Not all medical services are associated with financial charges. Some procedures are bundled into an overarching service. For instance, the simple closer of an incision made by a healthcare provider is considered an integral part of the incision procedure, while the simple closer of a laceration due to trauma, is considered a surgical procedure in […]
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Put plainly, commercial health insurance is any healthcare policy that is not administered or provided by a government program. Most commercial health insurers are publicly traded companies that operate to generate a profit for shareholders. Some commercial health insurers are non-profit organizations. The Blue Cross Blue Shield Association, for instance, has member organizations that operate […]
Medical coders who work in the inpatient hospital setting utilize a different skill set than medical coders in other healthcare settings. The rules that govern medical billing and medical coding in hospitals require that a specific skill set be practiced that is different from those used by other professional medical coders and professional medical billers. […]
An ambulatory surgical center (ASC) is a healthcare facility that is dedicated to providing medically necessary surgical services to a patient in the outpatient setting. ASCs are paid according to a unique set of regulations and standards under the Medicare program, under Medicaid, and under contractual agreements with private commercial health insurers. This article focuses […]
Medical billing and coding for skilled nursing facilities (SNFs) seems complicated at first. Reimbursement for services received in an SNF are subject to an increasing number of regulatory restrictions, beginning with the Balanced Budget Act of 1997. In an effort to reduce potential fraud and abuse due to double billing by healthcare providers, SNFs currently […]
The Patient Protection and Affordable Care Act of 2010 (PPACA) mandates that the healthcare industry change the way it reports medically necessary services for reimbursement. ICD-9-CM, which has been the standard for reporting healthcare transactions under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), be replaced by ICD-10 in October, 2013. The International […]
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandates that Volume 3 of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) be used to code inpatient services on medical claims. While most professional medical coders and medical billers use the diagnosis codes in ICD-9-CM every day, the code manual also contains […]
Medical billers are the professionals responsible for the cash flow of a medical practice. They are knowledgeable about insurance regulations, health insurance contracts, medical coding, and bookkeeping. Medical billers spend much of their work day on the computer and the telephone. Medical billing is the act of communicating with third party payers what services were […]
Professional medical billers have mastered the specialized language of medical code, and this code is based on the language of medicine. Medical billers and medical coders need to comfortable using and understanding medical terms in order to apply the correct codes to describe services delivered to patients. Medical language is precise. Each of the specialized […]
Most healthcare providers, whether licensed individuals or institutions, find that the majority of their income comes from the care and treatment of Medicare beneficiaries. Medicare is a federal healthcare program that covers approximately 43 million individuals who are over the age of 65, or who are under the age of 65 and are disabled. Because […]
