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.