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3 STEPS TO HANDLE AR AND CREATE AN EFFECTIVE RCM CYCLE

  1. 1) 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…)

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8 proven methods to avoid coding and billing errors

 

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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5 Reasons to Outsource to a Medical Billing Company

Medical professionals train for years to get qualified to treat patients. While service to humanity is the overriding mission in their lives, they are sadly ill-equipped to handle their professions’ business side. The healthcare system has many parts and is not simple. Doctors have to handle tons of paperwork to get reimbursed for the services they render. The billing and coding paperwork has to be accurate, which adds further stress to the already stressed physician. Therefore, doctors prefer a medical billing company they can trust to do the coding and billing for them.

A billing company follows HIPAA and other industry guidelines and makes sure physicians receive payments quickly. Billers and coders go through regular training on Revenue Cycle Management processes, understanding the International Classification of Diseases (ICD) /other codes and keeping themselves updated with changes. The medical billing and coding company is fully equipped and competent to handle the entire RCM cycle, thus ensuring that physicians are financially healthy.

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