Blog

 5 Reasons to Outsourced Medical Billing Services

5 Reasons to Outsourced Your Medical Billing
  • Avatar photo Victor Bala
  • Jul 17 2024

Have you ever experienced the overwhelming feeling of being inundated by a large number of invoices and receipts?

Are your claims and follow-ups negatively impacting your productivity?

“Are you experiencing the phenomenon of working longer hours than usual, at the expense of your personal and social life?”

“Does it seem like your recent activities have primarily involved pursuing payers in order to maintain the smooth operation of your revenue cycle?”

“Do you sometimes feel more like a professional medical biller than a physician, given that your attention is primarily directed towards claims and billing?” 

 You are not alone!

Outsourced medical billing services can be highly demanding for small medical practices. The medical industry constantly goes through tremendous change. Dynamic regulations and stricter norms that govern the industry continuously shape its evolution.

If there’s one thing that medical billing heavily relies on, it’s accuracy and precision. A misplaced decimal or a missing zero could result in a ruthless rejection. Hence, it is highly critical to pay close attention to it. If you take it upon yourself to scrape through the various stages of billing and claims, you’re likely to miss out on your optimal patient care services.

This leaves you with two likely choices: one, to your outsourced medical billing services to a professional medical billing company, and two, to onboard an in-house medical billing team.

If you own a medical practice and have read this far, you’re probably wondering if outsourcing could work for you. We’re here to help you with some pointers in that direction. We’ve put together a list of five reasons why we think outsourcing your medical billing services may be right for you.

Speed and Economy

Your outsourced medical billing services will cost you a lot less than hiring and training a medical biller for your practice. Look at it this way: when you onboard an employee, you’ll also have to account for his or her overhead, insurance, paid vacations, and training costs. In addition to these expenditures, you must consider infrastructure costs such as installation and maintenance.

There will also be instances where you lose revenue due to billing errors and inadequate billing practices. You can eliminate all these bothersome expenses with reliable outsourcing. Working with a professional medical billing company will make a world of difference when it comes to billing errors. This will subsequently help your practice receive swifter payments and reimbursements.

Professional medical billers, like Velan HCS, work closely with insurance companies to better understand their processes, resulting in a shorter revenue cycle for clients.

More stress-less time

Managing and owning a medical practice is a challenging task. And as a physician, you’re likely to have a full plate. To be laser-focused on what you do best, i.e., treating patients, you should relieve yourself of the headaches involved in billing. We know you don’t have time to worry about tracking your medical billing or following up on a clearance claim. Working with a medical billing company allows you to free up your time and finally feel like a physician again.

The dynamic and ever-changing regulations constantly create headaches, even for in-house medical billers. With the ever-impending threat of an inspection, many medical practices are turning to professional medical billers.

If you don’t want to worry about compliance or chasing denials, let the billing company handle it. So you can finish that crossword puzzle before work, let them try.

Money

Outsourcing can save your practice thousands of dollars in annual salaries, perks, medical insurance, office supplies, furniture, software, equipment, and other costs. The software and billing equipment would require periodic upgrades and maintenance.

Most medical billing service providers charge a flat rate per claim. Some billing companies charge a percentage of the reimbursement on each claim, which might at times exempt charges on a failed claim. Either way, all this will account for a lot less than what you would pay for an in-house medical billing team.

So, why not save your practice some money, keep the revenue cycle ticking, and provide exceptional services with a primary focus on patients by simply outsourcing your billing?

Customer Satisfaction

Now that you’ve got the billing fiasco out of the way, you can spend more time doing what you do best: patient care. You’ll now have enough time to provide quality care to your patients. This will be highly desirable, especially for smaller physician groups that cannot afford large medical office staff. If you are bogged down by the financials of running a practice, it is likely to hurt the patient care that you provide.

A 4.8-star rating for your medical practice on Google is likely to generate more business for your practice than a 3.2-star rating. These are purely based on the customer service you offer. So, the ability to provide patients with excellent customer service can both retain old patients and generate new ones. However, juggling between the demands of rendering optimum customer service and handling billing issues effectively is almost impossible. 

Improved billing compliance and increased cash flow

One of the many hurdles in medical billing is coping with the changes according to regulations and authorities. Insurance companies are partially culpable. One aspect of third-party payers is their special task force that looks into whether a medical office that has agreements with such a party payer does everything possible to follow the protocol each payer demands. It is therefore very important for medical billing service administrators to keep an eye on recent changes in norms and regulations so that they can maintain compliance and submit clean claims.

COVID-19’s effects on medical billing and the healthcare sector are significant.

Medical billing, the critical link between medical coders, insurance companies, healthcare providers, and patients, is a key part of the overall revenue cycle for hospitals. A medical biller is there to ensure that the healthcare provider receives proper reimbursement for insurance claims, so he will always put his patients’ health first (that’s straightforward if we consider that he also works in a dental office). asserts.

Medical billing efficiency gets even more critical. One of the impacts as a result of COVID-19 is that we are losing the ability to bill out for certain lost revenue. Now more than ever before, this shines light on our need for medical billing efficiency. For the U.S. hospital, a moderate influx of COVID-19 patients is linked with an average decrease in gross revenue of 50%, according to surveys. An effective medical billing system, which could be in-house or outsourced, guarantees a steady revenue cycle and also ensures there won’t be any further exacerbations.

COVID-19 is taking its toll on the healthcare industry.

Combining the loss of jobs driven by COVID-19 and a massive reduction in revenue from Medicare funding, it is expected that there will be a logical move away from the post-commercial insurance era towards some form of socialized or government-backed model.

Meanwhile, government programs pay for nearly 50 cents (45.7 percent) of every dollar spent on healthcare—even more considering that some nonprofit services and institutions used by publicly insured patients are excluded from the totals. People’s payroll contributions largely fund these services through Medicare. Reports indicated that this would further strain Medicare, with 30 million Americans unemployed and another 27 million at risk of losing their employer-based insurance coverage, reducing payroll contributions to company fund authority for the program and leaving it insolvent.

This is going to hit all of those healthcare billing service providers who have been using their margins from commercial insurance to subsidize the losses they take on poorly reimbursed government programs. Without this scuttling of costs, healthcare providers could see a sharp loss in revenues as more government-funded programs are held as alternatives.

As people refrain from going to hospitals, telemedicine companies are also growing. Telemedicine and digital health can be key tools to achieve the goal of high-quality care at a lower cost. VC funding in this segment grew to $7.4 billion in 2019, and there is even more room for tech-enabled remote monitoring and diagnosis going forward.

The Future of Medical Billing and Coding Services in the Healthcare Industry

The capacity of the worldwide healthcare system to tackle COVID-19 has been demolished. There is a tremendous dearth of medical staff, places, and emergency centers for the healthcare industry as it becomes overburdened. During COVID-19, the healthcare industry must direct medical accounting and healthcare professionals where needed most while ensuring safety for staff to keep patient care operations running.

At the same time, patients are also responsible for their financial burden, as some have left medical bill obligations unmet in the wake of coronavirus symptoms.

Ever since the inception of AI tools, there has been a significant drop in all sectors using traditional methods. The same goes for the health sector. Automation and AI are doing heavy lifting on medical coding tasks that used to be very difficult because they were time-consuming.

As the patient base evolves and regulations change, providers need help keeping up with a constantly growing healthcare environment. Businesses in the healthcare field have turned to technology as one of their means to survive and thrive in a competitive market. This technology automates billing, payments, and all other administrative work.

One of the ways to guarantee quick reimbursement is through medical billing automation. In addition, when using automated medical billing software, providers can also generate superbills and submit claims right after the patient has been treated.

This seriously decreases the number of unpaid claims, and it helps get money back in your pocket much faster.

Conclusion: RCM’s Future in AI

It allows for the automatic completion of manual invoicing tasks, making the bill process more efficient. This means AI can automatically spot errors in claim submissions, allowing payers to correct them before processing. This frees up doctors and other professionals to focus on more important matters than fixing patients’s mistakes.

Given the constant flux of regulations and business trends, staying current on the latest technology is important, as that area changes constantly with new ways to reduce costs, increase efficiencies or make money.

This can be done by integrating AI with the revenue cycle management processes. Faster revenue cycle management processes: Data-driven administrative duties are automated, lowering the amount of administrative waste.

Benefits of medical billing & coding services

Invoicing software is used to automate most of the process so that you can say goodbye to stacks and files of paperwork. This manually accomplished job makes businesses susceptible to mistakes, but invoicing cookies might cut documents in half.

By enabling medical billing outsourcing services automation, paperwork and associated errors in physical form submissions can be reduced.

Automated invoicing systems help cut down on the number of errors made in managing claims and billing, as they provide easy options for processing them without breaking a sweat.

Eliminate paperwork in healthcare using automatic invoicing, which helps you save hours on form-filling.

By automating all our billing, we were able to save a lot of time and effort.

Given miscommunication and the different billing practices from one payer to another, this calls for a more accurate system of medical billings. In general, these billing errors could develop and rapidly circulate over the years.

By automating your billing process, you will free up more time to spend with patients face-to-face. Long-term patient health is beneficial for your clinic. Better doctor-patient relationships only mean superior outcomes for patients and, thus, better financial gains in the long run, i.e., the continued existence of your practice!

Automated billing: increasing accessibility for patients

The procedure and availability of patient billing data are improved by means of this automated medical billing software. Patient data is accessible via remote.

In turn, this allows you to centrally update accounting information and chase overdue payments that your staff can access when in the office or out on the job.

Speedy, more efficient payments require access to trusted and well-rounded information.

Medical Invoicing + A.I.

One of the most powerful healthcare AI applications is to automate invoicing and coding. Automation can help clerks do their billing tasks much faster and more accurately than they normally would.

AI can also identify and correct billing errors. That could decrease hospitals’ and clinics’ overall loss from billing errors.

Artificial intelligence collects and processes data on patient care to assist healthcare professionals in measuring trends and patterns. Using this data, the treatment and care strategies of the patient can then be optimized.

Benefits of AI in Medical Invoicing

Medical billing and coding services across all healthcare sectors. You can better understand the implications by considering the following advantages:

We can automate the coding process to create a low-skilled invoicing specialist solution that scales.

By issuing properly timed and accurate patient statements, you can improve cash flow.

A reduction in the normal work week for administrative staff could lead to productivity gains.

Real-time auditing bypasses the problem of not being able to identify an error in time to rectify it without spending a lot.

AI reduces the number of people and hours required to train manually to perform these tasks.

In addition, with AI, you can reduce the number of customer service inquiries or disputes regarding patient statements and save on other operating costs.

 
Top Barriers in Healthcare for AI

Complex code systems use sensitive ICD-10 and CPT codes that are hard to automate in medical invoicing.

Accuracy of the model in outsourced medical billing services, AI precision, and recalls are two popular indicators used to evaluate an evidence model; they, however, show more data integrity issues because medical billing continues inconsistently with false or incomplete claims due to deliberate overbilling practices for profit’s sake.

Integration with legacy systems: Many healthcare organizations still rely on older technology tools and may need to connect their existing technologies to the latest AI or automation innovations.

Difficulty in transforming: Obstacles in adoption: The integration of AI and automation solutions in healthcare may encounter difficulties due to the hesitancy of healthcare providers and billing businesses to transition from conventional techniques.

Cost and resource implications: AI and automation solutions often require heavy investments in hardware as well as skilled personnel to operate efficiently. This will be an impossible goal for some organizations.

Vagueness: The invoicing decisions made by AI can be opaque, which perpetuates errors and doubt.

Cyberthreats: The more that medical billing outsourcing services are automated, the greater the likelihood of data being exposed by hackers.

Best practices for billing and data protection

HC C&BT will implement important steps to secure sensitive data.

Protocols for encryption

We use advanced encryption algorithms to protect sensitive patient and financial information. In healthcare billing services, these protocols ensure the security of any PHI data exchanged between vital healthcare components, including providers, insurers, and invoicing entities. This also helps healthcare organizations comply with regulatory standards like HIPAA, which increases trust among patients and stakeholders and ensures better integrity through greater reliance on the medical invoicing process.

Access controls include

Access controls are used to enforce permissions, which ensure that only people with the need and right can access certain system information. This is particularly useful, as it helps to limit the amount of restricted data and who can view or modify invoice data in any coming transactions. Improves security for known issues and meets healthcare laws (e.g., HIPAA). Access controls are critical to protecting patient trust and creating confidence for the administration of sensitive healthcare information in an appropriate manner based on the confidentiality, integrity and availability of RCM or relevant data.

Authentication mechanisms

The authentication methods in such systems usually use two-factor security, which generally involves users requesting more than one type of verification, either a combination of passwords, smart cards, or biometrics. Robust authentication protocols used by healthcare organizations help reduce the probability of data breaches and unauthorized access.

Perform routine audits and monitoring

Ensuring the invoicing system is running with integrity—thanks to continuous auditing and real-time monitoring of its activities—helps detect any irregular behavior. Furthermore, practices can assure compliance with industry regulations like HIPAA and detect any discrepancies in billing records sooner.

Firewalls and intrusion prevention systems

However, firewalls and intrusion prevention systems should be put in place to control the flow of network traffic and protect your brand from cyber threats, as well as prevent any unauthorized access. With the convergence of these technologies, a robust stance can be taken to ensure that patient and financial data are secure from intrusions. Firewalls and IPS: These also increase the overall resilience of invoicing infrastructure by securing against unauthorized access and other unwanted traffic.

Employee training and awareness

Have an informed and educated staff. Having an educated and trained staff is paramount to preventing security breaches and maintaining compliance with regulations such as HIPAA. Dangerous, clumsy leaks of information are prevented through continuous training regarding the best practices for protecting data and developing a real awareness culture. Training programs that inform employees of the most current safety concerns, along with data protection protocols and proper management of sensitive information.

Drawing from the above points, technology-driven billing systems can help protect the confidentiality of sensitive financial and personal information through their approach to secure patient data, and so on.

Why Velan HCS?

Background details and experience in outsource medical billing services over more than a decade have given us exposure to the intricacies that come along with it. We keep on top of every new rule that could help with your cases.

We look forward to providing our services and becoming a part of the Velan family, consistently meeting your billing requirements.

If you would like to know more about what we do and how to be better at it, go check out our site for outsourced medical billing services, or fill out the form below and request a free quote.

Call us today.

Embrace a stronger canvas for a smooth journey through the maze of receipts!

Our expertise in medical billing at Velan HCS can help you decrease denials and expedite the clearing of your claims.

Over 95% of the time, we at Velan HCS send in clean claims.

Avatar photo

Victor Bala

Medical & coding

About the Author:

Victor has over a decade of experience in delivering revenue cycle management services to the US healthcare providers. He has a proven track record of accelerating revenue collection by streamlining the billing, coding and AR processes. His team at Velan has been delivering revenue cycle management cycle, appointment scheduling, pre-authorization and credentialing services to physicians, group practices, and hospitals.

He can be reached at [email protected]

A Growing Collaboration Between US Healthcare Providers and Indian Outsourcing Companies

US Healthcare Providers and Indian Outsourcing companies
  • Avatar photo Victor Bala
  • Jul 12 2024

To survive the challenging times in the US healthcare industry, a number of companies have come up with some fairly creative and unusual ways to reduce expenses, boost revenue, shorten turnaround times, and streamline operations. Most enterprises usually give top priority to a contract with a reputable medical billing outsourcing company, which is virtually ubiquitous in India.

At first, it was thought to be a cost-cutting measure to contract with a medical billing company to handle part of the revenue cycle management. Cost-cutting by itself, though, will not meet the demands of American healthcare providers. They need practically immediate help from a service provider who functions as an extension of their company and can handle unforeseen workload increases, which are a natural part of the business.

For businesses that contract with outsourced medical accounting services for billing, judicious turnaround—which is usually a major operational barrier in the market—is no longer an issue. Actually, it is widely known that Indian medical billing service providers are well-oiled machines that can quickly manage unforeseen surges in job volume, even if they approach 40%, without delaying turnaround times. Any client will definitely be pleased with this kind of business continuity.

The Emergence of Healthcare Outsourcing

Although outsourcing is not a novel idea in the healthcare sector, in recent years, these partnerships have expanded dramatically in both scale and importance. Outsourcing certain aspects of operations to specialized service providers in nations like India is increasingly bridging the gap between the United States’ healthcare system and the global workforce.

Why do US healthcare providers choose Indian outsourcing firms?

Many times, medical billing outsourcing companies kept medical professionals in the dark. The times have surely changed. These days, outsourcing companies have grown. They provide clients with regular analytical reports and discuss operational specifics with them in order to help them make wise decisions about their long-term growth.

  • Cost savings: The group has grown mostly because US healthcare providers are able to achieve substantial cost savings. Outsourcing to Indian companies is a desirable choice because India has substantially lower labor and operating costs than the United States.
  • Expertise and Quality: Processes and technology in this field are often well-known to Indian outsourcing companies. They engage very talented professionals who are proficient in doing challenging tasks, including radiography reporting, billing, typing, and medical coding. This experience contributes to raising the standard of service.
  • Compliance and Data Security: Indian outsourcing companies comply with stringent US data security and privacy laws, particularly HIPAA. They make investments in robust security measures and policies to safeguard the integrity and secrecy of patient information.
  • Scalability: Healthcare providers have the flexibility and responsiveness to change demand and adjust their outsourcing needs up or down as necessary. This scalability is particularly helpful in the frequently changing healthcare industry.

Increased patient satisfaction is the outcome of US healthcare providers reallocating their resources and attention to important activities like patient care, research, and innovation by outsourcing non-core tasks.

The Effect on Industry

  • Cost reduction: By allowing healthcare providers to significantly reduce operational costs, patients may eventually pay less for their services.
  • Enhanced Efficiency: Healthcare professionals can reduce errors, streamline processes, and increase overall efficiency.
  • Increased Patient Care: Better results and patient satisfaction come from healthcare staff having more time to provide patient care when the administrative burden is lessened.
  • Technology Developments: Indian outsourcing companies regularly make investments in state-of-the-art software and technology, giving US healthcare providers access to the newest developments in healthcare administration and IT.
  • Global Partnership: By encouraging the sharing of best practices and healthcare innovation, international partnerships between healthcare professionals in the US and India develop a worldwide perspective.

Obstacles and Points to Remember

There are certain challenges, even if the cooperation between US healthcare providers and Indian outsourcing companies has many advantages. These could be time zone differences, communication barriers, or regulatory compliance. To allay these fears, healthcare providers need to carefully choose their outsourcing partners and put in place strong communication and security procedures.

Different research on the US outsourcing market revealed that Indian outsourcing companies helped businesses that decided to outsource save over $6 billion.

Indian medical billing companies are partnering with US companies to support the US healthcare industry as it progresses into the next stage of ongoing growth.

Own an American healthcare business?

Handling healthcare revenue cycle management services in-house is a challenge. Velanhcs skilled RCM team can manage it, offering you a sense of comfort and future focus on customer service. Contact us now!

Avatar photo

Victor Bala

Medical & coding

About the Author:

Victor has over a decade of experience in delivering revenue cycle management services to the US healthcare providers. He has a proven track record of accelerating revenue collection by streamlining the billing, coding and AR processes. His team at Velan has been delivering revenue cycle management cycle, appointment scheduling, pre-authorization and credentialing services to physicians, group practices, and hospitals.

He can be reached at [email protected]

Billing in Gastroenterology: A Complete Guide

Gastroenterology Billing Overview
  • Avatar photo Victor Bala
  • Jul 11 2024

Any gastroenterologist knows that GI services are hard to bill. To receive payment for the delivery of your services, you have to comply with a large number of codes and regulations. This blog post reviews key principles for billing GI services. We discuss everything from CPT codes to ICD-10 codes. We will also provide tips on how to earn higher pay for your services. Therefore, if you are ever interested in a how-to-bill GI series with much-needed guidance about billing for your gastroenterology services,.

Gastroenterology Definition

What is Gastroenterology medical billing? It is a segment of medicine that deals with the diagnosis and treatment of diseases impacting the stomach, esophagus, large intestine, small intestine, gallbladder, biliary tree, and pancreas. Gastroenterology has a wide range of diseases, from common ones like diarrhea and heartburn to serious ones (e.g., colitis and cancer). They also provide colon cancer prevention and screening. Gastroenterologists are trained in endoscopy, a procedure that requires the use of tubes or scopes to see inside body cavities. Gastroenterologists use endoscopy to treat and diagnose conditions like ulcers, tumors, or blockages. Naturally, as medical practices evolve with time, gastroenterology is one of the specialties that tend to experience sudden growth and changing procedures.

Gastroenterology Medical Billing Services

Medical billing is the process of submitting and following up on claims to health insurance companies in order to receive payment for services rendered by a healthcare provider.

Coding: Conversion from billing to numerical codes related to medical diagnoses and treatments. The importance of medical billing and coding in gastroenterology is that they help clinicians get reimbursed for the services offered to a patient.

Endoscopies, colonoscopies, and upper GI endoscopies are some of the procedures performed by gastroenterologists. All of these standardized procedures can be utilized with a specific code that represents the medical procedure used to prescribe drugs or medications under insurance, so long as the mentioned process is completed successfully. To process claims properly, medical billers and coders need to be knowledgeable about diagnosis codes in addition to procedure codes. Many diagnostic codes can be used by gastroenterologists (e.g., GERD, abdominal pain, and celiac disease). When it comes to medical billing and coding in gastroenterology, the range of services can tend to make things challenging. Nevertheless, gastroenterologists can make sure that their claims are submitted accurately and promptly by working with trained medical billers and coders.

Outsourced Gastroenterology Billing Workflow

When a patient receives medical care from a provider, such as in the office of a doctor or outpatient clinic (or hospital), the process starts. The provider will then create a claim; essentially, this is the same as an invoice in any business except that it lays out what services were provided and how much each one of them costs. This sends the medical claim to their insurance for payment. The insurance carrier also has to process your medical claim and determine if it adheres to its provisions for you to receive payment. For each medical claim that is approved, the insurance company will pay for a portion of or the full cost of whatever service is provided by the provider. Medical billing is a complicated process, and providers have to understand it so that they will receive payment for their services. Medicine is complicated, and gastroenterologists should work with experienced medical billers to ensure their claims are correct.

Top Professional Outsource Healthcare Billing and Coding Services

Outsourcing medical billing can be an effective way for healthcare providers to manage their revenue cycle efficiently. One of the primary benefits of outsourcing is the ability to leverage the expertise of specialized billing companies that are well-versed in the nuances of medical billing and coding. This is particularly beneficial for gastroenterologists, who often deal with complex procedures and a wide range of diagnostic and procedural codes.

Velan HCS is one such company that provides comprehensive medical billing, credentialing, and accounts receivable management services. They specialize in ensuring that claims are accurate and compliant with the latest healthcare regulations, which can significantly reduce the likelihood of denials and improve overall revenue.

Outsourcing can also save time and reduce costs. Medical practices do not need to invest in hiring and training staff or maintaining the latest billing software. Instead, they can focus on providing quality patient care while the billing company handles the administrative burden. However, it is important to choose a reliable and experienced billing partner to avoid potential issues related to control and data security.

Coding and Billing in Health Care: Best Practices for Gastroenterology

Medical billing for gastroenterology is the process of submitting and following up on claims with health insurance companies to receive payment for services such as office visits, colonoscopy, endoscopic retrograde cholangiography (ERCP), and endoscopic ultrasound (EUS). A medical coder takes the text in a patient chart and applies codes to diagnoses and services per an established classification system so claims are accurately processed by payors (and you get paid). Gastroenterologists are required to familiarize themselves with the coding system used to correctly code for the medical services rendered. Another step for pathologists (and other providers) is to be knowledgeable about the criteria established by various insurance companies and third-party payers to avoid denial of reimbursement. Following coding guidelines will help ensure your medical billing is correct and payouts come through on time for gastroenterology.

Billing and Coding for Upper Gastrointestinal Endoscopy

The following ICD-10-CM codes support medical necessity and offer coverage for CPT codes: 43200, 43201, 43202, 43204, 43205, 43206, 43212, 43215, 43216, 43217, 43220, 43226, 43227, 43229, 43231, 43232, 43235, 43236, 43237, 43238, 43239, 43240, 43241, 43242, 43243, 43244, 43245, 43246, 43247, 43248, 43249, 43250, 43251, 43252, 43255, 43257, 43259, 43260, 43261, 43262, 43263, 43264, 43265, 43266, 43270, 43274, 43275, 43276, 43277, and 43278.

In certain cases, a physician may need to state that a procedure or service was unique or independent of other services, and CPT® modifier 59 may be appropriate depending on the circumstances. CPT® Modifier 59 is used to identify procedures or services that are not generally reported simultaneously. This includes the following procedures or services that are not commonly encountered or performed on the same day by the same doctor:

  • A different session or patient interaction
  • A different procedure or surgery
  • A different site or organ system
  • A separate incision/excision
  • A separate lesion
  • A separate injury (or area of injury in serious injuries)

When an existing established modifier is acceptable, it should be used instead of CPT® modifier 59. CPT® Modifier 59 is an important National Correct Coding Initiative (NCCI)-linked modification that is frequently misused. It should only be used when no other descriptive modifier is available or when it best describes the situation.

For example, the 59 modifiers can be used with the codes shown below:

  • 45380 — Flexible colonoscopy with biopsy, single or multiple
  • 45385 — Flexible colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) using the snare technique
  • 45386 — Flexible colonoscopy with trans-endoscopic balloon dilation
  • 45387 — Flexible colonoscopy with removal of tumor(s), polyp(s), or other lesion(s) using hot biopsy forceps or bipolar cautery

Proper coding and modifier use are crucial for accurate billing and avoiding claim denials. Gastroenterologists must stay updated on coding guidelines and payer policies to ensure compliance and maximize reimbursement.

ICD-10 and CPT Codes in Gastroenterology

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the Current Procedural Terminology (CPT) codes are essential tools for gastroenterology billing and coding. These codes standardize the reporting of diseases and procedures, facilitating accurate billing and insurance claims processing.

ICD-10-CM codes are used to describe the patient’s diagnosis, while CPT codes are used to describe the medical procedures and services provided. For example, a colonoscopy might be coded with CPT 45378, and a diagnosis of irritable bowel syndrome might be coded with ICD-10-CM K58.0.

To ensure proper reimbursement, gastroenterologists must use the most specific and accurate codes available. This often involves keeping up with annual updates to the coding systems and payer guidelines.

Challenges in Gastroenterology Billing

Billing for gastroenterology services comes with a unique set of challenges. These include dealing with a wide variety of procedures, each with its specific codes and guidelines, as well as managing the documentation and coding for complex cases that may involve multiple procedures or comorbid conditions.

Another significant challenge is staying compliant with constantly changing regulations and payer policies. Failing to adhere to these can result in claim denials, payment delays, or even audits and penalties.

To navigate these challenges, many gastroenterologists turn to specialized medical billing services. These services can provide the expertise and resources needed to manage billing effectively, ensuring accurate claims submission and timely reimbursement.

Top Professional Outsource Healthcare Billing and Coding Services

Outsourcing medical billing can be an effective way for healthcare providers to manage their revenue cycle efficiently. One of the primary benefits of outsourcing is the ability to leverage the expertise of specialized billing companies that are well-versed in the nuances of medical billing and coding. This is particularly beneficial for gastroenterologists, who often deal with complex procedures and a wide range of diagnostic and procedural codes.

Velan HCS is one such company that provides comprehensive medical billing, credentialing, and accounts receivable management services. They specialize in ensuring that claims are accurate and compliant with the latest healthcare regulations, which can significantly reduce the likelihood of denials and improve overall revenue.

Outsourcing can also save time and reduce costs. Medical practices do not need to invest in hiring and training staff or maintaining the latest billing software. Instead, they can focus on providing quality patient care while the billing company handles the administrative burden. However, it is important to choose a reliable and experienced billing partner to avoid potential issues related to control and data security.

Another reputable outsourcing option is Billings Clinic Gastroenterology, which offers end-to-end revenue cycle management services. MBC’s team of certified coders and billing specialists ensures that claims are processed accurately and efficiently, helping healthcare providers maximize their revenue.

Additionally, Accurate Billing provides tailored billing solutions for gastroenterology practices. Their services include claim submission, denial management, and patient billing, all designed to streamline the revenue cycle and reduce administrative burdens on healthcare providers.

When choosing a medical billing service, it’s essential to consider factors such as the company’s experience in gastroenterology billing services, its compliance with industry standards, and its track record of success. By partnering with a top professional outsourcing service, gastroenterologists can ensure that their billing processes are efficient, accurate, and compliant, ultimately leading to better financial outcomes and more time to focus on patient care.

Conclusion

Effective billing in gastroenterology requires a thorough understanding of coding systems, payer policies, and the specific challenges associated with GI procedures. By staying informed and leveraging the expertise of professional billing services, gastroenterologists can optimize their revenue cycle, reduce claim denials, and ensure timely reimbursement for their services.

Whether you choose to manage billing in-house or outsource to a specialized company, the key is to maintain accuracy, compliance, and efficiency in your billing processes. This will not only improve your practice’s financial health but also allow you to focus more on delivering high-quality care to your patients.

Avatar photo

Victor Bala

Medical & coding

About the Author:

Victor has over a decade of experience in delivering revenue cycle management services to the US healthcare providers. He has a proven track record of accelerating revenue collection by streamlining the billing, coding and AR processes. His team at Velan has been delivering revenue cycle management cycle, appointment scheduling, pre-authorization and credentialing services to physicians, group practices, and hospitals.

He can be reached at [email protected]

Ambulatory Surgical Center Billing: Current Trends, Common Billing Errors, and Six Important Things to Know

Ambulatory Surgical Center Billing: Current Trends
  • Avatar photo Victor Bala
  • Jul 9 2024

Ambulatory Surgical Center (ASC) billing outsourcing services simplify and streamline the process, leading to a greater return on investment (ROI). Offshore Outsourcing can help US-based Medical Billing Companies gain better benefits and profitability. Ambulatory Surgical Centers have more criteria and specialty-based subtleties when it comes to charting out claims and processing them with insurance payors, making it difficult and time-consuming to manage in-house. To understand why outsourcing has become the latest trend in ASC, let us try to comprehend the intricacies involved in billing for ASC.

What is an Ambulatory Surgical Center?

Ambulatory Surgical Centers are organizations that offer outpatient surgical services as part of a large medical group, a hospital, or as a standalone facility. CMS has stipulated that only specific surgical procedures can be performed in an ASC setting. These characteristics and standards from CMS and Medicare protocols distinguish ASC from other specialties. As a result, the medical billing process for ASC can be relatively complex and intricate.

ASC Medical Billing and Coding Challenges

As they are mostly a combination of hospital and physician medical billing claimed on the professional claim form CMS 1500, medical billing and coding for ASC can be very different from other medical specialties or the typical physician billing or facility billing.

  • ASC billing utilizes Current Procedural Terminology (CPT) and Healthcare Common Procedural Coding System (HCPCS) codes.
  • Because ASCs cover the majority of hospital-based treatments but are billed on the physician billing claim form, billing and coding for ASC services can be very varied and variable, even if the same principles and protocols are followed.
  • CMS and Medicare only allow certain surgical procedures to be performed in ASCs, making insurance billing and reimbursement difficult due to OON coverage restrictions.
  • It is required for ASC to deliver services that have been diagnosed by primary care physicians.
  • Frequent updates to coding guidelines and billing requirements can further complicate billing and coding for ASC, necessitating an experienced billing and coding team with an understanding of ASC claims processing.

With the rising attrition rate and staffing challenges caused by the current pandemic, it can be difficult to find and keep highly skilled ASC billers and coders. Inadequate or inexperienced workers might have an impact on revenue cycle management and monthly collections. Offshore outsourcing can provide you with a professional staff to rely on during times of hardship or uncertainty. Outsourcing ASC billing can be useful in several ways, as outlined below:

  • Skilled claim management, with an awareness of the subtleties of specialization and customer.
  • Insightful approach with insurance carriers, understanding how to deal with claim rejections, denials, and low payments, ensuring that the claim is closed with the maximum compensation.
  • Unlike in-house billing, which can be hampered by employee absenteeism and attrition, we provide continuous service coverage.
  • It eliminates the overhead costs associated with hiring, recruitment, training, staffing, infrastructure, upgrading to advanced technological tools, and adjusting your workforce to them.
  • Dedicated team and account managers to guarantee that the entire revenue cycle management process runs smoothly and stress-free, with a focus on your bottom line.

Current Trends in Ambulatory Practices

ASC hospital and ambulatory surgery center billings have been turbulent for almost all industries in 2021, including the medical field. Across healthcare, many specialty-based practices and medical groups saw drastic declines in patient volumes they never anticipated or could afford.

Ambulatory Surgical Centers (ASC) suffered significantly during COVID-19 and the pandemic. However, recent trends show that ASCs are the fastest-expanding section in the medical field. Ambulatory surgical center trends are discussed in this article.

Upgraded Technology and Techniques:

New technology for non-invasive procedures has recently emerged, as have advanced operating room configurations. What is clear, though, is that you want to keep your ASCs at the top of their games by updating them with newer technologies to maximize financial benefit and achieve continuous business success.

Telehealth & Virtual Care:

Thanks to state-of-the-art technology updates, professionals can now pay attention to how they want to provide patient care. Mobile Apps, Telehealth Settings Drive Boost in Patient Visits Ambulatory Practice: Virtual or remote patient care has been a boon for the practice to be successful.

Prioritize patient care:

For that matter, ASC has to eliminate all distractions to deliver only shared attention, resulting in quality treatment and patient delight. As opposed to being an in-patient or hospital stay, at ASCs, patients have their surgical procedures within the specified time frame, which is typically 24 hours. During these brief hours of service, both physicians and patients anticipate a stress-free environment to facilitate treatments. With a team of billing and coding experts handling the billing functions, ASCs should be able to establish themselves as the top service provider in their area.

ASC Billing and Coding:

Coding criteria for ASC are continuously revised, and coders and billing teams should adhere to the CMS guidelines to avoid errors that lead to denials. With skilled coders and billers assigned to manage ASC billing, any practice should be able to withstand the pandemic and beyond.

Running an ASC practice is no simple task, and when it comes to billing, it is better left in the hands of a billing partner who specializes in providing medical billing services exclusively for an ASC. Thus, this indirectly ensures your safe and secure billing, which leads to commendable cash flow and affects patient care.

Offshore Outsourcing

The benefits of offshore outsourcing revenue cycle management are certainly greater.

Time and cost savings:

For billing partnerships, offshore outsourcing has been turning out to be the most suitable option for everyone because it saves time and costs too. As we see, amidst a global pandemic, offshore has grown to an even larger scale of outsourcing than what most practices and billing companies have currently been using in their business models.

Ambulatory surgical center billing services has the following advantages:

  • A well-established medical billing company has hands-on experience handling the multi-specialty billing procedure.
  • Experienced and skilled crew with frequent training for upgrades and modifications.
  • Coders and billers have experience managing claims for multiple payers, making it easier to adjust to billing requirements that are specific to the client or payor.
  • Increased quality and denials are under control.
  • Efficient accounts Receivables and Denial Management.
  • End-to-end Revenue Cycle Management.

Common Billing Mistakes That Drive Down the ASC Revenue Cycle

Let us examine in depth the billing errors that push down the ASC Revenue Cycle.

Insurance eligibility and benefit verification are missing from ASC billing

Verifying insurance eligibility and benefits before service coverage is critical for determining payment responsibilities and avoiding unneeded confusion and follow-ups after services. This will also help to reduce major reimbursement delays caused by incomplete or incorrect claim information.

Failure to get prior authorization and a referral:

To improve the quality of the billing process, the streamlined process should include ensuring that proper authorization and referral numbers are received as needed by the policy.

Delayed Claim Submission:

The difficulties associated with billing for ASC may result in delayed claim submission; yet, it is critical to ensure that the files are completed and sent within the Turnaround Time (TAT). This can be accomplished by implementing a streamlined billing procedure and assigning a skilled and experienced team to manage ASC claims.

The Billing Process Is Not Streamlined:

Ambulatory surgical center billing services can be more difficult and complex than billing for other specialties; nevertheless, a streamlined billing approach with suitable rules and process protocols can help avoid billing errors and ensure smoother and faster invoicing.

Neglecting Critical Information:

Understanding payer contract subtleties, coding specific criteria, and adhering to CMS contract laws and regulations will all benefit your bottom line. Furthermore, ASC billers should be updated with managed care contract payment techniques and carrier-based policies to ensure your process is intact at every phase of revenue cycle management.

Medicare Payment Guidelines for ASC Billing Ignorance:

Medicare has established payment standards for ASC billing services, which state that ASC services are covered by Medicare Part B and that claims must be submitted solely in Claim Form CMS 1500. Some commercial payors accept ASC claims in CMS 1500, and other insurance companies accept the UB04 claim form. Here are the Medicare ASC billing and claim filing guidelines:

  • ASC cannot include different line items or HCPCS Level II codes on separate bills for procedures, services, medications, equipment, DME, and so on.
  • ASC will be compensated for these, but they will be included as a package in the authorized payment. For example, the budget for surgical treatments will include all services, medications, gadgets, post-operative pain management, and other expenses.

Outsourcing ASC Medical Billing

With all of the complications outlined above, Ambulatory Surgical Center (ASC) billing and coding require a competent and streamlined strategy to ensure maximum efficiency. Outsourcing ASC medical billing to an offshore medical billing company with high customer retention and experience managing various specialties might benefit your entire financial health.

6 Important Things to Know About Ambulatory Surgery Centers Billing and Coding Services

Many providers and healthcare organizations work with professional medical billing companies in the hopes of receiving ASC billing services as well. However, most US medical billing organizations lack the expertise to handle ambulatory surgery center billing. ASC medical billing and coding differ from processing traditional physician billing claims. It has numerous variations and is highly sophisticated in terms of billing and coding. Because there is potential for significant claim denials, the in-house medical billing team cannot handle both conventional and ASC billing independently. As a result, engaging with an offshore vendor who is proficient in ambulatory surgery center billing would be the best option. In this post, we’ll look at the six most important aspects of ASC billing and coding services, as well as how offshore suppliers can help with them.

Facts About ASC Billing: In what ways do ASC medical billing and coding differ from traditional physician billing?

To know the solution, we must first understand how ambulatory surgery facilities operate.

According to Medicare, ASC is an independent company that offers outpatient ambulatory surgical services exclusively to its consumers.

  • Sometimes, it might be managed as a part of a large healthcare facility and labeled a “provider-based department of the hospital.”
  • ASC does not offer office visits, laboratory services, or diagnostic tests.

New trends:

  • To be eligible for compensation, Medicare expects ambulatory surgical center billing guidelines to sign up for a participating provider agreement with CMS.
  • CMS intends to convert ASCs into “bed-less hospitals” to lower patient bills. This allows patients to have their operations and be discharged on the same day. They can heal from the comfort of their own homes by contacting their providers via phone.

Ambulatory Surgical Center Billing Services: How Does It Work?

  • Unlike traditional physician billing, ambulatory surgery facilities use a blend of hospital and physician billing.
  • Most ASC billing systems utilize CPT and HCPCS Level II codes. Some insurance companies allow ASC services to be billed using ICD-9-CM numbers.
  • ASC claims should be filed using the CMS 1500 form according to Medicare requirements.
  • Medicare also requires CG modifiers to distinguish between ASC and physician bills.

Approved Surgical Procedures:

According to CMS, only certain approved treatments can be performed in an ambulatory surgical center billing guidelines setting. This list includes:

  • Non-emergency, life-threatening operations
  • Procedures that cannot be performed safely in a physician’s office
  • Elective procedures
  • Urgent procedures

Best practices for avoiding critical errors:

Here are some of the best strategies for avoiding serious errors in ambulatory surgical center billing

  • It is often recommended to study the entire surgical report instead of just considering the procedure heading while coding.
  • Complications may cause an arthroscopic surgery to be converted to an open procedure. It should only be considered an open procedure for billing. Many coders accidentally bill for both operations, which is incorrect.
Avatar photo

Victor Bala

Medical & coding

About the Author:

Victor has over a decade of experience in delivering revenue cycle management services to the US healthcare providers. He has a proven track record of accelerating revenue collection by streamlining the billing, coding and AR processes. His team at Velan has been delivering revenue cycle management cycle, appointment scheduling, pre-authorization and credentialing services to physicians, group practices, and hospitals.

He can be reached at [email protected]

Benefits of Outsourcing Insurance Claims Processing Services

Benefits of outsourcing insurance claims processing services
  • Avatar photo Victor Bala
  • Jun 27 2024

Introduction

One of the basic building blocks in the insurance sector is claim processing. This sort of fraud impacts consumer satisfaction, which can help both the insurance company look better in the public eye and the employer’s bottom line. Fast and accurate administration may help in keeping the promise of financial protection, it also helps, in addition, to build consumer trust, which in turn, improves retention rates and increases word-of-mouth referrals. This competitive edge is crucial to Ambetter throughout the highly competitive insurance market and for the life span of the company’s growth and strategic goals.

What is more, claims processing not only lowers operational costs by avoiding unnecessary losses but also provides help in the tracking and prevention of fraudulent activities, thus the company does not incur any losses. It also ensures regulatory compliance and enables insurers to uncover crucial data learnings from a claims perspective for enhancing risk assessment and underwriting measures.

Advantages of Outsourcing Insurance Claim Processing for Insurers

  • By outsourcing claims processing, insurers can operate more efficiently by capitalizing on a third-party supplier that is specifically designed to handle these functions. As a result, operational costs are reduced as insurers do not need to pay for expensive claims processing staff, technology & infrastructure in-house.
  • Moreover, the specialist insight of insurance outsourcing medical billing companies further strengthens the claims processing for any insurance company by expediting the process, making it easier for them to settle claims faster and keep customers happy.
  • In cases of high claim season or during a disaster, this is another reason to use the services of claims outsourcing, as it allows for the external companies to expand their operations quickly to handle claims that may have increased and policyholders that need assistance.
  • This flexibility and business continuity enable insurers to maintain service levels without hiring and training additional workers.
  • Outsourcing non-core services like claim processing allows insurers to devote more resources and attention to their key business activities, including underwriting, risk assessment, and customer service, thereby increasing their business strengths.
  • Reputable outsourcing healthcare billing providers often invest in advanced insurance claims processing technology and tools, benefiting insurers without the requirement for significant upfront investments in technology infrastructure.
  • Insurance claims outsourcing partners, well-versed in industry legislation and compliance requirements, assist insurers in ensuring that their claims processing adheres to all necessary regulatory standards.
  • Specialized outsourcing partners have mechanisms in place to detect and prevent fraudulent claims. This helps insurers decrease their exposure to fraudulent actions and associated financial losses.
  • Most outsourcing agreements include thorough reporting and performance indicators for claims handling, enabling insurers to monitor the effectiveness of the outsourced relationship and make data-driven choices.

Considerations on Outsourcing of Claim Processing Services

Key considerations include:

A. Selecting the Right Outsourcing Partner

Conduct thorough research and analysis on your potential outsourcing partners. Search for providers that have a proven track record in insurance claims and public safety answering point (PSAP) experience, all the while having a good reputation for dependability, transparency, and quality in claims handling. Additionally, check that the outsourcing partner understands the complexities of the insurance sector, such as relevant rules, compliance standards, and best practices. Consider the vendor’s ability to handle fluctuating claim volumes, particularly during peak seasons or periods of elevated claims activity. They should also be able to grow or shrink as needed.

B. Protect Data Security and Compliance

Because data security is imperative to the insurance sector, ensure the outsourced vendor follows stringent data protection protocols and complies with the necessary data privacy regulations. Incorporate stringent data protection and access clauses into the agreement.

C. Maintaining SLA

Culture, communications, customization, collaboration, and commitment. Develop clear SLAs that detail what your expected turnaround times, processing times, quality, etc. will be. In addition, they should provide proper means of communication to notify you of the claims and difficulties. Consistent communication is essential for transparency and alignment. Also, discuss your unique requirements with the vendor and assess their willingness to tailor their services to your company’s processes and demands. Determine whether the vendor’s values and work culture are consistent with those of your firm. Behavioral alignment is one source of a superior partnership.

D. Technology, Training, and Infrastructure

Evaluate vendor technology and tools for claim management and processing. Check that their systems are current, can handle your claims volume, and are compatible, if applicable. Understand their claims handling training and experience. They need to be a team of experienced and knowledgeable people who know the quirks of your insurance products and workflows.

E. Disaster Recovery and Business Continuity

You need to ask about the disaster recovery and business continuity policies of the vendor. With strategies to ensure business continuity in the event of unforeseen outages.

F. References and Case Studies

If you want to know the outgoing vendor’s track record, demand some case studies and contacts, and you will get the truth out of either. Know about the insurance companies they have worked for. Evaluate the success stories. This could give you a good idea of their overall abilities.

G. Costs, Contracts, and Transition Plan

Know the terms and conditions of the outsourcing contract. Ensure there are no additional undisclosed costs and that the agreement spans every part of the partnership dealing with cancellations. Discuss how the transition from in-house to outsourced processing will be managed to establish a well-defined transition strategy to minimize interruptions during the changeover.

H. Legal and Compliance Considerations

Legal concerns like copyright, liability issues, and jurisdiction. Additionally, make sure that protection is provided for both parties in the outsourcing agreement.

Why should you outsource insurance claim processing services to Velan?

Velan HCS commitment to data security and privacy ensures the confidentiality of sensitive information. Our flexible solutions can handle variable claim volumes, guaranteeing smooth operations during peak periods. Partnering with Velan will enable you to optimize costs and reduce risks by emphasizing compliance, transparency, and specialized services. This allows you to focus on your key talents, eventually generating business success in a competitive environment.

Avatar photo

Victor Bala

Medical & coding

About the Author:

Victor has over a decade of experience in delivering revenue cycle management services to the US healthcare providers. He has a proven track record of accelerating revenue collection by streamlining the billing, coding and AR processes. His team at Velan has been delivering revenue cycle management cycle, appointment scheduling, pre-authorization and credentialing services to physicians, group practices, and hospitals.

He can be reached at [email protected]

How Does Outsourcing Dermatology Billing Services Benefit Your Practice?

Outsourcing Dermatology Care Billing Services
  • Avatar photo Victor Bala
  • Jun 27 2024

Introduction

Every healthcare company requires a reliable method for managing medical billing procedures. Practitioners and physicians must submit accurate insurance claims, collect patient balances on time, and manage revenue responsibly. However, in the field of dermatology,, medical billing services are frequently more difficult.

For dermatologists, it is critical to find medical billing professionals who can competently and consistently handle their practice’s revenue cycle and billing procedures. Stay tuned as we explain how outsourcing dermatology billing services to a reliable partner can increase income and effectiveness at your office.

Why is medical billing necessary in my dermatology practice?

Although working in medical billing and coding is not an effortless job, dermatological billing is usually far more difficult than general medical billing. Understanding the procedures, legislation, regulations, and contractual obligations unique to dermatology medical billing is essential.

Billers who support dermatology practices must complete a specialized training program and get certificates. Furthermore, this profession requires ongoing training in the latest medical billing and coding standards, as well as meticulous attention to detail.

Coding and billing training

For instance, we must code dermatology procedures using the International Classification of Diseases (ICD) or Common Procedure Terminology (CPT) codes. Every time these laws undergo amendments, approximately once a year, billers must undergo additional training to stay updated on any changes and new restrictions. Each treatment varies depending on the form and size of the dermatological procedure site. Different billing and classification systems apply to different dermatological procedures, including skin examinations, skin issues, lesion removals, and so on.

This necessitates a highly specific set of skills and knowledge. Someone trained in standard medical billing procedures likely won’t know how to appropriately bill for dermatology billing services. As a result, the majority of dermatology clinics are unable to manage their medical billing effectively. They are required to collaborate with medical billers who have received specialized training.

Dermatologists can also look for medical billing businesses that have extensive experience working with other dermatological offices. Consequently, dermatologists frequently outsource medical billing services.

What are the advantages of outsourcing dermatology medical billing services?

Dermatologists have several compelling reasons to outsource their medical billing responsibilities. We should not overlook the various benefits of outsourcing dermatology practices.

  • Increase Revenue
    Professional Velan HCS is willing to go above and beyond to help your practice generate more cash. The correct presentation of each billing claim directly impacts your revenue. That means if you don’t hire qualified medical billers, you risk losing the money you’ve worked so hard for your clinic. A relationship with a medical billing company sometimes includes payment for each accepted insurance claim and patient payment. They thus have a strong motivation to fight for the timely, accurate, and proper submission of each insurance claim. In most circumstances, this increases your bottom-line revenue.
  • Cut hiring and staffing expenditures
    Outsourcing medical billing services will enable your dermatology clinic to save money on hiring back-end workers while also generating revenue. When dermatologists decide to hire in-house billers, they must consider factors like manpower, compensation, and software, among others. In terms of cost savings, outsourcing is preferable.
  • Ensure correctness
    You must avoid hiring a billing team that may submit incomplete or erroneous insurance claims. Professional dermatology billers have undergone extensive training in medical coding and billing procedures. As a result, they reduce the likelihood of your claims being dismissed, thereby enabling you to generate more revenue over time.
  • Enhancing the credibility of your practice
    Dermatology practices run the risk of losing clients due to inaccurate billing. If you bill each patient’s operations on time and precisely, your practice will develop a strong reputation for dependability and professionalism.
  • Obtain accurate information
    Most medical billing organizations utilize state-of-the-art software that seamlessly integrates with their back-end systems. As a result, you will never have to worry about how patient claims are developing, outstanding balances, or other financial details. While you may get real-time data at the touch of a button, your billers will handle the complex billing and coding procedures.
  • Maintain HIPAA compliance
    Professional medical billing companies have received considerable training in HIPAA compliance. You will never have to worry about harming your practice if you violate patient privacy policies.
  • Prioritize patient care
    When a professional medical billing service handles your financial needs, you will have less work and less stress! Instead of focusing on time savings, think about how much time you’ll have available for patient care.

Dermatology billing challenges

Coding and billing for medical services is tough for any medical practice, but dermatological clinics have additional challenges. Some of the most common cases are described below.

Multiple insurance coverages

Dermatology is the most common medical specialty in terms of procedures and treatments. Each payer pays for dermatology services differently, based on their insurance coverage. The prospect of unpaid services affects the physician’s financial status. However, when dermatology medical billing and coding specialists do the treatment, they know what to look for to send accurate claims to payers and get you paid on time. Our dermatology medical billing agency comprehends the intricacies of the standards and precisely codes every procedure to guarantee the correct reporting of the covered procedures.

Cosmetic versus medical procedures

Dermatologists treat a wide range of ailments, some of which may or may not be “medically necessary,” depending on their severity, concurrent conditions, and other considerations. Once again, coding specialists need specialized training to correctly identify each diagnosis and operation and apply the appropriate coding modifications. Our team keeps up with the latest code updates and specializes in dermatology medical billing. Contact us today to optimize your reimbursements.

Bundling procedure

In many cases, combining charges for similar treatments simplifies coding. However, billers and coders must comprehend the contents of bundles and refrain from billing for items not included, as this would violate the over-coding limitations. You can be sure that we will handle your claims correctly and prevent over- and under-coding when you use our medical billing services.

Denials and rejections of claims

Due to the numerous rules and differences between covered and uncovered services, dermatology firms deal with a large number of rejected or refused claims. Resolution necessitates the employment of expert billing professionals who can quickly identify the issue or disagreement and determine how to explain the code for the claim to be reimbursed.

Hire a dermatology billing expert

Outsourcing to a trustworthy medical billing company may be a viable option for professionals who are having difficulty with dermatology medical billing themselves. Because medical coding in this subspecialty is so complex, physicians may find it difficult to stay on top of billing regulations and ensure proper reimbursement. By cooperating with a professional billing company, dermatologists can streamline their billing procedures, free up internal resources, and obtain complete billing services, all of which improve income.

Get started with Dermatology RCM

A comprehensive revenue cycle management solution for dermatology lets you respond rapidly to industry developments, streamline your procedures, and ultimately improve your profitability. However, many practices don’t know where to begin. Start by asking essential questions to improve your dermatology medical billing processes.

  • What is your overall clinical collection?
  • What is my net collection ratio (the percentage of money collected compared to the amount owed legally)?
  • What are your existing insurance adjustments and write-offs? Are they justified?
  • What is the outstanding amount from my day’s sales, and how long does it take to collect the money from the service?
  • What are my outstanding accounts receivable balances, and how much can I expect to collect within the next 0–60 days?

Conclusion

With the increasing complexity of dermatologists’ coding practices, an expert such as Velan HCS is required to assist with outsourced medical billing services and collections. For the best dermatology medical billing solutions, call Velan HCS immediately at (+1) 727-756-1632.

FAQ’s

Q: Should I consider outsourcing dermatological medical billing?

A: Outsourcing dermatology medical billing can boost your practice’s collection rate by up to 20%. It enables you to focus on patient care while experts handle billing, coding, and claim follow-ups, resulting in faster and more accurate compensation.

Q: How does outsourcing boost revenue collection?

A: Professional Velan HCS are familiar with dermatology billing codes and standards. They can eliminate claim errors, accelerate claim filings, and provide regular follow-ups, resulting in increased revenue collection and fewer denials.

Q: Will outsourcing billing lead to increased regulatory compliance?

A: Yes, outsourcing to a specialized medical billing company, such as Velan HCS, helps to assure compliance with industry norms and laws. This lowers the risk of audits, penalties, and other compliance difficulties.

Q: Will outsourcing dermatology billing result in lower operating costs?

A: Outsourcing can considerably save operational expenses by reducing the need for in-house billing personnel, training, and costly billing software. It allows you to pay for only the services you require, providing a cost-effective alternative.

Q: How do I select an appropriate dermatology billing service provider?

A: Look for a dermatology billing provider with a proven track record, such as Velan HCS. Make sure they provide upfront pricing, cutting-edge technology, and individualized customer service. Inquire about their expertise with dermatology practices and success rates for improving collections.

Q: What kind of assistance might I expect from an outsourced billing service?

A: You may expect complete support, such as frequent communication, thorough reports, and a dedicated account manager. Velan HCS provides tailored billing solutions and continuous support to match your dermatology practice’s specific requirements.

Q: How do I start outsourcing dermatological medical billing?

A: Reach out to the Velan sales team at [email protected] or (+1) 727-756-1632 to initiate the process. They will conduct a free consultation to better understand your billing requirements and create a customized plan to maximize collection and improve revenue cycle management.

Avatar photo

Victor Bala

Medical & coding

About the Author:

Victor has over a decade of experience in delivering revenue cycle management services to the US healthcare providers. He has a proven track record of accelerating revenue collection by streamlining the billing, coding and AR processes. His team at Velan has been delivering revenue cycle management cycle, appointment scheduling, pre-authorization and credentialing services to physicians, group practices, and hospitals.

He can be reached at [email protected]

Revenue Cycle Outsourcing 101: In-House vs. Outsource

Comparison between in-house and outsourced revenue cycle management
  • Avatar photo Victor Bala
  • Jun 13 2024

The revenue cycle is the process of billing and collecting payments for healthcare services. It is a complex and time-consuming process, and it can be difficult for healthcare organizations to manage it effectively in-house. This is where revenue cycle outsourcing can come in.

Revenue cycle outsourcing is the practice of hiring a third-party company to manage all or part of the revenue cycle. This can free up healthcare organizations to focus on other priorities, such as patient care.

There are many benefits to revenue cycle outsourcing, including

  • Improved efficiency: revenue cycle outsourcing companies have the expertise and experience to manage the revenue cycle more efficiently than most healthcare organizations.
  • Reduced costs: revenue cycle outsourcing companies can often provide services at a lower cost than healthcare organizations can provide them in-house.
  • Increased cash flow: revenue cycle outsourcing companies can help healthcare organizations collect payments faster, which can improve cash flow.
  • Improved compliance: revenue cycle outsourcing companies are experts in healthcare regulations, which can help healthcare organizations avoid compliance problems.

However, there are also some risks associated with revenue cycle outsourcing, including:

  • Loss of control: When healthcare organizations outsource their revenue cycle, they lose some control over the process. This can be a problem if the revenue cycle outsourcing company does not meet the organization’s expectations.
  • Data security: Healthcare organizations need to be careful about the security of their data when they outsource their revenue cycle. Revenue cycle outsourcing companies should have strong data security measures in place.
  • Communication problems: Communication problems can sometimes arise between healthcare organizations and revenue cycle outsourcing companies. Errors and delays may result from this.

Overall, revenue cycle outsourcing can be a good option for healthcare organizations that are looking to improve the efficiency and effectiveness of their revenue cycle. Before making a choice, it’s crucial to carefully balance the risks and advantages.

In-House vs. Outsourced Revenue Cycle Management

There are two main ways to manage the revenue cycle: in-house and outsourced. Every technique has advantages and disadvantages unique to it.

In-House Revenue Cycle Management

With in-house revenue cycle management, the healthcare organization handles all aspects of the process, from billing to collections. This gives the organization more control over the process, but it can also be more time-consuming and expensive.

Outsourced Revenue Cycle Management

With outsourced revenue cycle management, a third-party company handles all or part of the revenue cycle. This frees up the healthcare organization to focus on other priorities, but it also means losing some control over the process.

Which Approach is Right for You?

Depending on your unique demands and circumstances, you can choose the appropriate strategy. If you have the resources and expertise to manage the revenue cycle in-house, it may be the best option for you. However, if you are looking for a more efficient and cost-effective solution, outsourced revenue cycle management may be a better choice.

Before making a decision, consider the following:

  • The organization’s size and complexity
  • Your budget
  • Your level of expertise in revenue cycle management
  • Your willingness to give up some control over the process

If you are still unsure which approach is right for you, it is a good idea to consult with a revenue cycle management expert. They can assist you in determining your needs and creating a strategy that is suitable for you.

How to Choose a Revenue Cycle Outsourcing Company

If you decide to outsource your revenue cycle, it is important to choose a reputable outsourcing revenue cycle management company.

Here are some tips for choosing a revenue cycle outsourcing company:

  • Get referrals from other healthcare organizations.
  • Do your research and compare different companies.
  • Verify the company’s expertise in your particular industry.
  • Get everything in writing, including the contract terms and conditions.

By following these tips, you can choose a revenue cycle outsourcing company that will help you improve the efficiency and effectiveness of your revenue cycle.

The ideal partner can hasten your progress and help you achieve long-term financial success. Outsourcing revenue cycle processes can be a strategic instrument to underpin the transformation and assist you in achieving elusive profits in these times of constrained hospital finances.

Avatar photo

Victor Bala

Medical & coding

About the Author:

Victor has over a decade of experience in delivering revenue cycle management services to the US healthcare providers. He has a proven track record of accelerating revenue collection by streamlining the billing, coding and AR processes. His team at Velan has been delivering revenue cycle management cycle, appointment scheduling, pre-authorization and credentialing services to physicians, group practices, and hospitals.

He can be reached at [email protected]