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Monday, February 1, 2010

Billing update from Humana

Please confirm this with Humana for latest update.

• CPT 82565 will not be separately reimbursed when submitted with CPT 80050.
• CPT 11101 will not be separately reimbursed when submitted with CPT 17000.
• CPT 36415 will not be separately reimbursed when submitted with the following CPT codes:
80048 82105 82627 83540 84550 85652
80050 82150 82670 83655 84702 86304
80051 82247 82728 84132 84703 86308
80053 82306 82785 84144 85007 86592
80055 82310 82947 84146 85014 86677
80061 82330 82948 84153 85018 86703
80069 82465 82950 84403 85025
80074 82550 82951 84436 85027
80076 82565 82962 84439 85060
80164 82575 83001 84443 85610
82040 82607 83036 84450 85651
• CPT 36416 will not be separately reimbursed when submitted with the following CPT codes:
80053 82465 82962 83655 85018 85610
80061 82947 83036 85013 85025
82247 82948 83540 85014 85027
• CPT 36540 will not be separately reimbursed when submitted with the following CPT codes:
80053 85025
• CPT 71010 will not be separately reimbursed when submitted with the following CPT codes:
99284 99285
• CPT 71020 will not be separately reimbursed when submitted with the following CPT codes:
99283 99284 99285
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 74022 will not be separately reimbursed when submitted with CPT 99285.
• CPT 77417 will not be separately reimbursed when submitted with CPT 77427.
• CPT 78890 will not be separately reimbursed when submitted with CPT 93015.
• CPT 90760 will not be separately reimbursed when submitted with CPT 99291.
• CPT 90765 will not be separately reimbursed when submitted with CPT 99291.
• CPT 93010 will not be separately reimbursed when submitted with the following CPT codes:
92980 99232 99254 99291
99223 99233 99255
• CPT 93041 will not be separately reimbursed when submitted with CPT A0427.
• CPT 93042 will not be separately reimbursed when submitted with the following CPT codes:
99232 99233
• CPT 93508 will not be separately reimbursed when submitted with CPT 92980.
• CPT 94150 will not be separately reimbursed when submitted with the following CPT codes:
94620 95117 99214
• CPT 94760 will not be separately reimbursed when submitted with the following CPT codes:
36415 93010 99212 99215 99284
80051 99203 99213 99244 99285
93005 99204 99214 99283 A0427
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 94761 will not be separately reimbursed when submitted with the following CPT codes:
99214 99284 99285
• CPT 96110 will not be separately reimbursed when submitted with the following CPT codes:
99391 99392 99393
• CPT 99000 will not be separately reimbursed when submitted with the following CPT codes:
11100 80050 84443 99204 99385 99395
36410 80053 85018 99211 99386 99396
36415 80061 85025 99212 99387 99397
57454 81002 88142 99213 99392
58100 82948 88175 99214 99393
80048 83036 99203 99215 99394
• CPT 99173 will not be separately reimbursed when submitted with the following CPT codes:
99213 99383 99392 99394
99214 99384 99393 99395
• CPT A4209 will not be separately reimbursed when submitted with CPT 99211.
• CPT A4212 will not be separately reimbursed when submitted with the following CPT codes:
96413 99211 99213 99214
• CPT A4215 will not be separately reimbursed when submitted with CPT 36415.
• CPT A4556 will not be separately reimbursed when submitted with CPT E0730.
• CPT Q0091 will not be separately reimbursed when submitted with the following CPT codes:
99385 99386 99395 99396 99397 G0101
• CPT 94664 will not be separately reimbursed when submitted with the following CPT codes:
99213 99214 99244
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 97002 will not be separately reimbursed when submitted with the following CPT codes:
97110 97140
• CPT 97140 will not be separately reimbursed when submitted with CPT 98943.
• CPT 99051 will not be separately reimbursed when submitted with the following CPT codes:
99203 99212 99213 99214
• CPT 99053 will not be separately reimbursed when submitted with the following CPT codes:
99282 99283 99284 99285 99291
• CPT 99070 will not be separately reimbursed when submitted with CPT J7050.
• CPT 99215 will not be separately reimbursed when submitted with CPT 99396.
• CPT 99420 will not be separately reimbursed when submitted with CPT 99395.
• CPT 99215 will not be separately reimbursed when submitted with CPT 28190.
• CPT 11101 will not be separately reimbursed when submitted with CPT 17000.
• CPT 36415 will not be separately reimbursed when submitted with the following CPT codes:
80048 82247 82728 83655 84450 85651
80050 82306 82784 83891 84460 85652
80051 82310 82785 84132 84550 86003
80053 82378 82947 84144 84702 86038
80055 82465 82948 84146 84703 86304
80061 82533 82950 84153 85007 86308
80069 82550 82951 84402 85013 86592
80074 82565 82962 84403 85014 86677
80076 82575 83001 84432 85018 86703
82040 82607 83036 84436 85025 86706
82105 82627 83516 84439 85027 86787
82150 82670 83540 84443 85610
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 36416 will not be separately reimbursed when submitted with the following CPT codes:
80061 82947 83036 85014 85027
82247 82948 83655 85018 85610
82465 82962 85013 85025
• CPT 36540 will not be separately reimbursed when submitted with the following CPT codes:
80053 85025
• CPT 69210 will not be separately reimbursed when submitted with CPT 99396.
• CPT 71010 will not be separately reimbursed when submitted with the following CPT codes:
99284 99285
• CPT 71020 will not be separately reimbursed when submitted with the following CPT codes:
99284 99285
• CPT 83891 will not be separately reimbursed when submitted with CPT 87491.
• CPT 83901 will not be separately reimbursed when submitted with CPT 87491.
• CPT 90760 will not be separately reimbursed when submitted with CPT 90774.
• CPT 93010 will not be separately reimbursed when submitted with the following CPT codes:
99213 99214 99223 99232 99254 99291
• CPT 93041 will not be separately reimbursed when submitted with CPT A0427.
• CPT 94150 will not be separately reimbursed when submitted with the following CPT codes:
99213 99214
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 94760 will not be separately reimbursed when submitted with the following CPT codes:
36415 99203 99204 99213 99214 99215
• CPT 94761 will not be separately reimbursed when submitted with CPT 99214.
• CPT 96110 will not be separately reimbursed when submitted with the following CPT codes:
99391 99392
• CPT 99000 will not be separately reimbursed when submitted with the following CPT codes:
11100 80053 84439 99204 99215 99394
36415 80055 84443 99205 99385 99395
57454 80061 85025 99211 99386 99396
58100 80076 88175 99212 99391
80048 81002 99202 99213 99392
80050 82947 99203 99214 99393
• CPT 99001 will not be separately reimbursed when submitted with the following CPT codes:
36415 80053
• CPT 99144 will not be separately reimbursed when submitted with CPT 77003.
• CPT 99173 will not be separately reimbursed when submitted with the following CPT codes:
99213 99383 99392 99394
99214 99384 99393 99395
• CPT A0999 will not be separately reimbursed when submitted with CPT A0429.
• CPT A4206 will not be separately reimbursed when submitted with CPT 95117.
• CPT A4208 will not be separately reimbursed when submitted with CPT 99211.
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT A4212 will not be separately reimbursed when submitted with the following CPT codes:
36415 96413 96523 99211 99213 99214
• CPT A4215 will not be separately reimbursed when submitted with the following CPT codes:
36415 99211
• CPT A4216 will not be separately reimbursed when submitted with the following CPT codes:
90765 96413 96523 99213 99214 S9501
• CPT A4245 will not be separately reimbursed when submitted with the following CPT codes:
36415 99211
• CPT A4263 will not be separately reimbursed when submitted with CPT 68761.
• CPT A4550 will not be separately reimbursed when submitted with the following CPT codes:
99202 99203 99213 99214
• CPT A4556 will not be separately reimbursed when submitted with CPT E0730.
• CPT A4930 will not be separately reimbursed when submitted with CPT 99211.
• CPT Q0091 will not be separately reimbursed when submitted with the following CPT codes:
99385 99386 99395 99396 G0101
• CPT 76857 will not be separately reimbursed when submitted with CPT 76830.
• CPT 82310 will not be separately reimbursed when submitted with CPT 82330.
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 85027 will not be separately reimbursed when submitted with CPT 85025.
• CPT 94260 will not be separately reimbursed when submitted with CPT 94240.
• CPT 94664 will not be separately reimbursed when submitted with the following CPT codes:
99204 99213 99214
• CPT 97002 will not be separately reimbursed when submitted with the following CPT codes:
97110 97112 97530
• CPT 99051 will not be separately reimbursed when submitted with the following CPT codes:
99203 99212 99213 99214
• CPT 99053 will not be separately reimbursed when submitted with the following CPT codes:
99282 99283 99284 99285
• CPT 99070 will not be separately reimbursed when submitted with the following CPT codes:
A4550 J1100
• CPT 99213 will not be separately reimbursed when submitted with CPT 99214.
• CPT A4215 will not be separately reimbursed when submitted with CPT A4550.
• CPT G0101 will not be separately reimbursed when submitted with the following CPT codes:
99214 99395 99396
• CPT 99050 will not be separately reimbursed when submitted with CPT 90772.
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 99203 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99204 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99212 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99213 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99214 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99395 will not be separately reimbursed when submitted with CPT 90772.

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Medical Billing

What is the overall Billing process?

The physician doesn’t get paid for his services immediately after they are rendered. Majority of the patients have insurance coverage and details of such coverage are provided to the physician before treatment. It is the responsibility of the physician to submit claims to the insurance company and get paid for his services. Submitting Claims and getting paid is a lengthy process and involves a lot of rules and regulatory systems and is very complicated. The physician needs to adhere to all these rules before submitting claims. This is the concept of Medical Billing. Sometimes the physician cannot provide his entire attention to this activity. He entrusts this activity to Billing Companies. This is a process of the physician providing rights to Billing Companies to bill Medical Insurance claims in order to save his time energy, and money.

After the provider renders services to the patient, the billing company will submit bills to the insurance company/ payer, using the insurance information that was last provided, as well as information about the reason for the examination, and the exact type of procedure performed.

Medical coding is the process of converting Medical terms to numeric code and it required Medical knowledge skills.

Medical billing is the process of submitting the claims and get paid behalf of provider.

I have listed the important process in Medical Billing. Each process is very important.


1. Insurance verification.

2. Demo and Charge entry process.

3. Claim submission.

4. Payment posting.

5. Action on denials or Denial management or Account receivables.


Insurance verification

Process started from here and usually front desk people are doing this process. Its a process of verifying the patients insurance details by calling insurance or through online verification. If this department works well, we could resolve more problem. We have to do this even before patient appointment.

Demo and Charge entry process

Demographic entry is nothing but capturing all the information of patients. It should be error free.

Charge-entry is one of the key departments in Medical Billing. Key department?? Yes, that's true. It is the keying-in department in Medical Billing. After receiving the super bills from the Doctor's office, it gets passed through the coding department, and then comes to the charge-entry department.


A Charge-entry person also has one other vital role to perform. That is, to look-up the codes entered in the claim, and to assign the relevant charges for those codes.

Claim submission Process

The next step after demographics and charge entry is claim generation. Claims may be paper claims or electronic claims. There are various types of forms for paper claims. The most widely used form is Health Care Finance Admin-1500 designed by the Health Care Financing Administration.

Electronic transmission of claims is the modern way of sending claims with less paper work. The most common means of transmission are through internet . The claim information is directly loaded into the insurance company's computer system or to the clearing house.


Payment Posting Process

Once the claims reach the carriers and they complete processing, they issue a check and prepare an Explanation of Benefits . The checks and the Explanation of Benefits would be sent to the pay-to address with the carrier or in the Health Care Finance Administrators.


In this processing we have accounted the money into the account as per the Explanation of Benefits. Now a days we are using Electronic payment posting also.

Action on denials or Denial management or Account Receivables

This is a most important function in the process flow of data. Unless this is taken care of, insurance balance will only be on an upward trend.

Problem in Medical Billing

•Inaccurate or lack of coding

• Incomplete claims

• Lack of supporting documentation

• Poor communication with the payer

• Not billing for services rendered

* Not being follow up AR balance claims


The person who is doing this process will be called Medical billing specialist.

Who is Medical Billing Specialist.

Medical billing Specialist is the one who is handling the below process and having well knowledge in each and every process.

* Insurance verification process

* Patient demographic and charge entry process.

* Submitting the claims by electronic as well as paper method. Tracking various claim submission report.

* Payments posting process for insurance as well as patient.

* Denial management.

* Insurance followup management.

* Insurance appeal process.

* Handling patient billing inquiries.

* Patient statement process.

* Preparing monthly reports such as revenue report and account receivable report and as per the provider requirement.

Medical Billing Specialists are in charge of reviewing patient charts and documents. They prepare and review all medical insurance claims based on the rules and regulations of insurance companies. Medical Billing Specialists also review insurance communications, payment and rejection notices to properly track all claims and payments.


Medical Billing specialist Professional

If a person is computer literate he is a fit enough candidate to take up the profession of medical billing and medical coding. However he will need to be trained and be aware of a lot of new information before he can start working effectively. He has to learn about the medical billing software and must be familiar with and master the various commands used while working with it.


Who are medical coders and how is it related to medical billing? Medical billing is a sub specialty of medical coding. Medical coding is the first step in the billing process. All patient records are maintained using the ICD-9 index system so that it is compliant with the federal rules.

A medical Biller’s most important skill includes filling up of the various medical forms correctly without any mistakes what so ever. All information required should be complete without any mistake at all. And the work will be include the following

Patient demographic entry

Insurance enrollment

Charge entry

Insurance verification

Billing and reconciling of accounts

Payment posting

Insurance authorization

Medical coding

Scheduling and rescheduling

Account receivable follow-ups and collections

Is it worth taking a medical billing program?

Usually don't spend too much cost on Medical billing program because the program will not do anything with real experience. What you learn from these kind of program will not be going to match with when you are working in the real environment. Hence just use as the start kind of program and get the real time experience even in small salary and later you can come up with more demanding one.


Problem of In House Processing of Medical Claims

Medical claims are generally very complex and have long extended details. While processing medical claims, one has to be highly critical and do efficient follow-up in order to get results. The process requires a lot of time and effort. And even after all this, there can be cases where files get lost or a small error can ruin the entire lot and everything has to be re-submitted again. Usually practice staff can be held up with lot of current work rather than submitting the claim and resubmitting the corrected claim hence it will lead to time delay on payment flow and it will affect all the relationship with in the practice. Even cost wise is also not effective when compare to outsourcing.

Advantage of Medical Billing Outsource

Medical Billing Company helps you in managing all your billing requirements proficiently. By choosing right medical billing company, you can get benefit such as improved financial strength.

Medical Billing task is very tedious and time consuming. However, billing must require more accuracy and special attention to strengthen the financial condition of clinical or hospital. You can do this task at own or assign to clinical staff but you have to be pleased with low patients satisfaction. Medical billing company can help you in supportive task. By efficient medical service, you will get highly satisfied patients.

A Medical Billing service can improve the efficiency of your billing system, reduce denials, cut down operating costs, boost reimbursements and save valuable time that can be devoted to patient care. These services are better equipped to adapt to continuously changing billing codes and industry requirements.


* Prince is low compare to doing it in house

* Dedicated Highly Skilled Professionals

* No need to maintain the hardware . Ability to perform Medical Billing remotely, using the software of your choice

* Usually Maximum reimbursements and fewer denials

* Accuracy is high when compare

* Faster transaction


Question need to ask when Medical Billing Outsourcing

1. Check with their referral and how long they are doing this business.

2. Are they HIPAA compliance

3. Where they are doing their work. If possible just visit there.

4. Data security.

5. Compare the price with others.

6. what are the reports they will provide

7. Your specialty wise question

8. Their software skills.


Services and process involved in Medical Billing

* Coding ( CPT, ICD-9, and HCPCS)

* Patient Demographics Entry

* Charge Entry – All specialties

* Payment Posting (Manual and Electronic)

* Payment Reconciliation

* Denials/rejections analysis, re-billing

* Accounts Receivable Follow-up

* Systemic A/R projects, re-billing

* Collection Agency Reporting

* Refunds


Medical Billing Salary Range

Depending on the education qualification, the hourly rate varies from $12-$15. Another most important factor that affects billing pay is how long someone has worked in the field. Medical specialist with experience of 1 year earns around $12 per hour. Those who have more experience in billing earn up to $16 per hour. However, the geographic location also plays a role in pay scale. For instance, areas where cost of living is high, the pay will be more. Billers who work in New York City, Houston, Chicago and California are able to pull a good amount of salary. Work locations such as hospital, billing company or private practice will also affect the salary. Since there are lots of factors which affect the salary of billing, it is really not easy to predict the pay scale. Studies have shown that 50% of people earned around $35,000-$45,000 annually.


Most of the medical Billers are paid hourly, rather than annually. While Biller who is experienced can earn around $40,000 a year as an independent contractor working from home, a billing and coding specialist who runs his own firm can earn $100,000 a year. However, people who are searching for home based job should be very careful. There is lots of fraud going on in this field. These spammers charge hundred to thousand dollars and in exchange they claim they will help to get a placement in billing. They also promise that medical billing job can earn a substantial amount of money and no experience required. But in reality, those who paid to get a job end up with no job, no money. Billing is a very competitive field, so without experience or training in medical billing field, it is almost impossible to get a job.

Selecting Medical Billing Software - 10 things to consider

1. The first step is to evaluate your needs. And when evaluating different systems look for a package that goes one step ahead of billing. Choose a medical practice management system MPP. This will handle considerably more that just medical billing.

2. Determine whether the system handles electronic transmission of claims, direct billing for patients, co-pays, co-insurance, and expenses not covered by insurance.

3. Weigh the pros and cons of different medical billing systems and ask to see a system in operations. Always check out the references yourself.

4. Look for a medical billing management system that is user friendly. When a vendor demonstrates get your office staff to be present. This way you will be able to check how the software functions. Any software must be easy to use to be productive. The system should be fool proof.

5. Ask whether the medical billing software is a traditional system, one that will work on your office computers or an application service provider system (ASP), one that will process data at the software company’s data center.

6. Always get quotes from at least three medical billing software providers.

7. Ask whether they are offering an evaluation period or trial. This will enable you to know in actuality whether the system works or not.

8. Find out about training your office people, up-gradation of system, and whether the software is compatible with your office computer systems

.9. Find out whether the system will handle appointment scheduling, maintenance of records and so on apart from electronic medical records, SOAP notes, and billing. Choose a system that is comprehensive.

10. An ideal Medical Billing software system must include aspects like payment posting, reconciliation; follow up, secondary submission, and patient billing.Choose a transparent billing system that enhances your office efficiency. Install a system that you can use not one that will lead to frustration and problems.Medical billing systems must free your time and that of your office staff not make you run in circles. Choose a system with care.



Disclaimer

All the contents and articles are based on our experience and our knowledge in Medical billing. All the information are educational purpose and we are not guarantee of accuracy of information. Before implement anything do your own research. All our contents are protected by copyright laws and guidelines.
If you feel some of our contents are misused please mail me at medicalbilling4u@gmail.com. We will response ASAP.