Keeping up with trends impacting medical coding and billing
For medical coding and billing professionals, the change from ICD-9 to ICD-10 was drastic. With the pace of recent technological advancements, keeping up with trends is more difficult than ever. But once you get a grip on how to do it, you can come out top of the game in this tremendous, incessantly evolving industry.
The fast-paced, critical role of medical billing and coding has experienced a lot of the immense changes in recent days:
- The Affordable Care Act(ACA)
- CPT Core Updates
- ICD-10 Transition
- Increasing use of EHR systems
- Ever-evolving industry trends
While healthcare jobs have been on a rise (according to a report by the Bureau of Labor Statistics), this exciting prospect also means a lot of work on your part to learn new and crucial information impacting the profession. This can be a difficult task, so we have a few suggestions to help you with your learning process:
- Become adept at using ICD-10 proficiently
The transition from ICD-9 to ICD-10 last October has left for professionals a mammoth task of mastering a whopping 71,924 procedure codes and 69,823 diagnosis codes. You may have been trained to use it well enough, and although you won’t be all 141,000+ regularly, learning all of it might be exactly what you need to stay ahead in the field
- Working with EHR systems
The EHR system is being increasingly put to use as digital patient records because of its ability to improve patient care, enhance efficiency and lower costs – if you are hesitant in tapping into the potential of this machine, you will fall behind.
With it having become a regulatory focus, more than 75% hospitals nationwide now use EHR. It’s no wonder all healthcare professionals are working on navigating it skillfully; it’s time you hone your computer skills too. You have to get comfortable with HER systems.
- Keeping up credentials
The CPC from AAPC, the CCA from AHIMA or others of the like are reputed credentials. If you don’t have one, you are advised to get it immediately.
If you do have credentials, it is important to keep your credential recent by completing the required education. New codes are always being added to ICD-10, and it is best to stay on top.
- Keep pace with the dynamic industry
Legislation can affect this profession as much as technology can. It is important to stay abreast of current affairs and daily news, so that when changes like the Affordable Care Act happen, you can be up to date.
Don’t risk being left behind as a practicing or aspiring specialist; always stay relevant and vigilant.
ICD9/ICD10 Codes: What Are They And Why Are They Important
The United States Health and Human services department has mandated that every entity covered by the HIPAA (Health Insurance Probability And Accountability) must transition into a new set of codes, the ICD, effective October 1st, 2015.
The WHO published the first ICD code. ICD standards for the International Classification of Diseases. This code was first implemented in the US, 1999, for mortality coding. The US HSS then developed the ICD – CM, International Classification of Diseases – Clinical Modification, the latest being, ICD – 10 – CM. Further, a Procedure Coding System (PCS) was developed for inpatient procedures.
Currently, the ICD – 9 – CM codes are the foundation for classifying diseases, infections, injuries, in patient procedures and health encounters in morbidity settings. All health officials, especially state officials, rely on ICD – 9 – CM coded data from all HIPAA covered institutions to conduct any disease related activity. Such activities include chronic injury and disease surveillance, health care events and utilization, experiments, etc.
They are also used to find birth defects, disabilities, rare types of cancers, etc. This data is made public for analysis. These codes are used for claim reimbursements.
There are primarily two sorts of users for this.
- Primary User: A primary user is generally a healthcare professional like a doctor, nurse or a medical coder.
- Secondary User: A secondary user uses the coded data for research. Public health analysis is largely a secondary user of the ICD coded data.
Why These Codes Are Important
These codes are not just important but are mandatory for all health institutions. The quality of data for the following is greatly enhanced with the use of these codes. These codes are important for:
- Keeping a check on public health.
- Epidemiological research improvement.
- Measuring outcomes of patient treatment.
- Measuring care provided to a patient.
- Making medical decisions wisely.
- Identifying fraud and medical abuse.
- Designing payment systems.
- Insurance claim reimbursements.
Benefits To The Public Due To These Codes
The ICD9/ICD10 coding systems have standardized the diagnostic procedure. Furthermore, with the coded data it is very easy to compare morbidity to mortality. Additionally, terminology and the classification of diseases are on par with the advancing medical technology.
Any fraud and medical abuse is easily identifiable. All health institutions that accept insurance use this data which makes it easy to apply for the reimbursement of claims. It is thus imperative that all health care facilities follow the ICD – 10 – CM.
Utilization Review And Management Services
Utilization review is the process of reviewing a medical case to confirm whether the proposed treatment plan is covered by the health insurance policy. This review helps the insurance company to minimize costs. Utilization management is the process of requesting approval for future medical needs and review is rechecking past medical history. Utilization review requests are made by both insurance companies and medical service providers.
Oracle’s Novel Utilization Review And Management Approach
Oracle utilization review services use a novel approach to speed up the process yet ensure maximum quality. We employ our in-house licensed physicians and doctors, with more than 15 years of experience, to conduct all reviews. After the review, our medical professionals collaborate with the treating physicians in hope of lowering appeal rates.
We further upon the industry standards integrating our billing and utilization review platforms. Our utilization review results are electronically transferred to our bill review systems. This ensures that clients only pay for services that are approved by our experts.
Both utilization management and review cases are handled with the same approach. Our services surpass the accreditation standards of the industry.
Oracle Utilization Review And Management Services
Our services include the following.
- Review of all medical treatment plans by licensed and experienced doctors
- Simultaneous medical case review during treatment by Oracle’s doctors and physicians
- Direct collaboration with treating physicians ensuring the most appropriate treatment for patients
- Peer review of recommendations as and when necessary
- Integration with our billing system to ensure payment of only approved services
- On call basis customer support
- Quick turnaround
- Guarantee reduction of costs with appropriate treatment plan
- All types of utilization reviews
Types Of Utilization Reviews We Provide
We provide the following types of utilization reviews.
- Precertification Review
This review is the pre-approval process for treatment on the insurance policy’s list. It includes non-emergency hospitalization, nursing, rehabilitation, home care, outpatient surgery, etc.
- Concurrent Reviews
Concurrent reviews are requests of approval for current medical treatments of the patient.
- Retrospective Reviews
This reviews enables insurance companies to approve or deny medical coverage for treatment that has been received.
From review to the appeals, we take care of our customers like our own. We provide all sorts of treatment reviews and ensure that the best treatment possible is received for the lowest prices. We bridge the gap between patients and medical care providers and insurance companies. Hire our services and don’t lose out on valuable care for lower prices.
Insurance Payment Adjustments
Insurance policy terms can be quite confusing. Many a time insurance policies are misunderstood and patients end up paying more. Likewise, insurance companies end up paying more for treatment plans that are unnecessary. This is where insurance adjustment comes in.
Insurance adjustment is necessary for medical care providers, patients and insurance companies. At Oracle, we understand that slight miscalculations turn expensive for both care providers and insurance companies. We believe in bridging the gap.
How Do Insurance Payment Adjustments Work?
Insurance companies pay for treatment plans that are covered in the policy chosen by patients after a few years of the payment of premium. Most plans have deductibles. A deductible is the amount that is paid by the patient; insurance providers pay the rest. An adjustment is a part of the medical bill that has to be written-off by the medical care provider.
Just as insurance providers and policy holders enter contracts, medical care providers and hospitals also enter contracts. This enables hospitals to provide better treatments for lower costs and insurance companies to pay lesser for treatment plans.
Insurance companies pay lower than the amount charged by the medical institutions. The amount above what the insurance policy deems payable is known as the insurance adjustment. Medical providers who accept insurance discount the adjustment so as the policyholder receives appropriate treatment.
This is so because they believe that access to a greater number of patients is better than billing patients the full amount. Even if they receive payment from the insurance companies, with the greater number of patients, their services are profitable.
Insurance companies earn revenue with the premiums paid by policyholders who have not yet received any treatment. They also agree to pay amounts that are feasible to them.
How Does Oracle Help With Insurance Adjustments
Oracle believes helping those who ask for help. Our in-house licensed and experienced doctors review medical cases, advise on treatment plans and deduce the adjustments to figure out what can be reduced. Our novel approach of reviewing medical cases and electronically transferring them to our billing systems helps us reason with each party so no one loses out.
Our doctors are handpicked from various fields of medicine. They are well versed with latest treatment procedures and costs. Also, our service agents have a background of insurance management. Our doctors and agents collaborate with medical care providers and insurance companies to figure out plans that help all parties. Hire us and don’t lose out.
Verification Of Benefits
Verification of Benefits, often considered trivial, is a highly overlooked process in insurance management. However, if not done right, the processes that follow will fail.
Oracle prides itself on being the pioneers of insurance management processes, specifically Verification of Benefits. We strive to verify benefits of treatment providers’ patients, within an hour, with great precision and accuracy.
Our process is highly comprehensive; we do not miss a thing! We have a humungous database which keeps track of insurance policies and their outcomes within a moment’s reach. This enables us to provide the latest and accurate information to our clients who then inform their patients what claims they are eligible for. Our information includes everything from mental disorders to substance abuse.
Why Oracle Billing And Services
- We are accurate – You won’t find accuracy like ours anywhere in the country!
- We are timely –Perfection delivered each time, on time.
- We are informative –We pay attention; we find unreliable payers!
- We deliver fast – Short turn around on request
Our Work Ethic
Our team of Claim Representatives verifies benefits for our clients. Once an order is placed, a team member contacts the insurance company cross referencing all information.
If required, more team members are allotted to the task. On an average, a Verification of Benefits process takes about an hour. We set up a schedule on all the case files to be verified per day. Case files that have requested a shorter turnaround are prioritized first.
We are obsessed about quality; we strive to be highly accurate, no matter the turnaround. VOB is the first step in the billing process and we understand its significance. We not only provide the verification; we add a little bit of Oracle into the process – we provide a short benefit summary that is comprehensive and informative.
In addition, we provide information of the insurance carrier, the policy and any red flags we encounter during the verification. We also provide you with a short snippet explaining our experience with the insurance carrier.
We Are The Best
Our skilled staff find the latest eligibility and benefits in the shortest time possible – we’ve been doing it for years! We increase clean claim rates, help avoid rework and speed up reimbursement. We know what to ask, when to ask and how to ask to get the most accurate information possible. We are best at verifying. Don’t let incomplete information nab you of what is rightfully yours!
Let us do the Bill Work-Efficient and Constraint-sensitive!
It is a worrying state of affairs – doctors in recent days spend more time writing out paperwork; filling forms and processing transactions for their bills, than ensuring the welfare of the patient.
This is an issue that has to be addressed and we have taken the responsibility of addressing it. Our medical billing and coding team ensure that the relationship between doctors and their patients works out smoothly. We give room to our clients to focus more on their core profession; efficiently and effectively, we take care of everything else.
Saving Time: How we’re useful to medical institutions and physicians
Each of our billers can attend to an average of five clients per day. A quick turn-around time is a significant benefit of working with us.
With a 5:1 ratio of clients to billers, one might suppose that a quick turn-around time to be quite improbable. However, the trend in the industry happens to be that solutions providers surpass that turnaround time even with that kind of a ratio.
With the assistance of advanced technology, and the implementation of efficiency improving, revolutionary methods, we have hastened transaction processing. We always ensure that we meet the standards set by our clients.
Expenses: When less is more
The primary concern in any business is to lessen expenses but still maintain; improve, if possible, the quality of the end product. The reason medical billing and coding companies have been gaining in popularity recently is because they do exactly this.
Constraint-sensitive, but quality service is a rare gem. We devote ourselves to work once a client has chosen us. You can see our dedication reflected in the results of our other clients. You will see a remarkable improvement in results once you hire our medical billing and coding company.
Exceeding expectations with pinpoint precision
Our company is capable of designing a billing process that demonstrates and ensures the quality of the service rendered. According to a study, 8 out of 10 bills contain errors when done yourself, due to extreme pressure and lack of time in the profession.
We take a number of measures to ensure the transactions turn out 100% error-free. Through methods like meticulous data reviews and weekly call reviews, we perfect the process.
The key benefit of seeking assistance from us, besides 100%accuracy rates, 24-hour turnaround time, and cost effective work, is that our work will instantly and directly improve a client’s revenue cycle.
Importance Of Having A Professional Biller
There are two very critical components of the medical practice that are often overlooked, often done with little care – billing and coding. For the safety of the patient, efficient operations and rapid payment, these steps have to be undertaken with utmost accuracy.
In order to ensure these proceedings take place smoothly, adept professionals are required; skilled professionals who can maintain patient confidentiality; who can read, interpret, record and track complicated medical information quickly and efficiently.
Medical coding and billing is essential to modern medicine in the following ways:
- Complexity of Coding
During the treatment of a patient, information comes in to the doctor from many different sources and many different forms. This information can be about diagnoses, procedures, medicines, equipment, treatment etc.
Medical coding takes this information and translates it into alphanumeric code. Since it comes from a number of sources like medical notes, transcriptions, electronic records and laboratory results, it is a tricky and elaborate job best dealt with by certified professionals.
Blood work, urinalysis and pathology, and radiologic assessments; all have distinct sorts of codes. Medical coding professionals convert these codes and transfer them to medical billing systems and patient records. Coding is crucial to submit medical claims and bills.
- Patient Care
How well the coding is done indirectly relates to patient care, because it relates to insurance reimbursements. Coding is critical as it gives the insurers diagnostic codes. In today’s money-minded medical environment, appropriate payment ensures physicians can work to the best of their ability.
Coding is also crucial because it helps demographic assessments, treatment outcomes, studies of disease prevalence and reimbursement based on accountability.
- Complying with Regulations
Medical billing and coding have to comply with many federal and state regulations. One such guideline is the Health Insurance Portability and Accountability Act (HIPAA). It ensures confidentiality of personal information of the patient.
Also, practitioners are usually bound by contracts with insurance companies, and accuracy of billing and coding ensures that practices are compliant with the contract.
- Flow of the Revenue Cycle
Professional medical billers need to have specialized knowledge of different medical regulations, private and public insurance policies, claim follow-up, appeal submissions, claim denial resolution, and bill adjustments, and collections management.
All these facets of the billing process have to be managed proficiently in order to ensure the smooth functioning of the revenue cycle.
Therefore, a professional at medical coding and billing is significant in the process of healing a patient.
Accreditation of an organization by a governing body helps reinstate its quality of services. Alcohol and drug rehabilitation facilities that are CARF accredited are held in high honor. CARF accreditation is also necessary to apply for insurance and get paid. Oracle Billing and Services helps rehabilitation facilities achieve CARF accreditation by advising on business operations, improvement of services, etc.
Having helped many medical institutions achieve CARF accreditation, we know what the inspectors from CARF look for. Most rehabilitation facilities focus only on patient care. With our advice, improve other aspects of your facility in order to achieve the approval of inspectors.
CARF stands for The Commission on Accreditation of Rehabilitation Facilities. Founded in 1996, it is the international standardization organization for all alcohol and rehabilitation facilities. With the help of medical professionals CARF provides a standard framework that every institution should strive for. It is a non-profit organization which validates services provided by health and medical organizations.
How CARF Accreditation Helps Rehabilitation Facilities
Getting accreditation helps facilities and patients alike. CARF accreditation enables facilities to apply for insurance, funding, referrals and so on. It holds the facility accountable to the community. CARF accreditation promises better honor, results and more patients.
Get your alcohol and drug rehabilitation center accredited with our services. We take care of the whole process from application to inspection and accreditation!
With the same, insurance payers recognize superior performance. As a service provider, you will have the advantage of having clearly defined standards on par with internationally acclaimed institutions.
What Does CARF Accreditation Mean For Patients
A CARF accredited facility is acclaimed for:
- Reducing risk
- Addressing health concerns
- Addressing safety
- Respecting patients and individual preferences
- Providing the highest quality care
- Respecting patients’ cultures and backgrounds
With accreditation, rehabilitation facilities promise patients their value and are holding them accountable to the society. Each individual’s preferences are respected and specific commitments are made to each patient. Such an accreditation speaks very highly of the rehabilitation facility
Why Hire Oracle To Get Credited
Providing patient care requires all resources possible. Putting aside specific resources to get accredited not only reduces the quality of services provided but is also cumbersome and tiring. Moreover, most medical facilities are not familiar with the process. With professional accreditation services, get accredited in half the time! Oracle has been helping medical rehabilitation centers get accredited for more than 20 years! Hire us and get CARF accredited. We take care of you like you take care of your patients!
Accreditation of any firm by a standardization body is necessary to establish its quality of services. Medical facilities with JCAHO accreditation are held in high honor. JCAHO accreditation is required by medical institutions to apply for insurance. Oracle billing and services helps medical care providers achieve JCAHO accreditation. We help you from application to business operations and improvement of services.
With years of experience in helping institutions gain JCAHO accreditation, we know what inspectors from JCAHO look for. Most medical institutions focus on patient care which is not sufficient to achieve accreditation. We help improve other aspects of organization so that you can focus on patient care. We make it easier and quicker to achieve accreditation.
Why JCAHO ?
JCAHO stands for the Joint Commission on Accreditation of Healthcare Organizations. The JCAHO is an international standardization body that has accredited more than 21,000 health care institutions in just the US. Employing the help of experienced and noteworthy medical professionals, the JCAHO creates a standard framework that every health care facility has to strive for. A non-profit and tax-exempt organization, JCAHO validates services provided by facilities ensure quality.
How JCAHO Accreditation Helps Medical Facilities
Accreditation of a facility helps both the care-provider and the patient. JCAHO accreditation enables medical care providers to apply for insurance, funding, community help, referrals, etc. Accreditation promises better honor, results, patient care and number of patients.
With our services, get JCAHO accreditation faster. We take care of you like our own. From application to accreditation, we are with you.
Get more insurance companies into contract without and higher insurance payouts with JCAHO accreditation. Being a service provider, you will have a standardized framework to help you achieve your best.
JCAHO Accreditation Benefits For Patients
A JCAHO accredited facility is acclaimed for:
- Risk management
- Addressing health concerns and safety
- Respecting patients’ preferences
- Providing quality care
- Respecting patients’ cultures and backgrounds
With accreditation, medical facilities are deemed to promise patients their value, holding them accountable to the society. Specific commitment is made to each patient.
Why Hire Oracle To Get Accredited?
Your patients are your top priority! They require all resources possible. Putting aside resources and time to get accredited reduces the quality of services. Moreover, most medical facilities are not familiar with the accreditation process.
With Oracle’s services, get accredited in half the time! Hire us and get JCAHO accredited. We take care of you like our own.