model, you need IT infrastructure to support the product as well as IT and computer assistance to support both the software and hardware. Many today still use this model successfully and actually prefer to have their data in their procession. Many are finding an alternative in the online solutions.

The online solutions for sure have pluses. Some of these are:

· An internal server is not required to host your medical billing or practice management database.

· Server maintenance is no longer required, saving you money on the server hardware as well as the associated maintenance contracts.

· No more software updates. Due to the fact that the solution is completely online, the online software vendor will maintain the software included in your monthly fee.

· HIPAA Secure. Most all of the online solutions maintain HIPAA Security and accreditation. This means that you can prove HIPAA compliance using their software.

· Your Data Is Offsite. This is often a plus in that your data is offsite in the event of a disaster.

· Reduced support costs. Due to the fact that your server is offsite, you may now require less time from your IT provider.

The Con’s In Using Online Billing Software

There are in facts some risks and disadvantages to consider in an online billing solution. Some of these are:

· The viability of the software vendor. You must select a vendor that is financially solvent. In the event the vendor goes out of business you need to make sure you can get your data to move into a different solution. One option is you can have the vendor put your software in escrow as part of the contract.

· Dependent on the Internet. The internet is very reliable but can lose connectivity at times. You need to take efforts to make sure your own internal internet connection is reliable for a online billing solution.

· Can you always get rid of your server? Often times your vendor will sell you the fact you can get rid of your server. While that is true if you ONLY use medical billing and practice management you may still need the server. This means that you might be actually increasing your costs in the long run.

Take your time in selecting the right product and you may find that the online option is just for you.

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Your wedding invitation is your first chance to make an impression, so you want to make sure that it is a great one! Just as there is traditional wedding invitation wording, there is also a form to follow when it comes to addressing the envelopes for the invitations. For every situation, there is a proper way to write out the address. This handy primer covers what every bride should know about how to address a wedding invitation envelope.

Even the most informal wedding is still a special occasion, and the invitations should reflect that. It does not matter if your style is to wear bridal jewelry which is a family heirloom for a grand wedding at “the club” or if your wedding is more like simple handcrafted bridal jewelry worn for a wedding in a state park. Either way, it is important to take care when addressing the wedding invitation envelopes.

The first tip is to either hire a calligrapher or to learn calligraphy on your own. The hasty scribble you use to jot down your grocery list is not elegant enough for the invitations! Calligraphy, by the way, may sound very formal and fancy, but there are also styles which are modern and unique. For an extra added detail, think about ordering custom postage stamps.

Everything on a wedding invitation should be spelled out, with the exception of “Mr.”, “Mrs.” and “Dr.”. This includes words like Street, Drive, and Avenue, as well as the city and state. Military titles should always be spelled out in full, so you would use “Captain”, not “Cpt.” and “Lieutenant”, not “Lt.”. Also write out words such as apartment, rather than using the abbreviation “apt.” or #. Since the word apartment is long, you can use it on a separate line underneath the street address, if needed.

A wedding invitation addressed to a married couple would read as follows: Mr. and Mrs. Henry Tate / 306 Talbot Circle / Stamford, Connecticut / 06907. Notice that the zip code has its own line underneath the city and state. It looks best when it is set slightly off to the right so that it lines up near the end of the state name.

A married couple with two different names should be addressed thusly: Ms. Katherine Howard and Mr. Henry Tate. The name of the woman goes first, and be sure to use her full name, even if she goes by Kay, Katie, or Kathy normally. Sometimes the time spent discovering the full names of your friends can be one of the toughest parts of addressing the invitation envelopes. If putting both names on the same line makes it very long, it is acceptable to write each name on its own line, omitting the “and”.

An unmarried couple living together will have their wedding invitation addressed this way: Miss (or Ms.) Rachel Hill / Mr. Thomas Sessions / etc… The names will each have their own line, and the proper order is alphabetical by last name. The same applies to same sex couples who live together. For couples who live separately, avoid using “and guest”, and find out the name of your guest’s significant other. He or she should receive their own invitation, either at their home, or at the home of your primary invitee.

With this information in hand, you should be ready to address your wedding invitations in a manner that is timeless and elegant. When your guests receive them in the mail, they will make an excellent first impression, and get them excited about your wedding!

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We get a lot of questions regarding the correct use of modifiers. Well, actually the questions are usually more on the lines of “One of my services was denied, what modifier can I use to get the service paid?”

The first thing I want to make clear is that it is never okay to add a modifier strictly to get a service paid. Modifiers, like cpt codes, help to describe the services that were performed. So the provider, or a coder who is reviewing the chart would have to determine if a modifier would be appropriate. A biller, just looking at the services cannot add a modifier just to ensure payment.

Having said that, it is important that billers understand modifiers and their use. Many providers do not understand modifiers, or even know that they exist. As a biller, you can educate the provider as to what the modifiers mean and what situations they should be used in. It is ultimately the provider who must determine if the services that were performed warrant adding the modifier.

A good example of this is if you receive a superbill indicating that the patient was seen for hypertension, diabetes, hypercholesterolemia and bursitis of the shoulder. The doctor indicates that he did an established office visit level 4, or a 99214 and an injection of cortisone, 20610. The provider doesn’t indicate that a modifier should be used. If both of these charges are billed out for the same date of service, most insurance carriers will bundle the office visit in with the injection.

As a biller you should question if the provider should be reimbursed for both since there were other medical conditions that the provider addressed. You can’t assume this based on the information that you have and since you were not in the room. That’s why you must check with the provider, not just add the modifier. Ask the provider what the main reason for the office visit was, if the other medical conditions were addressed, how much of the office visit was spent on the bursitis vs the other conditions, and advise him/her that the codes will most likely be bundled together.

Then you can advise him/her that there is a modifier, 25, that indicates that the office visit was a significantly separately identifiable service from the other procedure that was performed. The provider would need to advise the biller if the 25 modifier would be appropriate to use for the situation.

There are many other modifier that can be very useful as well. It is important though that billers do not get caught up in the task of getting claims paid and just use modifiers to accomplish that task. They must be used appropriately, when indicated by the provider of service. You may want to have some of the most commonly used modifiers added to the superbill so that the provider can easily indicate when the modifier is to be used.

Here is a list of some of the more common modifiers:

RT - right

LT - left

25 - significantly separately identifiable E&M service

26 - professional component

TC - technical component

50 - bilateral

59 - Distinct procedural service

79 - Unrelated procedure or service by the same physician during the postoperative period

Copyright 2010 - Michele Redmond

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Last week, we talked with Pamela Biffle CPC, CPC-I, CHCC, CHCO, who gave us some tips for acing the exam. She taught us so much, we’re back for more.

But first, a fun fact: Biffle is so passionate about coding she actually collects vintage CPT manuals, and her collection dates back to the groovy 1970s! You can be sure someone with that level of dedication to our profession has some good advice, so here are her 4 tips:

1. Make sure you have a sound coding foundation before you take an exam prep class

Three-day CPC exam training camps like Coding Cert.com aren’t designed to teach you coding from scratch, Biffle stresses. If you don’t have some coding knowledge before you begin the class, it won’t do you much good.

Instead, she and her fellow instructors aim to teach you how to take the test and help you fill in your coding knowledge gaps. If you’re unsure about whether you’re ready to take an exam prep training camp, you can contact a friendly customer service rep at CodingCert.com. She’ll ask you some screening questions to help you judge whether you’re ready and whether a class is a good investment for you.

2. Come up with your OWN mnemonics, or tools for remembering things

A mnemonic is an acronym or phrase that helps you remember important facts. For example, the orthopedic coding editor at Supercoder.com uses the mnemonic “Students Like The Professor To Teach Complex Hypotheses” to remember the carpal bones: Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate.

But even the cleverest memory tool won’t help you unless it makes sense to you, Biffle stresses.

3. Mark up your manual as you study

We’ve discussed this general technique often on My Coding Career, and Biffle has some particularly clever tips. Example: Using the Physician Fee Schedule, mark all the codes in your CPT manuals that can take modifier 26. This is a long list of codes, so use a stamp to quickly move through your book. Students who take Biffle’s class get her list of modifier 26 codes, so they don’t have to wonder during the exam.

4. Exam Room Time Management Tip:

Complete the shortest questions first. All the questions on the exam are worth the same number of points, whether they are one-liners you can read in a flash or longer coding scenarios that take you several minutes to plow through. So you can rack up the most points if you complete the shortest questions first.

When you first get your test, find all the short answers in your test booklet first and answer them if you can, Biffle suggests. Then move to 2-line questions, and so on. Then, go to the longer op note and coding scenario questions later, starting with the specialties you’re most comfortable with.

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If you’re really into medical billing you know the importance of doing a HCPCS update. You also know the headaches that doing these can give you. In this particular installment, we’re going to look at some basic things about HCPCS, including, for the uninformed out there, what they are, how the updates are done and what problems you are likely to encounter when doing yours.

The first thing that probably should be explained is what HCPCS stands for. HCPCS is an acronym for HCFA Common Procedure Coding System. So just what is this system? Well, it’s a system where every procedure and piece of equipment that is sold in the world of medicine is given a specific code to identify it. Now you might be thinking, “Why is this so important?” Well, look at it this way. Imagine a medical biller needing to look up the pricing for a particular item and this item just happens to be one of 100 different items that start with the same alphabetic characters, such as the word motorized for wheelchairs. Without the procedure code, this biller would have to look through every single description until they found the one they wanted. With a procedure code, they can go right to it as the codes are all unique and indexed in alphanumeric order.

While this may seem like a wonderful thing and it is, there are problems with HCPCS codes that drive medical billing people crazy. For starters, the codes are constantly being modified. Usually every quarter there are new HCPCS codes that are added to the list. So medical billers have to constantly keep on top of this. And if they do their billing with software, then it’s not enough to just have a manual of the new codes. These codes also have to be loaded into the software so that when billing an item, the correct code gets pulled. Otherwise, the claim form will be printed without the code or the electronic billing transmission will go without the code included. In either case, the claim will most certainly be denied. You can bet your last dollar on it.

Most of the HCPCS updates are done in one of two ways. The first way and one that is slowly becoming outdated, is where the medical billing agency subscribes to a service and every quarter the service sends the agency a CD with the new codes on it for them to install into their software. It will also include a printable version as well. The problem with this is that the updates are usually so small that to justify putting such a tiny file on a CD just doesn’t make sense.

So what is becoming more common these days is for these subscription services to have a direct download from the Internet or their private BBS system. There are several problems you may run into with these kinds of updates such as bad Internet or modem connections or files that simply don’t download correctly and ultimately have to be sent via postal mail.

HCPCS updates are as vital to a medical billing business as the patients you’re billing. Without these updates, your billing operation will effectively be shut down.

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The latest ICD-9 2010 changes went into effect on October 1 this year. Because of thisyou need to adjust the coding software that you use to reflect some new diagnosis codes for special neurological screenings.

Effective October 1, diagnosis 348.8 (other conditions of brain) has gotten the axe. However, ICD-9 2010 has brought forth a new fifth-digit replacement - 348.89. Since the descriptor remains the same, you’ll be able to use it for the same circumstances as 348. 8.

What’s more, coders previously reported V80.0 (Special screening for neurological, eye, and ear diseases; neurological conditions) along with the patient’s symptoms such as 780.4 (dizziness and giddiness) or 784.0 (headache), before an MRI, MRA or another test to have a definitive diagnosis. You’ll need to do away with V80.0 as the new ICD-9 codes have gone into effect. As per the changes, now you’ll need to report:

* V80.01 –Special screening for traumatic brain injury

* V80.09 — Special screening for other neurological conditions.

The replacements of V80.01 and V80.09 come with its own advantages, helping you tighten your reporting because they differentiate between screenings more specifically for traumatic brain injury (TBI) and other neurological conditions. So if you code for any of the following specialties - radiology, neurology, family practice, etc. - you’ll find these new codes helpful.

Keeping up with the ICD-9 code changes can be a tough ask. But attending audio conferences might just ease up your job and help you get a better insight on neurology coding. Attending one will help you master the slew of neurological coding changes for the year 2010 and in the process help you avoid payment delays or denials. Go for an audio conference and see the difference it brings to your practice.

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The transition from ICD-9 Codes to ICD 10 scares me - and here’s why.

Experience with NPI

Just judging by the adoption of NPI (National Provider Identifier) numbers and the challenges it gave our billing service, ICD-10 code implementation has the potential to be very disruptive if a practice or billing service has not planned and prepared.

And NPI was only ONE number - ICD 10 codes are much more complex. Even if you and your provider are prepared, what about clearinghouses and insurance payers? Not to mention the largest insurance payer of them all - Medicare!

When our billing service incorporated NPI, we had the cost and disruption of upgrading our practice management software, coupled with having to re-map our claim files sent to the clearinghouse. There were also problems and confusion with some insurance carriers regarding legacy ID numbers, group NPI, and individual NPI.

This resulted in many claims not getting paid on the first submission - or second - or third… In some cases claims had to be re-submitted many times over. This was a major disruption to our clients revenue - and ours. And our clients are looking to us as a billing service to have all the answers.

As with NPI, we can expect that everybody will have a different interpretation of what implementing the new ICD 10 codes will require.

What sill it Cost?

What will the cost be to the small medical billing service? What will it cost our providers?

October 1, 2013 seams like a long way off - but we need to be learning, planning, and preparing for this transition now. I don’t know if we have all fully grasped how much this will cost in direct and in-direct costs.

What I mean by direct costs are the time and money required for training, mapping ICD-9 to ICD-10, and potential costly software modifications. Indirect costs refer to interruptions to reimbursement for a providers - especially small ones. I have a feeling this is another unfunded mandate resulting from the 1996 HIPAA legislation thats going to cost all parties involved.

Brief Background of ICD 10 Codes

ICD-9 codes are nearly 30 years old and cannot be expanded any further diagnosis. Many of the diagnosis categories are full. ICD 9 codes are 3 to 5 characters. The first can be a number or letter, the 2nd through 5th are numbers with a decimal after the third character.

ICD 10 codes are 3 to 7 characters, the first one is a letter, 2nd through 7th are either a letter or number, with a decimal after 3 characters. These codes are arranged in chapters and sub-chapters with diseases grouped by letter. It allows over 155,000 diagnosis codes compared to a maximum of 17,000 ICD 9 codes.

Supposedly the greater number of codes in the ICD 10 will make it easier to find the right diagnosis code. ICD 10 has an improved structure and is more specific making it easier to use than ICD 9. Most practices use a relatively small number of codes related to the type of specialty.

Part of HIPAA

HIPAA legislation included the requirement for use of ICD 10 with a compliance date of October 1, 2013 to be implemented. The government agency requiring implementation is the Department of Health and Human Services (HHS). HHS has no plans to delay implementing.

Related to the switch to ICD 10 is the transition to the version 5010 standard for electronic transactions effective January 1, 2012. The 5010 changes are necessary to accommodate ICD 10 codes and NPI.

ICD-9 will no longer be maintained after implementation of ICD 10. ICD 10 is currently in use by other countries and is updated annually just like ICD 9.

Concerns

The issues of concern for most providers and those who serve them are the potential economic impacts. Will practice management systems be able to accommodate the greater number of diagnosis codes (up to 155,000) for ICD 10? Software applications from the front end physicians office to the clearinghouse to the payer will have to be able to accommodated ICD 10.

Will payers that don’t yet use ICD 10 codes map everything back to ICD 9 for processing?

Estimates for healthcare providers, coders, and billers to become proficient with ICD 10 is 6 months.

From what I’ve read about ICD 10, it’s an improvement to the current ICD 9 diagnosis codes, however the transition has the potential to be very disruptive. It seams like a long way off, but it’s important to begin planning and preparing for this transition now.

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Calling All Chiropractors

Step one in Maximizing your Profits

Successful insurance billing starts with successful insurance verification

The Biller needs to be very specific when we verify insurance coverage so we do not bill out for procedures that will never be reimbursed.

I have had some providers who do not want to pay the extra fee that is required to proved insurance verification, and these providers have lost much more money in neglecting to verify insurance than they would have paid me to perform the service. Penny wise and pound foolish?

So whether you, as a provider, do your own verification or if you rely on your front desk or billing service to do your verification, be sure it is being done correctly!

Is the Playing Field Even?

Perhaps you have noticed that when you call the insurance company, the first thing you will hear is the gratuitous disclaimer. The disclaimer states that no matter what takes place during your telephone conversation, chances are if you were given incorrect information, you are out of luck. The disclaimer may include the following statement: “The insurance benefits quoted are based upon specific questions that you ask, and are not a guarantee of benefits.” If you do not ask for details, they may not tell, so you are starting out with the short end of the stick! And since you are already at a disadvantage, then get a firm grasp on that stick and cover all of your bases.

To start with, you will need much more information than the online or telephone automatic system will tell you. Try to bypass the auto systems as much as possible. Ask the automated system for a ‘representative” or “customer service” until you actually find yourself talking to a real person.

Key Points for full reimbursement

I will provide an insurance verification form that you can use. Here are the key points:

The representative will give you their name. Write it down along with the date of your call. If you are out of network with the insurance company, get the in and out benefits, just so you can compare the difference.

Deductible Information Essential

Find out the deductible, then ask how much has been applied. Then ask, specifically, if the deductible amounts are common. If you do not ask, they will not tell you! If deductibles are common, you can be fairly certain that the applied amounts are correct. If the deductibles are not common, find out how much has been applied to the in network plan and how much has been applied to the out of network plan.

What does Common mean? Common deductible means that all monies applied to deductible are shared. Any funds applied through an in network provider will be credited for the in and out of network providers.

Second question: Is there a 4th quarter carry over? This is good to know towards the end of the year. If your patient has a one thousand dollar deductible and it is October, any money applied to that one thousand will carry over to next year’s deductible. This can save you and your patient some big bucks. If you do not ask, they may not share this information with you.

Know Your Limits

Since we are discussing Chiropractic, you will ask about the Chiropractic maximum. What is the limit? It may be a number of visits, it may be a dollar amount. If it is a dollar amount, then ask: Is this limit based on what you allow, or what you pay? Some plans consider the allowed amount the determining factor, and some will consider the paid amount as the determining factor. There is a big difference between the two!

If you bill Physical Therapy-and if you don’t, then you should!-ask about the Physical Therapy benefits. Can a Chiropractor perform Physical Therapy? If the answer is yes, then ask: Are the Chiropractic and Physical Therapy benefits combined, or are they separate? Usually you will find something like: 12 Chiropractic visits and 75 Physical Therapy visits are allowed. If they are separate, then after your 12 Chiropractic visits, you can begin to bill Physical Therapy only. If you add a Chiropractic adjustment on the claim after the 12 visits, that claim may be considered under the Chiropractic benefits and you will not receive payment. If you bill Physical Therapy codes only, then the claim will be considered under the Physical Therapy benefits and you will receive payment.

We’re Not Done Yet!

However! You need to be even more specific about this. After being told that the Chiropractic and Physical Therapy benefits are indeed separate, and you have been told that a Chiropractor can bill Physical Therapy, then ask: Is Physical Therapy billed by a DC considered under the Chiropractic or the Physical Therapy benefits?

At this point you can almost see your insurance representative roll their eyes at your incessant questioning. Don’t worry about that, just get the information. Sometimes you have to ask the same question a few different ways to get a complete reply.

I have gotten caught from not asking this question. Some plans will allow a Chiropractic to bill Physical Therapy, but if the doctor is a Chiropractor, then anything the doctor bills will be considered “Chiropractic Benefits.” In that case, you will only be reimbursed for the maximum number of visits allowed to a Chiropractor, even if you can bill Physical Therapy also.

There are plans that will allow a Chiropractor to bill Physical Therapy codes after all of the Chiropractic benefits have been exhausted. How will you know if you do not ask?

More good questions

Another good question: Is there a limit on how many units can be billed per day? Many plans have not limit, but some will limit 4 units per day. Four units, not modalities. 97110 is 1 modality, but if you bill 2 units of 97110, that counts as 2.

How many Office Visits (exams) are allowed per year? This can help you decide how many re exams to perform and bill for during the year.

And of course, it is helpful to ask: Have any of these Chiropractic and Physical Therapy (and Acupuncture) benefits been used this year?

Is pre authorization required?

The insurance representative will only give you partial information unless you specifically ask.

Document your call!

When you are satisfied that you have all of the information that you need, ask the representative for a reference number. If you have been given erroneous information, at least you can refer to the call when appealing the claim.

Happy billing!

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Medical claim billing is a process of complete paper work submission and claiming by insurance companies for retrieving payments. This process generally followed by medical insurance companies which are private or government companies.

Medical claims invoice process involves various types of activities but the main purpose of any claim billing company is to process super-bills and submitting medical claims to insurance companies in order to receive payments for their clients in a timely manner.

Once the procedure and diagnosis codes are determined, the medical biller will transmit the claim to the insurance company. Medical claims invoice is usually done electronically by formatting the claim as an ANSI 837 file and using electronic data interchange to submit the claim file to the payer directly or via a clearing house.

To run a profitable medical business, hospitals and other health care facilities should follow an effective way of collecting reimbursement.

Medical claims invoice process includes the below steps:

- Pre-certification & Insurance Verification

- Patient Demographic Entry

- CPT and ICD-9 Coding

- Charge Entry

- Claims Submission

- Payment Posting

- Account Receivables Follow-up

- Denial Management

Today, invoice process is become one of the most important outsourcing services in the healthcare industries and across the world. This services booming day by day in many hospitals and practitioner to outsource their invoice and reimbursement requirements to offshore facilities.

The concept of invoice outsourcing was started from the requirements to get additional billing specialists to perform those secondary tasks apart from the primary medical tasks which are managed by the billing specialists from the medical institutions such as the hospitals, private clinics, nursing homes etc.

Outsourcing of medical invoice service has been widely implemented in the medical industry today. Offshore Medical Billing has provided numerous medical health care and medical billing services. We also provides medical invoice systems with more than 17 years of experience, specialized in services provided with Medicare and Medicaid.

To outsource your medical billing requirements to us, please contact us.

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