You are already performing a wide range of medical billing services within your office. You should be getting reimbursed for all of them. In a nutshell, medical billing reimbursement medical healthcare solutions involves payments received for procedures and services performed, from commercial payers such as insurance companies, that act on behalf of healthcare programs. This reimbursement is determined by the claims submitted and documentation provided and filed by providers like you through the proper use of medical diagnosis and procedure codes.
Commercial payers must follow standards set by the U.S. Department of Health and Human Services (HHS), with many of these regulated by each state. With the exception of specific national mandates, like reimbursement for childbirth, commercial payers determine what their rules will be in regards to medical necessity or payment/reimbursement fee schedules. Federal intermediaries like Medicare will reimburse physicians and other providers for services provided to beneficiaries on a fee-for-service, or FFS, basis. Fee schedules are set for physicians, ambulance services and clinical laboratory services, as well as medical equipment, prosthetics, orthotics and supplies.
The Changing Role of Healthcare
Reimbursement in the realm of healthcare is changing. Even prior to parts of the Affordable Care Act began to take effect, a burgeoning focus on value-based care vs. volume has prompted many health-care organizations and providers to look at accountable and patient-centered care models whereby they take on a greater amount of risk. That’s why revenue must be managed in a different way to make sure that the value delivered to patients is paid for — both accurately and in a timely manner.
In order for hospitals and physicians to ensure their claims are paid out, they first have to understand the differences in various components of claims management and how they can affect reimbursement. This knowledge is time-consuming to attain but can pay off in the end.
You are likely handling several aspects of your company’s billing services. With overworked staff taxing that system, you could be overlooking many reimbursements for work you’re already doing. There are many components of the patient-provider interaction that fit within the revenue cycle and that could lead to loss or risk due to gaps in service:
- Pre-service (including pre-registration and pre-auth)
- Process of care
- Process-integrity practices (including code compliance)
- Billing services (customer support)
- Administrative services (debt collections, contract management, etc.)
Professional, Outsourced Assurances
The business of healthcare requires certified medical billers who possess the skills necessary to expertly tackle all aspects of the revenue cycle. Without this expertise in medical billing and the nuances of payer requirements, reimbursement is often compromised. Seeking out a professional medical billing and reimbursement specialist means you can submit claims in accordance with government regulations and private payer policies, follow up on the status of a claim, resolve denials, submit appeals, manage collections, and post payments and adjustments.
If you would like to know more about medical billing reimbursement and how it can help you, contact Medical Healthcare Solutions, Inc. in Andover at 800-762-9800.