What is pediatrics?

The American Academy of Pediatrics (AAP) has defined pediatrics as “the specialty of medical science concerned with children’s physical, mental, and social health from birth to young adulthood.

“Pediatric care encompasses a broad spectrum of health services ranging from preventive health care to the diagnosis and treatment of acute and chronic diseases. Pediatrics is a discipline that deals with biological, social, and environmental influences on the developing child and with the impact of disease and dysfunction on development”.

Hence pediatricians deal with numerous conditions, procedures, treatments, and preventive healthcare. Pediatrics is a high volume specialty, with pediatricians seeing 30-40 patients per day during the flu season. As the profit margins are thin, pediatrics billing mistakes can cost the practice dearly. (more…)

What is payment posting?

The medical revenue cycle is a long and complex process. At the end of a medical billing cycle, a patient’s payment records are posted in the patient’s account. Payments can be from both patient and payor. This stage of the billing cycle is called payment posting. Although appearing to be a simple task, accuracy and attention to detail are required besides being time-consuming.

Payment posting will reveal if there are under-payments by payors. Payment for every line item should be closely monitored for issues. Appropriate and immediate action should be taken to resolve the problems. (more…)

What is physician credentialing?

Physician Credentialing is the process of checking a provider’s competency, as demonstrated by education, training, licensing, and work experience. The Credentials Verification Organization will directly ascertain the medical provider’s education, training, licenses, work history and malpractice history.

Physician credentialing is essential to all parties in the healthcare industry. As a result, hospitals and clinics are guaranteed quality care from the physicians they hire. Physicians, when credentialed, can become part of an insurance company’s network. Furthermore, Medical Credentialing assures patients that the healthcare industry is maintaining the highest standards of care. (more…)

Medical professionals go through a long period of training before they can take care of patients. The rigorous training prepares them for a life of service to others. Sadly they are ill-prepared to take care of the business side of their practice. Here are three tips that will guarantee increased revenue.

1) Robust knowledge of processes

The primary and the most crucial aspect of reducing claims denials and improving medical practice revenue is understanding the medical coding and billing process completely. Medical billing and coding processes are rather complex and require that the individuals handling them be knowledgeable and aware of the industry’s constant changes. This requires an understanding of the insurance policy, the rules for processing a claim and a thorough knowledge of ICD-10, CPT, HCPCS and HCC. Finally, an excellent Revenue Cycle Management tool is needed for managing the entire process. Since every payor has its policy, it is imperative to understand their rules and regulations for processing claims. Equally, one should keep abreast of the changes introduced by payors. Such knowledge makes sure that claims pass through the system with minimal issues/denials, thus exponentially increasing revenue. Studying and analyzing past denials helps discover trends, which ensures that mistakes/omissions do not recur.  (more…)

For a practice to thrive, regular cash flow is vital. And for cash flow to be uninterrupted, the Account Receivables (AR) must be as low as possible. Billing professionals should, therefore, ensure submission of clean claims so that rejections are minimized and reimbursement is maximum. The following three steps will help you to minimize rejections and keep your AR manageable. Naturally, a low AR translates to a healthy revenue cycle.

Understanding Payor Rules

Insurance companies have their own set of rules that every revenue cycle management company must be aware of. The way claims are handled by Aetna may differ from the way BCBS or Cigna might handle the claim. Further, every insurance company has its provider reimbursement policy. So the difference between a good medical billing company and an excellent medical billing company is the difference in the claims first review pass rate. It all depends on how the claims are prepared, adhering to the payor’s rules, leading to fewer denials. And therefore, a much better rate of provider reimbursement.

Bristol Healthcare Services consistently ranks among the best since we have a high first claim pass rate. Every claim sent to the insurance company is scrubbed for code edits by payor. If a claim is denied, Bristol Healthcare Services immediately works on the denial to determine the issue causing the claim to be denied and makes sure to carry out the necessary amendments. Speaking about denials…  (more…)

Medical billing and coding are the critical processes of the Revenue Cycle Management. The sheer complexity of coding and billing can pose several difficulties to even an experienced organization. In the absence of well-trained and certified coders and billers whose knowledge is not up to date, errors of all types are bound to occur, which will adversely affect the turnaround time and ultimately clients’ revenue. Further, there are compliance issues to watch out for and up-coding is to be avoided at all costs.

Medical Billing and Medical Coding companies with broad experience and knowledgeable billing/coding teams have evolved to avoid medical billing and coding errors. It is pertinent to note that a report in 2010 by the Office of the Inspector General from the United States Department of Commerce indicates that 42% of the Medicare claims were not coded correctly while another 19% did not have the necessary documentation.

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