medical billing transcription supplier information

Contrary to popular belief, it is safe practice to allow any office member to take the review of systems and the family social history. These two evaluation and management history elements can actually be taken by absolutely anyone. It is ok in medical billing for a parent or a secretary to take down this information as long as the information is reviewed and signed off on by the acting pediatrician.

The only part of an evaluation and management visit that the physician or nurse practitioner must complete for medical billing purposes is the history of present illness or the reason for the visit.

By allowing your administrative staff to complete some of the patient documentation, a practice can save time and money as it frees up the pediatricians and nurse practitioners to have more time for the actual servicing of the patients.

Another great way to save your practice time and money is to outsource your medical billing. Your medical billing partner will make sure your pediatric practice gets the maximum return and if you're not using a medical billing company, you could be losing almost 30% of your medical billing revenue by simply not knowing how to get the maximum reimbursements that your practice is allowed for services rendered and general errors that occur when practices file their own claims.

Look into expanding the duties of your administrative staff and consider outsourcing your medical billing - the winners will be your patients and your practice!

When to combine history of present illness and review of systems causes a lot of confusion among many practices. However it is possible to do and is perfectly acceptable to document an element once to account for HPI and ROS.

In many instances, a physician will leave a medical billing company with tons of documentation for a review of systems, but not enough information for the history of present illness. The physician is missing out on some additional revenue by not documenting the ROS. The CMS states that physicians do not need to document an element two times for medical billing purposes. It is perfectly acceptable to use one element for both.

However, there is one situation when you cannot use the same element twice. That is when you are trying to use it in the same area. For example, the complaint of chest pain cannot be used in ROS for musculoskeletal systems and the cardiovascular system. It can be used only for one location in medical billing.

Also, watch your timing phrases that are used. A medical biller also cannot use a timing phrase such as "began two days ago" to account for both the HPI duration and timing. The bill must more exacting in the documentation.

Combining HPI and ROS is possible in medical billing, but there are some guidelines. Your medical billing partner knows exactly what those guidelines are and the best way to get medical reimbursement for services rendered.

Medical necessity is heart of your medical billing claim. Medical documentation is the services that were rendered due to the medical necessity. Carriers won't reimburse the practice for services without both of these valuable pieces of information. If someone representing a local store just showed up on your doorstep and said you owed them money, you wouldn't pay without proof, that's the reason that medical necessity and documentation are important. The carrier won't reimburse the practice without proper documentation.

Your coding must be accurate whether you use 3-digit or 5-digit codes. The more exacting procedure codes are found in the 5-digit range. Almost all carriers require the top listed procedure on your medical billing claim to be noted with a 5-digit code. 3-digit codes were adequate for many procedures but now they are considered too vague for reimbursement on many medical procedures.

Throughout the year more CPT codes are added to the growing list of procedures used in medical billing claims. Many medical practices are stretched to their limits and are unable to keep up with the fast paced changes and older and outdated coding is used. This results in the practice not realizing full reimbursement of their medical billing claims and that costs the practice in the form of real revenue lost.

Outsourcing to a medical billing partner can dramatically lessen unpaid and partially reimbursed medical billing claims. Look into outsourcing your medical billing today!

Medical billing software reviews are one of the easiest ways to find out important facts regarding the function and use of certain types of medical billing software, as well as their limitations.
One software package that regularly garners superlative reviews is Lytec medical billing software. Computer experts and users alike agree that Lytec software has many positives, including a clear interface and a simple approach to the medical billing process. The Lytec software suite tracks claims management, patient billing, insurance, and scheduling in a single package. The result is a workspace with a seamless quality in which a group of diverse functions, from electronic medical records to healthcare forms, behave in an integrated and coherent way.

A busy medical practice of any size can be a volatile environment, and a system that breaks down under heavy use is a real liability in this business. Lytec medical software is secure, auditable and completely expandable to your specific needs. More importantly it's simple enough to configure yourself.

NueMD is a medical practice management software created specifically for medical offices that also has received positive reviews. Comments have ranged from “NueMD is a functional and no-nonsense practice management solution transported over the Internet,” to ”NueMD allows online eligibility verification done by the client, claims submission, reporting, and analysis. This software is first-rate and is priced less than most systems of its kind.” Other reviews have indicated that the software is a success in small solo medical practices as well as large-scale operations, owing to its reasonable price and ease of use. The ease of use came up often, especially in terms of even a novice being able to pick it up quickly.

eClinicalWorks, another popular medical billing software provider, also earns a mention. It is considered one of the leading providers of integrated uninterrupted ambulatory EMR (Electronic Medical Records) and PM (Practice Management) systems for multiple-local medical practices that include diverse specialties. eClinicalWorks is an award-winning company focused on customer care and satisfaction. KLAS a research and consulting firm dedicated to improving the performance of healthcare information technology providers recognized eClinicalWorks, with its distinguished “Best in Klas Award” 2004. This accolade is considered one of the most important honors in the field.

Any of these three types of software are likely to provide the clarity, ease of use, and technological sophistication you require.

If you aren't getting a reimbursement for the services rendered to patients by a nonphysician practitioner (NPP) affiliate with your practice, you're leaving money on the table for the insurance company that rightfully belongs to your practice.

Learn the rules of the carrier and take the time to bill under the NPP provider number and statistics show that over three-fourths of the health plans billed would reimburse at an average rate of 85%. While this isn't a full reimbursement, it is far better than not receiving anything in return for your services rendered.

There are two main rules for using this type of billing. The patient's physician or another affiliated physician must be available in the office during the time the services were rendered. Also, shared visits apply where the patient sees both the physician and the NPP.

Each individual carrier has their own policies in place for the credentialing and reimbursement to NPPs. Find out what the patient's insurance plan covers up front before you compile your medical billing.

When you combine calling the carrier and getting the hard-line of what exactly is covered and what is not along with medical necessity of services rendered, you will have an air tight medical billing claim.

If you aren't getting a reimbursement for the services rendered to patients by a nonphysician practitioner (NPP) affiliate with your practice, you're leaving money on the table for the insurance company that rightfully belongs to your practice.

Learn the rules of the carrier and take the time to bill under the NPP provider number and statistics show that over three-fourths of the health plans billed would reimburse at an average rate of 85%. While this isn't a full reimbursement, it is far better than not receiving anything in return for your services rendered.

There are two main rules for using this type of billing. The patient's physician or another affiliated physician must be available in the office during the time the services were rendered. Also, shared visits apply where the patient sees both the physician and the NPP.

Each individual carrier has their own policies in place for the credentialing and reimbursement to NPPs. Find out what the patient's insurance plan covers up front before you compile your medical billing.

When you combine calling the carrier and getting the hard-line of what exactly is covered and what is not along with medical necessity of services rendered, you will have an air tight medical billing claim.

Medical Billing is the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered by a healthcare provider. The same process is used for most insurance companies, whether they are private companies or government-owned.


In brief, when a physician or any licensed healthcare provider sees and offers some sort of treatment to a patient, the healthcare provider wishes to be paid for the services rendered. If the patient directly pays to the treating physician, the process is over there itself but when the patient has a medical health insurance, the physician has to submit a claim on the patient's behalf to the corresponding insurance provider for approval of the payment for services provided.


Usually, an HCFA (a standardized format) for billing record either in paper or electronic media is used which is an authorization directing the insurer to make payment directly to the health care provider rather than to the insured. The insurance provider after receiving the claim then determines if benefits are to be payable and how much of the total amount filed.

The generation of this electronic record or on paper is the work of the medical biller. The medical biller is responsible to translate medical terminology, diseases, diagnoses and procedures into coded billing statements (ICD-9 and ICD-10 codes), enter patient information into databases, mailing patients’ billing statements to the insurance providers, checking for payments received, and following on for unpaid insurance claims. Hence, an efficient, educated and well informed medical biller is required to file claims properly so that they are not rejected or disapproved.

Certification as such is not required in USA for employment but almost every professional in the coding and billing industry is certified as it is always felt to be advantageous and provides a solid footing for future growth. If one is experienced though working but not certified, it could be detrimental for growth and career wise.

Hence, it becomes of utmost importance to get certified and we would also advocate for it because of the excessive and stiff competition in today's arena. Professional certification is one way to increase the likelihood of getting a good job in today's highly competitive job market. So choose the right course from the right people and get yourself certified. Though experience always counts but what better than having a professional certification with good years of experience. Certainly, you are bound to score better over others.

There are some cases when certain medical billing practices can get your office more financial reimbursement. The use of the current procedural terminology code 77470 is one of those instances. This code, however, cannot be used all of the time. There are certain things you must keep in mind before using the medical billing code 77470 for your claims.

Sometimes the physicians in your clinic can see patients with special needs. For instance, an oncologist may see a patient that has a pacemaker. The pacemaker can make visits and treatment plans more time consuming for the physician. In this instance, the medical billing code 77470 may be used.

77470 in medical billing means: Special treatment procedure. The only time this code should be used is when you are doing medical billing for a patient that needs extra planning than normal for a certain procedure. If this is the case, the documentation with your medical billing should reflect this. Be sure your oncologist thoroughly explains what extra work and planning is involved for the particular patient.

There is another note of interest with the medical billing CPT code 77470. It can only be used once per type of therapy in medical billing. This is the case even if your patient has problems in addition to the pacemaker. Insurance companies and other payers will only reimburse you once for 77470.

It is important to follow the rules and standards set forth in medical billing. Failure to do so will not only get your claims denied, but may set up red flags for your future submissions or get your billing claims audited. You should always make sure your medical billing staff is kept up to date with changing policies and provisions, if this is becoming difficult, it may be time to consider outsourcing your medical billing to the pros that can get your practice reimbursed.

For several decades, medical billing was done almost entirely on paper. However, with the advent of computers it has become possible to efficiently manage large amounts of claims. Many software companies have arisen to provide medical billing software to this particularly lucrative segment of the market.

The billing field has been challenged in recent years due to the introduction of the HIPAA act. Due to the many restrictions that were enacted as a result of this new law, many software companies and medical offices spent thousands of dollars on new technology and were forced to redesign and rebuild their business processes and software in order to become compliant with this new act.

If you're looking for a home-based business that can help you pull in $20,000 to $45,000 a year using your computer, a work-at-home opportunity doing medical billing may sound like the perfect choice. But before you part with your money, consider this: The Federal Trade Commission (FTC) has brought charges against promoters of medical billing opportunities for misrepresenting the earnings potential of their businesses and for failing to provide key pre-investment information required by law.

Medical Billing Scams

Ads for medical billing business opportunities appear on the Internet and in the classified sections of local newspapers and "giveaway" shopper's guides. In the "Help-Wanted" classified sections, the ads may appear next to legitimate ads for hospital medical claims processors, leading consumers who respond to think they're applying for a job, not buying a business opportunity.

The ads lure consumers with promises of substantial income working from home full- or part-time - "no experience required." They direct consumers to call a toll-free number for more information.

If you call, a sales representative will entice you to sign up by telling you that the processing of medical claims is a lucrative business, that doctors are eager for help with electronic claims processing, and that you - even without any experience - can do this work from the comfort of your home.

Medical billing scammers charge a fee of $300 to $500. In exchange, they claim to provide everything you supposedly need to launch your medical billing business: the software program to process the claims and a list of potential clients.

But the reality is that few consumers who pay for medical billing opportunities find clients or make any money, let alone earn the promised substantial income. Competition in the medical billing market is fierce, especially for those who are new to it. Many doctors' offices process their own medical claims. Doctors who contract out their medical billing often use established firms, not individuals working from home.

Promoters of fraudulent medical billing opportunities are not interested in helping consumers, either. They only want their money. Many times, the client lists they provide are based on out-of-date databases of doctors who haven't asked for medical billing services. The software they send may not work or may not have been properly authorized and so is useless. And the money-back "guarantees" often prove worthless. Even after making repeated calls to the promoter or complaining to their credit card companies, government agencies or consumer groups, only a few people actually get refunds.

How to Protect Yourself

To avoid losing your money to a bogus medical billing business opportunity, the FTC advises you to:

Ask the promoter to give you the names of many previous purchasers so that you can pick and choose who to call for references. Make sure you get many names from which to choose. If the promoter provides only one or two names, be careful: The contacts may be "shills" - people hired to give favorable testimonials. Interview the references, preferably where the business operates, to get a better sense of how the business works. Ask for the names of their clients and a description of their operation.

Consult with organizations for medical claims processors or medical billing businesses and with doctors in your community. Ask them about the medical billing field: How much of a need is there for this type of work? How much work does medical billing entail? What kind of training is required? Do they know anything about the promotion or promoter you're interested in?

Check with the state Attorney General's office, consumer protection agency and the Better Business Bureau in your area and the area where the promoter is based to learn whether there are any unresolved complaints about the business opportunity or the promoter. While complaints may alert you to problems, the absence of complaints does not necessarily mean the company is legitimate. Unscrupulous companies may settle complaints, change their names or move to hide a history of complaints.

If the medical billing opportunity sells another company's software, check with the software company to find out whether company representatives know of any problems with the medical billing promoter.

Consult an attorney, accountant or other business advisor before you sign any agreement or make any payments up front. An attorney can review the promoter's contract and advise you on how best to proceed.

When performing medical billing for fractures, it is imperative to know if you are dealing with definitive care or restorative care. Not knowing the difference could cost your physician a lot of money. There are a couple scenarios to keep in mind when deciding if your medical billing should be claimed as definitive or restorative care.

The first step in proper medical coding and medical billing is understanding the nature of definitive fracture care in medical billing. For example: a 33-year old woman is seen in the emergency room for a minor fracture of the radial head. The emergency room physician gives her a sling and a short arm splint. The doctor then states that the patient should keep the splint on for three to four weeks. This would be considered definitive care.

The medical billing staff would report this definitive fracture care with the current procedural terminology code 24650 (Closed treatment of radial head or neck fracture; without manipulation). Since the patient will not receive and did not receive any restorative treatment, 24650 is the correct medical billing code to choose. There will be no follow up for this care, and that is what defines definitive treatment.

The next step is to understand restorative care. For example: a 33-year-old male comes to the emergency room with an angulated mid-shaft fracture of his radius. Blood flow to the head of the radius is decreased. The emergency room doctor not only gives the patient pain medicine, but also reduces the fracture and does a hematoma block. This is called restorative fracture care in medical billing.

The correct medical billing code for this scenario is 25505 (Closed treatment of radial shaft fracture; with manipulation. By performing manipulation on the fracture, the doctor was performing restorative care. Simply put, restorative care helps restore a fracture back to its original state and usually requires follow-up. Your medical billing should always represent the precise type of fracture care that was performed and have medical documentation backing up the procedure will result in the maximum reimbursements on your medical billing claims.

Managing your time at your job is essential to getting projects accomplished. Most people work for a paycheck, not considering how important their actual job duty may be to their employer.

Prioritizing your work is the first key to managing your time. First of all, if you have deadlines for certain tasks, you need to meet them.

Using a 1-31 file is extremely helpful for daily tasks. For example, if you are researching information, a 1-31 file can be extremely helpful. First get 31 file folders and number them 1 through 31.

Let's use checking insurance claim status as our example. Once your claims are filed, on a daily basis hopefully, print a day sheet or ledger sheet of all claims filed that day. Considering most insurance claims are paid within 2 to 3 weeks, file the "day sheet" 21 days from the date you first filed the claims. If the claims were filed on the first of the month, then "file" your day sheet in the folder marked "14". When the 14th of the month rolls around, pull the folder first thing in the morning to check on claims that should be in process if not already paid. With this method, you have a "daily" task of checking on your work everyday. Claims filed on the second of the month would have their day sheet or ledger filed in the folder marked 15 and so on.

Another way to manage your time is to give yourself time limits on certain aspects of your job duties. As an example, claims should be filed daily and should be the first thing you do in the morning, from charges generated the previous day. Two hours should be sufficient,if not overly generous, to allow yourself to enter your claims. Your next task should be posting payments received from patients and insurance carriers. Depending on the volume, this should account for 2-3 hours of work. As you are posting these payments, you should be able to define any claims that may require a letter to appeal a denial or rejection. If needed, these appeal letters should be generated almost immediately due to time constraints imposed by the insurance carriers.

Once these task are completed, you should have 2-3 hours to check your 1-31 file to call on claims status. Any claims showing not received can be added to the next days charges to refile. Therefore, the next day you use the same process again.

Some medical billing offices may be set up where one person files claims, one person posts payments, one person checks claims status and one person writes all of the appeals. If this is the case in your office, then I would suggest you set goals to accomplish a certain amount of work in a certain time period. You need to be quick but concise. Medical billing is basically an accounting position and should be treated as such.

Work at home medical billing seems like the perfect job for you. You own a computer, you want to stay home, pick your own hours. You will even be trained and given leads to professionals that need your service.But the chances of making the money claimed are slim. Consumers don't realize what they're getting into. Newcomers to the medical billing market with no experience and no contacts in the medical field will face fierce competition. As the FTC alleged, most of the consumers didn't earn a dime.Not all medical billing opportunities are scams. For consumers interested in buying a medical billing business opportunity, the FTC offers advice:


• Check with the state Attorney General's office, consumer protection agency and the Better Business Bureau in your area and the area where the medical billing promoter is based to learn whether any unresolved complaints about them or the promoter are on file. Be aware, however, that the absence of complaints doesn't necessarily mean the medical billing company is legitimate. But at least you can rule them out if there is.


• Be wary of the medical billing promoter wants to only provide a few references.


• Interview these references in person and ask for the names of their clients and a description of their operations.


• Consult an attorney, accountant or other business advisor before signing any agreement or paying any money.


• Consult with organizations for medical claims processors or medical billing businesses and with local doctors.


• If the medical billing opportunity sells another company's software, check with the software company to find out whether company representatives know of any problems with the medical billing promoter.


All these things may seem like a difficult task, but real medical billing is a business. You need to treat it like one. Don’t be afraid to ask the medical billing promoter questions.

Do you have trouble keeping all your files, data, and reports sorted, yet easy to find? The latest medical billing software will do that for you as well as save the amount of time you spend searching and accessing that information; the costs it takes to manage all the different databases, and the headaches you get from worrying about all the various aspects of your business.


Consolidate Offices—Medical billing software allows you to consolidate all your offices together. You will not have to log-in and log-out of a bunch of different databases; that’s all taken care of with this system. All you need to do is log-in through this billing system, and manage each separate account without the hassle of going into multiple databases.


Work From Home—Do you have a computer and broadband connection? That means you are ready to go. Once logged into the system, you can work from your home, office, or on the road. If you’re not in the office, you don’t have to worry whether or not your business information is staying up-to-date. With medical billing software, you’re able to manage and stay on top of your business functions at all times and places.


Easy-to-Use—The #1 web-based software is simple to use. Your clients will reap the benefits from you using this system. Without the hassle of going through multiple databases, you will be able to close out all your business day dealings in a timely manner. The data always stays separate and doesn’t require duplication or extras hassle. Quick, easy, and efficiently, the job will get done right and on time for the convenience of your customers.


Security—Your data is safe and backed up at all times. Medical billing software is protected through HIPPA-compliant servers that only you and other authorized staff members can access. If you ever have a problem, a team is ready and willing to help at all times. The support team will answer as quickly as possible to solve any needs or concerns about your system.


Payment—Medical billing software won’t take much money out of your business either. You can pay monthly as you go and don’t have to worry about or deal with large, up-front software fees. Best of all, no long-term commitment is required. You’ll see and experience the benefits right away as you use the software to maximize your business.

With the large upfront expense and all the time that is required to properly implement an Electronic Medical Record Software, do the pros outweigh the cons? We all want our investments to pay off, and while EMR may deliver better patient care and keep you more organized, it needs to be financially worth it. There are 4 key financial benefits that can come from an EMR implementation.


1) Improved productivity
2) Increased revenue
3) Avoidance of costs
4) Increased profit


Increased productivityOrganizations see improved productivity as a result of the many processes that become automated through the use of EMR technology. Tasks like pulling/filing paper charts become replaced by simply clicking a patients name in the EMR system. End-of-day reporting becomes much easier as reports can be generated directly from the EMR system. Lab and imaging results can be placed directly into the EMR, thereby making it easier for users to access. Integration with diagnostic devices enables users to input results/findings directly into the EMR, eliminating the need to manage the many types of forms used in today’s offices. Though it is clear that EMR can make our offices more productive; what we do with this new time doesn’t necessarily translate into financial benefit.


Increased revenue
EMR can increase our revenue by giving us the ability to offer new services to patients. Many EMR vendors offer features for patients to view their medical information, schedule/cancel appointments and complete forms ahead of time via the organization’s website. This can help attract new business and reduce the load on your staff. EMR also enables offices to reduce their physical storage space by drastically reducing the amount of paper used for each patient. This can translate into having more office space available for treatment, possibly providing room for an additional associate. Improved insurance re-imbursement as a result of better coding and billing procedures can also increase your revenue. Being in closer touch with patient’s treatment plans and filing documentation at the right time can help maximize our reimbursement.


Avoidance of costs
EMR can help us reduce the many expenses associated to paper charts, poor documentation and high malpractice premiums but also creates new expenses as a result of support contracts, computer maintenance and product updates. Reducing paper chart costs including purchasing stationary (folders, paper), copying, management (pulling/filling) and storage (office space, cabinets) is the clearest benefit of EMR. Transcription costs can also be reduced as EMR can provide us with an easier means for patient documentation and report writing. When we become busier we can avoid the cost of hiring new staff by becoming more efficient with the EMR system. We can avoid expensive medications by offering patients more cost effective alternatives. We can help keep our malpractice premiums lower as a result of higher quality documentation and drug prescription alerts. A long-term implementation plan and commitment to eliminate paper charts is crucial if cost avoidance benefits are to be realized.


Increased profit
In order for us to increase our profit we need to take into account all these possible benefits and compare them to the new costs that we will incur as a result an EMR implementation. Many benefits however are difficult to quantify as benefits like, improved care, patient satisfaction and office image are items that contribute to higher profits as a result of increased patient referrals and better patient retention.

Whether you are a person who is thinking about becoming a medical billing specialist or a company looking for a medical billing specialist, then this article is for you. There are several things that you should be aware of in the medical billing industry and I will walk you through them so that you will have the background information that you need to help you make a decision that will best suit your needs. We will first take a look at what it takes to become a medical billing specialist, and then we will also explore the alternatives to hiring a medical billing specialist.


What is a Medical Billing Specialist? A specialist is someone who works with a medical office and is in charge of the company’s medical billing. If you desire to be a medical billing specialist then accuracy and attention to detail is a must as you will most likely be in charge of claims processing, charge entry, and billing and collections. However, most medical offices will hire someone to do more than just be in charge of medical collections. They will want someone to be more of a medical assistant as well. Job duties will then expand to include things like:


Accounts payable, payroll and banking tasks
Prepare and maintain patient charts
Schedule appointments
Receive and make phone calls
Perform insurance verification, pre-authorize and referral duties


How do I become a Medical Billing Specialist?
Most businesses will require you to either have several years of experience working as a medical assistant or some kind of advanced certification as a medical assistant. There are several programs out there to help train and educate you to become a medical billing specialist. By doing a Google search for “medical billing specialist” you should be presented with a lot of options to help guide you to becoming a certified medical billing specialist. There are programs that you can complete online and at your own pace. Others require you to attend some classes for a couple of semesters. In my search I found many of the programs to cost around $1000 but some were as much as $6500.


Is it worth it to become a medical billing specialist?
The medical industry is experiencing a tremendous demand for individuals knowledgeable in medical office operations. Medical billing specialists are one of the fastest growing professions and are currently a very high demand job. According to the American Medical Association, there are over 1.2 million Medical Specialists in the United States. If you are interested in this kind of profession, it would be to your advantage to learn more about it.