Both Medicare and private insurance plans use many different methods to identify and avoid incorrect or improper payments. The methods and tools used can vary depending on the review type, and whether they are used in the pre-payment or post-payment stage. 

Both are important, but understanding pre-payment review is the first step in understanding the beginning of the payment review process. Pre-payment review in particular can help prevent improper payments, saving money from day one.

What Is Pre-Payment Review?

The Medicare insurance pre-payment review is a simple step in the claims process. It is the review of a claim before it is paid by the insurer. In some cases, the pre-payment review can result in the denial of the payment. The pre-payment process includes medical review as well as the application of edits where needed. An edit can provide automatic verification of certain claim details, even across sets of claims, so make sure they meet the criteria for payment. Edits are applied by processors between submission and payment of claims.

When Is Pre-Payment Review Required?

Pre-payment review is when Medicare, or potentially any private insurer, wants to review all of the claims from a particular office or facility before they pay them.

This often happens when using a doctor, facility, or office that has had a history of claims that resulted in improper payments. In many cases this could be because they’ve submitted documentation that doesn’t support the coding, unnecessary services, billing inconsistencies, and more. Sometimes, payers determine that there is an anomaly in claims that is traceable to other providers in the region.

What Is The Pre-Payment Review Process?

In general, there are two primary types of pre-payment reviews, the complex, and the non-complex. The complex review is going to require documents aside from the claim itself, such as medical records or consultation to review the validity of the claim. The non-complex review isn’t going to require any additional documentation.

There are three criteria on which reviews are based. These are National Correct Coding Initiative edits, edits classified as Medically Unlikely, and Medical Review. Both the National Correct Coding Initiative edits and Medically Unlikely edits will generally be non-complex reviews.

Medical review, however, can be a relatively complex process. It will usually be performed by Medicare Administrative Contractors or Supplemental Medical Review Contractors, and the review contractors will focus Medical Review activities specifically on the already-identified problem areas, and will determine the action to take based on the severity. These actions can include:

• Pre-payment review
• Post-payment review
• Education or feedback for the healthcare provider

If the decision made is to enact pre-payment reviews, the insurer or payer will ask the provider to send pertinent records and other documents for any claims made within a predetermined time frame. In many cases the records period is three month’s worth, but in some rare cases they can go much further back.

Ending Pre-Payment Reviews

To remove pre-payment reviews, providers or coders should first review all of the pertinent medical records and double-check that all codes used are supported by the medical records. Additionally, they should make sure that their billing and coding department is adhering to the requirements of each insurer when actually assigning codes or creating billing claims. Coding and billing staff should also be trained to properly check for bundling and unbundling of codes.

AMS Solutions Can Help Prevent Pre-Payment Reviews

When it comes to preventing or avoiding pre-payment reviews, AMS Solutions can provide coding and billing professionals that are kept up-to-date and completely educated on all aspects of claims billing.

What Is Concurrent Review By An Insurance Provider?

Many people wonder what the standard concurrent review definition is. A concurrent review is a review that takes place while the patient is actively receiving care during an admission to a healthcare facility. The concurrent review’s purpose is to have some framework for oversight during treatment that allows examination and scrutiny of the type of care that is being administered to the patient. It also evaluates the necessity for that level of care, as well as the setting.

Why Are Concurrent Reviews Needed?

The goal of concurrent reviews is to make sure that healthcare is delivered effectively and efficiently, to reduce or prevent the improper use of inpatient medical services and treatment, and to ensure that all patients receive the high quality of care that is indicative of inpatient treatment. It works similarly to prior authorization, in that the concurrent review can help foster more effective communication about the patient to various areas or departments of the healthcare organization itself. 

Additionally, concurrent reviews also help provide access to other health services and support features that may help with the coordination or continuation of care, particularly in regard to transitions from one level of care to the next. This may be either discharged to a care facility, or even to their home. A concurrent review is also able to identify patients that may benefit from various care methods, including case or disease management, or any number of other options depending on the diagnosis and treatment needs. 

The Concurrent Review Process

The concurrent review process is designed to optimize care during a hospital or treatment facility admission. The goal is to ensure that the patient receives the right care, right when it’s needed and that the treatment is in line with the insurance plan and coverage requirements. The concurrent review process includes aspects such as:

• Collection and aggregation of all patient information directly from the care team regarding their condition and progress in treatment
• Evaluating patient treatment information from the care team to determine treatment coverage
• Maintaining informative communication between all parties involved in the patient’s care when a decision regarding coverage is made
• Identifying situations when patients may be given a discharge and continuing care plan early in the stay
• Continual evaluation and assessment of the care plan during the stay
• Identifying and referring any potential concerns about the quality of care or patient safety that may require additional review

Concurrent Review vs. Peer Review

A concurrent review is functionally much different than a peer review when it comes to the process by which they happen, as well as the goal of each. The concurrent review process is an ongoing process that should be happening seamlessly as a part of all levels of care for an insured individual. 

The peer review process, however, is meant to address specific and often highly complex treatment needs on an ad hoc basis. This process consists of any current treating practitioner submitting a request to consult with a medical health professional within the insurance company. Often this is to discuss a utilization issue or to go over needed care that may be required for long-term care services and other continued care support services.

AMS Solutions Can Optimize Your Coding For Review

One of the biggest factors in ensuring your organization is paid promptly and correctly is leveraging expert billing and coding professionals. With more than 30 years of experience in the billing, collections, credentialing, and practice management fields, you can trust that AMS Solutions will be an effective coding and management partner. 

Those who work in the medical field have a significant amount of responsibility. Not only the doctors and nurses who treat you but also the coding and billing professionals that work behind the scenes on paperwork and medical records. There are countless medical regulations and processes that go into medical coding, and it is crucial that the coding is done properly. We’re going to look at what proper coding is, and exactly what is the importance of knowing proper CPT coding.

What Is A CPT Code?

CPT stands for Current Procedural Technology, and CPT codes create a uniform reporting and coding language that is used to make reporting easier, as well as more efficient and accurate. CPT codes are used for medical billing that is either five digits, or four digits and one letter long, and they indicate medical or administrative management procedures. They are used for claims processing as well as for the creation and modification of medical care review guidelines.

Why Is Proper CPT Coding Important?

Most medical facilities rely on insurance providers for the majority of their funding and revenue. Other sources like healthcare programs contribute as well, but the greatest portion is provided by insurers. Insurance companies make their money by charging policyholders a premium, or fee, that is often paid monthly. Since there are many more people who have insurance than are sick at any one time, it allows the insurers to cover most of the medical expenses or costs for those who hold policies. That said, there is a huge portion of income coming from reimbursements, and a very tiny share coming from patients’ pockets. 

 

This is why proper CPT coding is so crucial. Every single patient that visits a hospital, care center, or doctor’s office has a file of medical records that need to be kept updated and accurately documented. If the coding and billing are done incorrectly, it can result in the hospital losing significant amounts of money in lost reimbursements. Additionally, accurate and correct billing and coding are needed to ensure that patients are being charged more than they should be and that their respective insurer is charged the correct portion of the costs.

Types Of CPT Codes

There are codes assigned for every potential procedure or service that medical providers can provide or perform. CPT codes even include many unlisted codes for procedures or special services that are not specified in other unique CPT codes. There are three categories of CPT codes created by the AMA, the categories are:

CPT Category I

Category I contains the largest body of standard codes. These are the codes most commonly used by healthcare providers to report frequently used services and procedures.

CPT Category II

Category II contains supplemental codes that are used for performance management and other administrative purposes. There are codes relating to patient history, diagnostics, patient safety, and follow-up procedures.

CPT Category III

CPT Category III contains the most infrequently used CPT codes. It also contains temporary codes that are used to code and bill experimental services, rare procedures, or emerging treatments. 

Understanding CPT Codes And The Importance Of Proper Coding Is Vital For Accurate Recordkeeping

Hopefully, we’ve been able to shed some light on just why proper CPT coding is so essential to the continued operation of healthcare facilities. Without accurate and proper CPT coding, patients would be charged wrong amounts for procedures they never had performed, and the facility would lose out on potentially millions in insurance reimbursements. This can jeopardize not only the health of patients but the longevity of the medical facility as well. 

Are you looking to get into the medical billing career field? Then it’s important that you know what that job will entail based on the type of facility you’re working for. There are clear differences between billing between healthcare and other industries within the medical field. The processing of medical claims across varying facility types and specialties is significantly different. No matter what, medical billers work with one of two types of billing: institutional billing or professional billing. We’re going to look more closely at the differences between facility vs professional claims.

What is Professional Billing?

The staff in a doctor’s office handles many different tasks, from greeting patients and getting them checked in, to scheduling appointments and collecting money. Medical billing is also handled within the office as well. The claims that are generated for the work done by suppliers, physicians, and other non-institutional providers are considered professional billing.

 

These professional charges are billed on the standard CMS-1500, which is a red ink on white paper claim form that both suppliers and physicians use for claim billing. Not all claims are billed on paper. Most insurance companies, including Medicare and Medicaid, primarily accept electronic claims. When the claims are submitted electronically, it’s the 837-P rather than a CMS-1500.

What is Institutional Billing?

Institutional billing is the billing of claims for work done by institutions. Healthcare facilities like hospitals, nursing homes, and similar facilities that offer inpatient and outpatient services use institutional billing. Not only will it include services performed by the facility, but also the use of various pieces of equipment, the use of laboratory services, radiological imaging services or equipment, and more.

Biggest Differences Between Billing Types

When you compare the basics, it may seem like there isn’t much difference between professional and institutional billing. However, there are some key ways they are separated. The biggest differences between a facility claim vs a professional claim are the duties available as well as the types of forms used. 

Different Forms

Professional billing claims are billed using a CMS-1500 form. The CMS-1500 is a standard form that has red ink on white paper. It is used not just for physicians, but for supplier claim billing as well. If the billing is done electronically, the digital version of the CMS-1500 is the 837-P, with the P standing for professional claims.

 

Institutional claims are billed using a form called a UB-04. The paper version of this form is also red ink on white paper and is used for the physical billing of institutional charges. The electronic version of the UB-04 is the 837-I, with the I standing for institutional claims.

Roles Addressed

When looking at professional vs facility billing, there are unique claims for different industries and jobs. Facility claims deal with hospital and laboratory services, while professional claims are for physicians that work in medical offices.

Duties and Skills

Regardless of the type of billing, professional vs. facility, medical billing professionals have a crucial responsibility. Medical billers must learn about five distinct areas of billing, including:

1. Understanding how to obtain or use information about each insurance company to submit claims efficiently.
2. Knowing how to perform their duties while maintaining medical confidentiality and avoiding HIPAA violations.
3. Having a working familiarity with the specific billing software that is used will result in massive time savings for training, will reduce errors, and prevent issues and headaches in general.
4. Understanding that coordination of benefits information is vital and that submitting claims in the proper order reduces delays in payment.
5. Understanding that each portion of a medical claim is representative of information collected during the entire time from patient scheduling through treatment.

Deductible vs. out-of-pocket is a common question asked by people who are considering health insurance and even by health providers who aren’t often experienced in medical billing terms and services.

The Difference Between Deductible and Out of Pocket in Health Insurance

Out-of-pocket healthcare costs, also known as copayments or coinsurance, are a set amount of money that you’re required to pay for certain services on top of what your insurance covers. With deductibles, there are monthly payments that you make before your insurance starts to cover anything at all.

The deductible is the amount that must be paid by the insured before their insurer will start paying for medical care, and it varies depending on the type of plan chosen. An individual may have to pay up to $2,000 in medical expenses before their insurer starts paying anything at all, while a family might have to pay up to $6,000 in medical expenses before the insurer starts picking up more than 50%.

This means that those with higher deductibles can end up paying a lot out of pocket for health care, which is why many choose to have higher monthly premiums to cover that cost. Some plans may offer lower deductibles for a monthly premium increase.

Other plans with slightly higher premiums may have higher deductibles. The type of plan chosen should be based on each individual’s own needs and preferences, so it is best to consult a financial advisor before choosing a plan.

What is a Deductible?

A deductible is the amount of money that a person must pay out-of-pocket before their insurance company will start paying for a medical service. Deductibles are most common in health insurance plans, but some other types of insurance have them as well.

The purpose of a deductible is to encourage people to be more careful about how they spend their healthcare dollars. For example, if you have a $500 deductible, it will take you five months to reach the point where your insurer starts paying for your care. This means that you’ll spend less on healthcare and be more careful about what services you need and how often you use them.

What is an Out-of-Pocket Maximum?

The out-of-pocket maximum is the most you will pay for your health care services. The out-of-pocket maximum is one of the key features of a health insurance plan. The maximum out-of-pocket amount is the most a person will pay for covered medical expenses. It’s what determines how much you will have to pay for your medical services in a given year.

The out-of-pocket maximum can be different from one plan to another, but it’s usually set at a certain dollar amount. For example, the average in 2018 was $3,000 per family. Unfortunately, not everyone can afford to pay out of pocket.

Why Do Some People Pay Out of Pocket?

The Affordable Care Act (ACA) requires that all Americans have health insurance coverage. However, some people are not able to afford the monthly premiums.

Some people may not be able to afford the monthly premiums because they are living paycheck-to-paycheck and cannot justify spending money on something they don’t need like health insurance. Other people may be eligible for Medicaid but do not know how to enroll or don’t want to take advantage of any government assistance programs that are available.

While some people may be eligible for Medicaid, they will often find that the Medicaid plans have high deductibles and copays which can make it difficult for them to get the care they need when needed.

In addition, many doctors are not accepting new Medicaid patients due to low rates of reimbursement from the federal government. If you need help with figuring out insurance policies and terms for your healthcare practice, please contact us today. You can also visit our detailed FAQ at your convenience.

Medical insurance in America has always been an uphill battle. Over the last decade, the number of uninsured or underinsured Americans has skyrocketed to 48 million. Even with President Obama’s Affordable Care Act, many Americans still struggle to afford their monthly premiums.

The Current State of Healthcare in America

The United States is the only advanced economy that lacks universal healthcare coverage. Despite this, the U.S spends more on healthcare per person than any other country in the world. The costs of healthcare are spiraling out of control, with no end in sight.

The medical insurance landscape has changed significantly over the past decade. The Affordable Care Act, also known as Obamacare, was passed in 2010 and it helped to change the landscape by requiring Americans to have health insurance coverage. Before this law was passed, people could go without coverage and not pay a fine if they didn’t have it.

The Affordable Care Act also required that insurers offer ten essential health benefits, including maternity care and mental health care. This meant that some plans had to cover these things that they never had before which caused many people to lose their previous plans because they didn’t offer these benefits.

How the Affordable Care Act Affected the Medical Insurance Landscape

The Affordable Care Act was a law that was passed in 2010 and went into effect in 2014. The goal of the act was to provide affordable health care coverage for all Americans. The ACA did this by creating exchanges where people could purchase private insurance, expanding Medicaid eligibility, and providing subsidies for those who couldn’t afford insurance.

The Affordable Care Act has had a huge impact on the medical insurance landscape. In states that did not expand Medicaid coverage, there has been an increase in the number of uninsured people, which has led to more emergency room visits and hospitalizations as these individuals wait until their conditions are severe before seeking treatment.

This act has also contributed to the rising cost of medical care in America. The ACA has increased the number of people who are insured and as a result, demand for services has increased. Furthermore, an aging population and the spiraling costs of prescription drugs have also been factors contributing to escalating medical costs.

The Future of Healthcare in America

The healthcare system in America is changing drastically. The US government has been trying to make changes to the system for a long time, but with no success. Recently, they have been trying to repeal and replace Obamacare with a new health care bill, but it hasn’t gone through yet.

The future of healthcare in America is dependent on the future of the Affordable Care Act. The Affordable Care Act has been a major player in the healthcare sector’s growth and development. The ACA has helped to expand coverage, reduce costs, and lower financial burdens on individuals.

What will happen if this law is repealed? We can only guess what will happen but it’s safe to say that the future of healthcare in America will be drastically different than it is today.

The medical billing process is typically long and complicated. It can be difficult to keep track of all the details and make sure that you are following the right steps. There are many mistakes that can happen during this process, which can lead to a patient’s account being sent to collections.

In this article, we will go over the most common medical billing mistakes and how you can avoid them so that your patients don’t end up with a bad credit score or a debt collector knocking on their door.

What Are Common Medical Billing Mistakes?

Medical billing mistakes can have disastrous consequences. Whether the mistake is with your patient’s personal data or the insurance code, a medical billing mistake can result in some very harsh consequences.

The 4 most common medical billing mistakes are:

1. Unbundling

It can sometimes be hard to tell when certain services should be billed together and other times it is not, often resulting in a higher total claim. Avoid this by always bundling services done at the same appointment.

2. Incorrect Billing

Incorrect billing is when a medical practice charges a patient for incorrect services or for services that they never received. Incorrect billing can also happen when a member of the staff inputs incorrect patient or provider information. 

3. Duplicate Billing

Duplicate bills often happen when someone accidentally sends the same bill twice. It could be that they failed to notice they already sent the claim and sent another, or it might mean there are duplicate procedures in a patient’s records.

4. Upcoding and Undercoding

If you don’t include a medical billing code for less expensive procedures, it can happen for a few different reasons. What matters most is that under coding always appears suspicious and your office can get into trouble – same with upcoding. 

Many medical facilities are faking the severity of procedures they offer in order to receive higher payments. This is the definition of upcoding and it’s a form of fraud that can lead to significant financial losses.

Hiring a medical billing company can prevent many of these common medical billing errors. Medical billing companies use billing software that effectively minimizes the chances of medical billing mistakes. These billing mistakes can ultimately have a negative effect on your office and your patients. 

How Billing Mistakes Negatively Impact Your Office

If you think making medical billing mistakes won’t impact your office, think again. This is what can happen when you consistently make billing mistakes:

• Hiring Extra Staff = Extra Expenses 

When a mistake is made in the medical billing process for your office, you’ll have to hire additional staff in order to fix the mistakes and current workload. This means extra expenses that wouldn’t have needed to be spent if the mistakes were avoided in the first place. 

• Delayed Payments 

The delayed billing caused by your remittance process makes it more difficult to project cash flow, as you can’t reliably know when revenue and expenses are expected to come in. This means that while the delays may be reasonable, this only complicates things when you need to explain why your rent is late or tell the insurance company that you are behind in processing payments. 

• Stressed and Confused Patients 

Explaining medical billing to a patient can be tricky, especially when it comes to medical billing errors. Someone who is sick or unable to work (because of an injury) may be worried about having to pay for their doctor’s visits and treatment. An unhappy patient is more likely to share their grief with family and friends. Negative word of mouth is the last thing you want for your office. 

• Unsatisfactory Revenue Cycle Management

The revenue cycle typically starts when an appointment is booked and concludes with the bill being paid in full. A short cycle is best while long cycles may indicate problems in your office’s revenue cycle. 

All of these mistakes can be avoided when you take the proper precautions and you have a professional medical billing company working for your office. 

How to Prevent Medical Billing Mistakes with Our Medical Billing Company 

Medical billing is a tedious process for medical providers, but with the help of AMS Solutions, it doesn’t have to be. Our comprehensive medical billing company provides a wide array of billing services for all medical providers. No matter what you need from us, we’re ready to tackle it!

We even offer a free practice audit! 

Contact us today to get yours. You can also call us at (214) 522-0210. 

Without the help of a medical biller, healthcare professionals are at risk of falling behind in billing their patients for office visits. Falling behind in billing your patients can mean a loss in total revenue. For this reason, medical billing is an integral part of every medical office. 

When a doctor’s office bills a patient for an office visit, the medical biller has to submit a claim through an insurance company to receive payments for the services rendered. Medical billing doesn’t just include data entry – it takes customer service skills, attention to detail, and expertise in health insurance.

Many doctors don’t have time to take care of medical billing. That’s why every medical office should hire a medical billing company. Medical billing companies are the backbone of every doctor’s office. Medical billers and coders are there to help you get the most revenue you can out of your healthcare practice.

What Does A Medical Biller and Coder Do?

The most commonly asked question is: what exactly does a medical biller and coder do? Does a medical biller and coder do different tasks than just a medical biller? 

In a nutshell, a medical biller does the hard work of dealing with insurance claims. It’s more than likely the average healthcare professional doesn’t have time to deal with calling insurance companies and checking on the status of a claim. Medical Billers are also the ones who follow up with patients that have past due balances on their accounts.

A medical coder uses a coding textbook to code for the type of office visit that occurred. A skilled coder will be able to code quickly with minimal to zero errors. Most reputable medical billing companies will offer both medical billing and coding services.

Medical billers and coders can specifically deal with the ins and outs of healthcare insurance. They have extensive knowledge about insurance that healthcare professionals don’t have the time to learn. 

Why Should I Hire A Medical Biller and Coder?

After dealing with patients all day (and sometimes all night), no healthcare professional wants to sit down at a computer and do a ton of billing work.

To put it simply, when you bring in a medical biller and coder, you’re taking the first step to maximizing your profits as a medical business owner. Not only do billers and coders help you with receiving payments from insurance companies and patients, but they can also give you aging reports to assess how your business is doing financially. 

Medical billing and coders are usually the ones who perform a follow-up call when a patient has an overdue balance on their account. Basically, they deal with everything and anything to do with medical office finances. If anything is not right with your finances, a medical biller and coder will catch it. 

What Qualities Does A Good Medical Biller and Coder Have?

A quality, professional medical biller and coder will have either a certification, a degree, or a combination of the two. There are multiple kinds of medical billing and coding certifications that a potential employee can have – which ones you’ll prefer depends on what skills you are looking for. 

Hiring the right medical biller and coder for your company means hiring someone who has the required education and background to fill the role. 

Common Medical Billing & Coding Certifications

• Certified Professional Coder (CPC)
• Certified Inpatient Coder (CIC)
• Certified Billing and Coding Specialist (CBCS)
• Certified Coding Specialist (CCS)

Checklist for a Good Biller/Coder

• Has a professional degree or certification
• Has relevant experience
• Has references to call upon
• Knows how to use medical practice management software
• Knows all the billing and coding lingo
• Knows how to use the required books (especially if coding)
• Can promptly communicate any issues to the healthcare provider

The Takeaway: Medical Billers Make Office Life Easier

Daily office life should be easy, organized, and as simple as possible for every healthcare employee involved. Work itself is already hard enough so don’t make it harder on yourself as a provider by billing your patients on your own.

It’s not uncommon for healthcare providers to breathe a sigh of relief after deciding to finally hire a medical biller and coder. Unfortunately, many healthcare providers don’t consider hiring a professional biller and coder until they are extremely behind in their billing. 

By contacting a professional medical billing service, there’s no need to continue stressing about how to manage the billing and coding part of every medical office. Medical billers and coders are a profession in high demand and with very good reason. 

Getting reimbursed for behavioral healthcare services can be a struggle.  The complex maze of insurance rules and regulations makes submitting behavioral healthcare billing difficult and frustrating.  This problem results in only approximately 85 percent of claims being paid.  For some, using a billing service can save their businesses.

Billing Rules Explained

Any insurance healthcare billing system is set up to ensure that real claims get paid fully and efficiently while fake or inflated claims are weeded out.  Large group practices usually have a dedicated staff for billing; smaller practices often use third-party billing services. For service providers trying to get paid, figuring out how to comply with those systems is vital to staying in business and running a practice.

Differences from Medical Billing

Behavioral services billing differs from medical billing because the underlying services are so different.  A specific treatment or test is billed at a specific rate in medical settings.  In contrast, in behavioral services, billing applies to therapy, medical management of patients’ illnesses, and psychological testing.  Insurers’ rules set the reimbursable length of a session, how many sessions per week they’ll cover, and usually a maximum number of sessions that will be reimbursed.  These rules do not change based on the client’s need for longer sessions or more of them.

Most of the time, a mental health professional will wait at least 30 days for reimbursement of a submitted claim.  Also, unfortunately, service providers who contract with insurance companies usually cannot bill for the balance remaining after the insurance company pays.  The balance is simply written off.

Clients’ insurance coverage for behavioral care changes frequently.  Service providers should be sure that clients know they should inform the provider of such changes.  Often, however, even the client isn’t aware of changes.  Thus, you as the provider should check your clients’ coverage frequently to see if you need to make changes in your billing practices.  It is better to change your treatment plan than to implement it and find out it won’t be reimbursed.

When considering how to handle your client payments, think about any given insurer’s pre-approval rules and their limits for payments.  Make sure you understand the length of the session they will cover and the number during each billing period and over the life of the illness.  The more you work with given providers, the more likely you are to do things as they like them.

How a Billing Service Can Help

You can avoid many of these headaches by using a behavior healthcare billing service.  They can improve your collection rates of return and get you to nearly 100 percent successful collections.  Services they can offer include:

Tracking patient demographics, onboarding, and insurance verification

It’s not enough just to have patients.  You have to properly bring them on board, know who they are, and make sure they have insurance that covers your services.  A behavioral healthcare billing service can handle this for you, leaving you free to provide services to these new clients.

Managing accounts receivable

Behavioral healthcare billing services let you focus on treatment while they manage your accounts receivable.  As they do billing and receive revenue, the service will discover problems and remedy them before real damage to your practice results.

Obtaining physician credentialing when required

A healthcare billing service can make sure that all of your workers are properly credentialed.  They can also ensure that each service billed was performed and billed by a professional with the appropriate credentials for that service. As you add new professionals to your practice, it’s vital to ascertain that they are properly credentialed to provide those services.

Auditing codes for maximizing revenue

Proper coding is the heart of getting paid in healthcare billing.  When you have a patient in your office, you record the visit or service in the client’s file.  You include an explanation of why you gave that specific service, test, or procedure.  Your healthcare billing service will work from that record to review and document your clinical records to ensure that the file is complete and that they obtain any missing information.  The service will then apply the correct ICD diagnosis and CPT or HCPCS treatment and procedure codes to the patient’s condition and file the claim.  The billing service then compiles this information under a chargemaster capture code that sets the standard prices for services and procedures you provide.

Reporting on revenue collections

Your healthcare billing service can keep you current on the success of your collections by providing periodic reports on revenue collections.  If there are problems with particular insurance companies or patients, these reports will reveal that to you.

In sum, behavioral healthcare billing allows you, the mental healthcare professional, to concentrate on providing behavioral healthcare.  Meanwhile, someone else devotes time and effort to ensure that you are well-paid for doing so.