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Coding, billing and collection practices in doctor's offices
Submitted by anonymous » Sat 10-Apr-2021, 21:36Subject Area: General | 25 member ratings |
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Everyone would agree that the primary function of a medical office is the care of its patients; however, to stay in practice and prosper Medical Billing Services, the practice must collect payment for services rendered. Coding, billing, and compilations are a vital part of medical office staff duties, and proper training and guidelines are vital to the successful fulfilment of these duties.
The billing department works closely with the coding staff in a doctor's office. In some cases, the same person performs the coding, billing and collection tasks, but these are three different positions. While some of the aspects of each job intersect with the others, they also have very specific responsibilities.
Coding actually makes the billing process easier by unifying procedures through recognizable codes. Using diagnostic codes and standard procedures that are recognized by insurance companies, all medical practices and relevant agencies related to care, the medical coder will ensure that the insurance companies or the "commercial payer" or the Centers of Medicare and Medicaid (CMS) recognize the item billed and how the diagnosis warrants that procedure, test, or treatment.
The billing process begins at the intake of patients. It is important to obtain all insurance information before seeing the patient, if possible, so that all parties understand what each visit and procedure will cost the patient. The fewer surprises your patients have regarding payment for services rendered, the happier everyone will be. When the patient arrives and presents the insurance information, it is vital that the information provided is verified with the insurance company as active, the benefits allowed, and that the provider is currently contracted with that specific payer. Websites have misinformation, contracts expire, and benefits change, so it is very important to verify the data.
To save time, income and inconvenience, each procedure that is outside the normal scope of an office visit must be preauthorized well in advance or within the time limits of the specific insurance plan. Any payment owed from the patient must be discussed and collected prior to the procedure, test, therapy, or treatment. Copays should always be paid before the doctor sees the patient, to avoid any problems later.
Collections of overdue amounts are the least effective form of reimbursement. The longer an invoice is overdue, the less likely it is to be collected and the more money it costs the office for time and payment hours. This is the best reason of all to have an effective billing and coding staff in your medical office.
A claim denied by a commercial payer is a probable reason for an invoice not being paid on time. When both the patient and the staff have done their due diligence beforehand, this is less likely, but it does happen. An appeal by staff may be necessary with any clarification or explanation. An appeal by the patient is another possible solution, but the patient should be informed of the possibility of being responsible for outstanding balances. While a payer agreement is usually one of the first orders of business when completing patient intake paperwork, the patient likely did not read the document carefully. Sometimes the patient they weren't feeling well at the time and were not paying attention to the document, or they were just hoping that most or all of their bills would be paid by the insurance companies. Discussing financial responsibility before a problem arises is the most effective course of action to avoid any awkward and possibly emotional encounters.
Coding, billing, and collections are important to a successful medical facility, regardless of size or specialty. Proper training, continuing education, and instruction in current changes in insurance laws, codes, or practices are imperative. Up-to-date reference materials and equipment enable these staff members to have a positive impact on both patients and the doctor's office.
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