In the current healthcare scenario, every patient encounter requires to be documented – both for future reference as well as for the facility to be reimbursed for the services performed. With the increase in healthcare services, the quantum of data has also increased manifold times. Along with increasing in sheer quantity, clinical data is also becoming increasingly complex.
According to the AMA’s health insurer report card, denial rates of claims for major private payers ranged between 0.54% and 2.64%. At the same time, denial rates for Medicare stood at close to 5%. Although the percentage does not sound like too much, given the fact that billions of dollars are claimed each year, the figures for denied claims suddenly assumes gigantic proportions.
The few picture frames on the wall showcase degrees and awards that have been bestowed a long time back. The magazines on the table are mostly journals – and old ones at that. Other than the soft humming of the air conditioner and the ticking of the seconds hand on the wall clock, the room is silent.
Dermatology Coding Challenges
According to ‘Coding 2017 and beyond’, an article published in the Dermatology Times, dermatologists should be prepared for increased audits by Medicare’s CERT (Comprehensive Error Rate Testing) program, OIG, ZPIC and the RAC of their dermatology billing. In order to avoid these increased audits, dermatologists will need to submit detailed documentation which has to include histopathology with Mohs operative notes.
Your medical practice has never had it so good. The number of patients is increasing and you have enough left over after paying all your overhead expenses and bills. You even have enough left over to take that European holiday after paying off your mortgage and the household bills. Wow! You are doing well and your practice is earning money….or is it?
Globally, medical practices are facing tough financial times. The growing population coupled with the rise in new diseases is taking its toll on the healthcare system. Healthcare claims are coming under intense scrutiny, and the ever-increasing paperwork and frequently changing laws ensure compliance issues being faced by a medical practice. One of the critical challenges facing medical practices is claims denial.
Why outsource RCM
A highly challenging and demanding task, medical billing is one of the pillars on which your organization stands. Mistakes made in your medical billing can sink your practice faster than the Titanic. While there are definite advantages to having your own medical billing staff, the advantages of outsourcing your medical billing far outweigh them.
With the prevalence of electronic health records (EHR), adequate and proper documentation and coding has become an important aspect of modern medicine. Although documentation in the form of electronic records carry benefits such as ease of inter-physician communication and legibility (for some reason a doctor’s handwriting is always tough to decipher) it can also pose coding risks.
Examination of chemical and other types of specimens taken from a human body for assessment, diagnosis, treatment and prevention of a medical condition are the prime services of a clinical lab. These services may be performed by physician office labs, independent labs, hospital labs, or labs located in other institutions.
The human body is both an intricate and complex system – where each part and organ works in co-relation with the other. Medical coding and billing, though not as intricate and complex as the human body, still requires each component to work in co-relation with the other. Although coding and billing for any service/process can be tedious,