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Purpose and Importance of Medical Coding and Billing - Medical Reimbursement. |
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Physicians and Hospitals provide services to patients and want reimbursement for what they do. An industry journal recently reported a nationwide shortage of medical coders. Why? The healthcare system has become complicated. Knowledge is more important than ever. Medical office personnel years ago could simply open a code book, place a code on an insurance form and submit it for payment. Now we see more HMOs and private carriers and we hear about medical institutions being fined or put out of business due to incorrect or fraudulent medical billing practices. New coding and billing positions have opened up and still more are expected. In addition to medical reimbursement, coding is used for planning and research. Investigators may track diseases. Administrators may determine if a hospital's facilities are being used effectively and if they are adequate for the needs of the community.
The medical reimbursement process includes descriptions of procedures and services the physician and hospital provides. As you can imagine, these would be terribly long and confusing left in narrative form. Someone was wise enough to realize that. They devised a system of code numbers representing each procedure and service a physician is likely to provide and another to represent each disease, disorder or injury. The physician's computerized billing software sends information showing what was done and the insurance company's software interprets it accurately, since they use the same coding system. This speeds up the reimbursement process so doctors are paid faster and better if the medical coding and billing is done correctly. The Office of the Inspector General may review medical coding of evaluation and management services, physician credit balances and correct use of diagnosis codes (ICD-9-CM). Doctors may be fined up to $10,000 for each item or service incorrectly billed. Is it any wonder they want to make sure that the person doing their medical billing, CPT-4 and ICD-9-CM coding knows how to do it accurately and effectively?
Physicians entrust their medical reimbursement responsibilities to medical coders and billers who can speak their language - medical terminology, anatomy & physiology and disease processes. They want medical coders who understand CPT-4, ICD-9-CM, Evaluation & Management, HCPCS and much more. They want someone they can depend on for knowledge, high quality of skills and excellence of work habits. |
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Q1.What is the Turnaround time between Transmission of Claims and Payment? |
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Answer: Usually 6-14 days with exceptions for claims when a special report or documentation is required by the payor. Payment can be received in as little as 2-3 days. |
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Q2. Does Reliant Health handle Billing inquires? |
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Answer: Yes. If a patient calls your practice with billing inquiries, simply refer them to us.
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Q3. How are Reports attached to Electronic Claims? |
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Answer: We use transmittal forms to submit unusual cases that are based on the payors procedures.
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Q4. Does Reliant Health Follow-up by phone when the carrier ignores the bill? |
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Answer: Yes. We routinely check the status of claims to determine what has occured on the carrier's end such as they never received the claim, if it is in progress or requires additional documentation. Tracers and/or additional information are submitted as necessary.
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Q5.What about Compliance Issues? |
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Answer: Reliant Health has a compliance program in place based on OIG guidelines. Our program is reviewed and updated on a regular basis.
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Q6. How do you handle Documentation Problems? |
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Answer: The provider's office is immediately contacted to address problems with illegible handwriting or if additional information/clarification is required for coding. We take the physician's documentation literally. If we can't read it or it isn't documented then it didn't happen. Any corresponding data from other professional sources will be in-house before billing is attempted.
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Q7. How often do you let the provider know the status of the Billing Process? |
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Answer: Monthly and as the provider requests.
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Q8. What about Confidentiality? |
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Answer: Reliant Health upholds standards of confidentiality regarding patients and providers. Records are kept secure and all appropriate laws are observed for handling the release of information. All transmitted documents include disclaimers. We make every attempt to verify that the party making any request for information is entitled to that information.
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Q9. Do you have an office? |
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Answer: Yes. We are not a home-based operation. |
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Q10. What am I saving by using Reliant Health as my Billing Out Source? |
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Answer: Believe it or not many in-house billing operations are more expensive than using a billing out source. Greater income results from increased efficiency of claims submission and collections. Many doctors will realize a 20%+ increase in reimbursement. Using Reliant Health can literally free up precious office space that can be converted into a productive income-producing exam rooms.
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Solution-driven billing without regard to problem analysis replaces existing billing problems with similar ones.
Claims management is continuously complicated by federal, state and private third-party payor rules, regulations and statutes.
Changes to the health care industry will continue to pressure providers in an attempt to control health care spending.
More than two-thirds of the income for an average physician practice comes from third-party payors. Forty-six percent of physicians surveyed cited serious problems with billing paperwork. Thirty-five percent of physicians reported having an inadequate understanding of medical billing. As reimbursement mechanisms change so must the claims filing process. Claims that are not submitted properly negatively affect income and cash flow and can increase liability of fraud and abuse. Updating software, hardware and EDI format is expensive not just in direct expenses, but in staff man hours to install, learn, test and implement. Inadequate attention to billing occurs with over utilization of staff. If your staff is overworked, underpaid, or untrained you already have problems that will only get worse.
Outsourcing your billing permits office staff to focus on medical responsibilities and patient relations which improves the image of your practice. It also assures consistent billing. Your cash flow is not interrupted by employee turnover, vacation or sick leave.
A recent survey of physicians has shown the average cost of in-house billing was as high as 112% of the practice's income.
Non-compliance of contracts by third-party payors must be monitored. Oversights can be corrected, however, continuous delayed or reduced reimbursement may be a signal that the payor is experiencing financial or administrative problem. |
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TECHNOLOGY |
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Software 
Reliant Health Utilizes a Proprietary Software which is easy to migrate with customers existing software and a reliable strategic partner to provide Billing and Practice Management Services. We utilize a proprietary software package because it provides us with the necessary flexibility to customize our software to reflect our individualized client needs. This ensures the maximization of physician cash flow resulting from patient reimbursement.
Hardware
Reliant Health also utilizes Dell as its strategic partner for computer hardware. Reliant Health recently implemented a state-of-the-art Dell Servers which ensures unsurpassed information integrity and systems reliability. The modular design and industry-leading scalability of the Dell system provides for easy upgrades and capacity for growth. Our service partnership agreement provides rapid response for any service needs. |
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