Time Management

Time Management

Physicians are often very  busy taking care of the patients, but sometimes physicians also have to waste their productive time waiting for a patient.

How can a physician overcome this ?  The only way is tracking and analysis.

I have worked with many physicians who complain that "I have spent a lot of time with this patient and what I am getting paid is very less."  Yes, this is the situation with many of the family care physicians.

I have actually got some tips on effectively utilizing the physician's time and managing patient appointments.

Confirming Patient Appointments:

The administrative staff needs to confirm a patient's appointment at least 24 hours before the appointment, although the patient's appointment has been already confirmed.  The only reason is patient might change his/her mind depending the importance of other schedules, priority tasks, etc.  Especially, when the visit is only for a preventive medicine or an annual checkup, because as there is no medical emergency, patient's tend to come at their convenience.

Prior Authorization:

Whenever a prior authorization is required, it should be obtained as early as possible and insurances should be followed with regards to that.  If there is any documentation that is required from the patient, it should be obtained without any delay.  Prior authorization is vital, especially for a specialist visit and other procedure visits.  This also helps in prompt payments from the insurances.

Appointment Tracking:

Tracking patient appointments plays a very important role in appointment analysis.  Each and every no show, cancelled, and rescheduled appointments should be tracked.  The administrative staff should make an effort to call the patient and know the specific reason as to why the patient could not keep up the appointment.   Also, send notices / bills to patients who miss more than 2-3 appointments.

Time Spent:

If a patient has minor problem, which meets a level 3 visit, but you spend more time counseling the patient on other issues, make sure that the time spent with the patient is documented.

Documentation:

Make sure that each and every service that is rendered to the patient is documented.  If a patient comes in the global period and is treated apart from the diagnosis related to the global period CPT.  It should be documented and appropriate modifier must be used.



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Practice Management

Appointment Scheduling: 

Practice management starts with scheduling an appointment of the patient.  All the appointments scheduled should be confirmed a day before the appointment.  By this way, the physician can be aware of the schedule for that day and accommodate stat patients, walk-in patients, etc.

Appointment Cancellation:

All the appointments that are cancelled or rescheduled should be tracked.  This helps the physician's office to maintain the resources and use them at its very best.


No Show:

No show is one of the major issues in a physician's office.  No shows should be handled very carefully.  Always make sure your patients are aware of the charge for a no show.  Before sending a bill to a no show, it is better to call the patient and analyse the reason for not showing up.  If there is really a good reason for not showing up, it is always better waive the charge and reschedule the appointment.  This also helps in growth of your practice.


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An overview of Medical Billing Process

The Medical Billing Process is basically divided into the following:

1.  Insurance Verification.

2.  Patient Demographic Entry.

3.  Medical Coding.

4.  Charge Entry.

5.  Claims Submission.

6.  Payment Posting.

7.  A/R (Account Receivable) Followup.

8.  Denial Management.

9.  Reporting.

Insurance Verification

• After an appointment is fixed with a provider, the patient submits the insurance details to the provider’s office.

• The provider’s office checks with the insurance if the patient is active and the services that need to be provided are covered by the patient’s insurance or not.

Patient Demographic Entry

• Demographics consist of the following:

1. Patient Name.
2. Date of Birth.
3. Age.
4. Sex.
5. Address, contact number.
6. Insurance Details.

All the above are entered into the EMR once the patient appointment is fixed and the insurance is verified.

Medical Coding

• Once the provider renders services to the patient, the provider documents all the services, diagnosis, and procedures.  The documentation is done through Medical Transcription or the provider enters directly into the EMR.

• All the documented services, diagnosis, and procedures are coded by a Medical Coder giving an alphanumeric code to each service, procedure and diagnosis.

Charge Entry

• Charge entry is the process of entering all the codes into the billing software.

• Also assigning the value for each code as per the fee schedule.

• Entering the insurance details for the respective patients.

Claims Submission

• Once all the charges are entered into the billing software, these are checked for any errors and transmitted to the respective insurance companies.

• If an insurance company accepts claims electronically, then they are submitted electronically or else paper claims are mailed to their respective addresses.

Payment Posting

• Once all the claims are submitted, we start receiving payments from the insurance companies between 7-30 business days.

• The checks/EFTs will be directly transferred to the provider’s account.

• The insurance company will also post an EOB/EOP (explanation of benefit/payment) giving details of the payment and how much amount has been paid for each claim.

• From the EOB/EOP, we need to post into the billing software the respective claim payments.

• We also receive ERAs directly into the billing software, which can be automatically posted.

A/R (Account Receivable) Followup

• We need to follow up on the claims, for which we have not received a payment or any response from the insurance company.

• Firstly, we check online status in the insurance website if any information on the claim is available.

• Then, we call the insurance company and know the status of the claim and reason for the delayed response.

Denial Management

• For the claims which have been denied by the insurance, we need to evaluate the reason for the denial and make necessary corrections and submit them for reprocessing.  This includes:

1. Calling the insurance for reason for denial.
2. Getting information from the provider if anything is required.
3. Getting the information from the patient, if there is an issue with the patient’s insurance plan.
4. Checking with the coding department for coding issues.
5. Finally, resubmitting the claim or filing an appeal with the necessary documents.

Reporting

• Reporting is a very important feature in the billing process through which the provider will know the status of his practice and the changes that needs to be taken in the practice to improve the revenue of the practice.  Some of the important reports are:

• Monthly reports:

1. Payments report:  Payment received for a month.
2. Charges report:  Volume of claims submitted.
3. A/R balance:  The amount still pending with the insurance.

 There are numerous reports, but depending on the provider’s requirement they will be generated.

Coding Preventive Care and Office visit on the same day

If an abnormality/ies is encountered or a preexisting problem is addressed

in the process of performing this preventive medicine evaluation and

management service, and if the problem/abnormality is significant enough

to require additional work to perform the key components of a problem-

oriented E/M service, then the appropriate Office/Outpatient code 99201-

99215 should also be reported. Modifier 25 should be added to the

Office/Outpatient code to indicate that a significant, separately identifiable

Evaluation and Management service was provided by the same physician

on the same day as the preventive medicine service. The appropriate

preventive medicine service is additionally reported.

An insignificant or trivial problem/abnormality that is encountered in the

process of performing the preventive medicine evaluation and management

service and which does not require additional work and the performance of

the key components of a problem-oriented E/M service should not be

reported.

Example: A 50-year-old established patient comes in to the office for an annual wellness visit and at the same time also complains of a severe chest pain.

The physician performs comprehensive preventive evaluation as well as a separate level III elements of an office visit  for chest pain and reports it in addition to the preventive medicine service, then the coding can be done as follows:

CPT       MOD        ICD

99396                   V70.0

99214    25           786.50.

What is Medical coding and purpose of it ?

The most common definition of medical coding is transforming the patient charts and disease conditions into alphanumeric codes.

Internationally, coding is done for the purpose of  mortality statistics.  These reports are scaled depending on the location, age, race, gender, etc.  Based on the statistics reports the governments identifies the root cause of these disease conditions and takes necessary steps and eradicate the disease conditions.

In the US Healthcare coding is done for the above reasons as well as it is the first step of billing process.

There are 3 types of coding:
Basically there are 3 books from which coding is done (outpatient physician coding):

1.  ICD-9-CM:  International classification of diseases  9 Revision, Clinical Modification.  Whenever a patient visits a physician or a hospital, all the conditions that the patient has been diagnosed are needed to be documented in the patient's chart.  All these diagnoses are coded from ICD-9-CM.  All these codes are either numeric of alphanumeric.  The code ranges from 3-5 digits.

2.  CPT:  Current Procedural Terminology.  These codes are also known as the HCPCS Level I codes.  These are the codes that represent physician services.  Codes are given based on the effort the physician has put in treating the particular patient's condition.  Each and every CPT code have different charges ($ value).  Based on these CPT codes the insurance company pays the physicians.  All the codes are 5 digit numeric codes.

3.  HCPCS:  Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as "hick picks").  These and HCPCS Level II codes.  These codes basically represent the supplies that a physician or hospital has provided to a patient.  There are also some G-codes which represent physician services and are billed to Medicare.

In conclusion, whenever a patient visits a physician and is treated for the disease conditions. All the physician services are coded from the CPT/HCPCS and the diagnoses are coded from ICD-9-CM.

What is Medical coding and purpose of it.

Medical Coding Career

Medical coding is going to be one of the best career in the Healthcare Industry, especially for the people who are associated with the US Healthcare Industry.  It is the fastest-growing career compared to other industries.  This is going to be a good job especially for the transcriptionists, who have the knowledge of US Healthcare Industry.  The good about it is that they need not wear a headphone/earphone or operate a foot pedal and fight with their keyboards.  It is all about application of ideas.  The good news for us is that there are many companies coming into coding in the near future and scope for growth is more.   Already, many big companies have been set up in Hyderabad (UHG, Humana, etc these are the leading health insurance companies in US)

Anyways, I will be updating this blog with all the news in the coding industry.

Anybody who wants Medical Coding in Hyderabad, contact me.  You can mail me at arunkumar.palakala@gmail.com