Ambulance transportation is a reimbursable service when the patient’s health condition is such that using any other transportation method would endanger the patient’s health.

Ambulance services are handled by paramedics and other medical professionals. They are well trained and equipped to carry out the first aid and transportation. Billing for ambulance services and coding are best done by professionals who are certified and trained in this work. (more…)

Importance of patient demographics

All medical facilities collect demographic details from patients, which are used for various purposes, including analytics. When it comes to claims submission and reimbursement from payors, the correctness and completeness of demographics data of patients  assumes importance. Patient demographics entry is the basis of a claim.

Inaccurate demographics entry results in claim denials and delayed payments. Studies show that healthcare organizations lose about 7% of their annual collections on account of errors in demographic entry. The process of demographic entry should be a streamlined one with checks inbuilt to eliminate mistakes at the initial stages of the revenue cycle. Investing time in capturing accurate patient demographics is crucial to successful revenue cycle management. (more…)

Dermatology coding is intricate

Accurate medical coding is indispensable to successful revenue cycle management. Among specialties, dermatology specialty coding and billing are intricate with unique aspects such as sizing wounds and lesions and many terms used. Therefore, dermatology coders must be able to distinguish between simple, intermediate and complex repairs. Also, they must understand terms associated with sizing (length, depth, width, and circumference) and actions such as shaving, destruction, and performing biopsies. (more…)

What is a Superbill?

A medical superbill or encounter form is the primary source of data for preparing claims, which may be submitted by the provider or the patient. The superbill contains the list of services provided to a patient. Along with the list of services, the superbill will show the costs and codes for each exam, treatment, or procedure. It will also contain information about the patient, provider, CPT codes, ICD-10 codes.

A superbill is not necessarily needed for preparing claims by the provider. However, a patient would require a superbill in case (i) the provider is not part of their insurance company’s provider panel, (ii) they are having a Health Savings Account (iii) they are utilizing out of network benefits and need to meet a deductible(s). In these cases, the superbill helps the patient prepare a claim and submit it directly to their insurance company. (more…)

The healthcare system is quite a complex system to navigate with many rules and regulations to follow. The medical billing sub-system has so much paperwork involved that healthcare providers find it challenging to surmount. Apart from this, rules keep changing and billing staff has to be well versed in them so that claims are not rejected. These factors are quite likely to result in increasing account receivables affecting the financial health of a practice. It would be prudent to opt for assistance from an offshore vendor to handle your back-office work effectively. (more…)

What is Accounts Receivable in Healthcare RCM?

Managing Accounts Receivable (AR) and a healthy cash flow is a major challenge for every healthcare professional and facility. In the healthcare industry, AR represents the amount that is due from insurance companies and patients.

To understand the AR status of a practice, “Days in AR “is computed, which is the average number of days it takes to collect payments that are due to the practice. The AR is then classified into buckets such as 0-30 days, 31-60 days, 61-90 days and so on separately for patients and payors. The aging AR bucket data indicates the performance of the billing department. (more…)