What’s the difference between medical billing and coding?

So in this post, my goal will be to outline the differences between medical billing & medical coding and try to connect these 2 together, in the way they work.

Many of you may understand these basic concepts, in which case bare with me. For all the others, you definitely want to read this post ’till end.

Medical billing is really the reimbursement for all services provided to the patient. So medical billing covers the evaluation and treatment of a patient from a medical provider.

Medical coding has to do with the language via which the process works and the transaction is completed. So medical coding really consists of coding which basically puts all billing actions into its own “words.”

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Consulting the general public: What type of health insurance should I prefer?

This post isn’t focused particularly for people in the medical billing space, or even healthcare providers specifically. I figured, since we are talking about medical billing (and health insurance plays a big role), I  should make a post that provides a plethora of information on health insurance. And since everyone has/needs it, then you being a healthcare professional can benefit from this post too.

First off let me say, that whenever you are dealing with insurance, it will be complicated no matter what. In any given industry, insurance plans can be a pain. Doesn’t matter if you are talking about health insurance, property insurance, pet insurance, political insurance or any other. I know for a fact that insurance in the limousine industry, is full of loopholes and chaotic situations.

So…

Where do we start? What do we do? The health insurance market is chaotic! 

Continue reading Consulting the general public: What type of health insurance should I prefer?

Physician billing & denied billing. What do you do?

In this post, what I’m hoping to touch on is a very common issue that every billing company, staff member or coder comes across daily. It’s the issue of “denied billing.” In other words, you send a claims form in the way that we talked about in another post, and the insurance company doesn’t accept to make the payment. This can create a very timely situation that can last from a few minutes, to even a few hours (or worst case scenario you don’t get paid.)

It’s really a troubling thing to deal with, as in the healthcare industry the whole team should be focused on serving patients – not jumping through loopholes. So I will be outlining below a few common reasons you are getting denied some billings and a few things you can do about this problem. Note that a very average denied claim statistic is about 20% of the claims sent. In some cases and in cases where – as I will detail below – the person in charge of the billing is doing a lousy job,  the denied billings can reach a percentage of 80%.

So probably the main reason you are having denials may start and end with the front desk. If the people in charge aren’t doing the registrations correctly, then coding or managing the rest of the billing process, wont really matter. Your staff or people in charge can be experts in coding. But if they are making registration mistakes, then that has no value. According to some sources and statistics, many times over 50% of claims are being denied, because of front desk mistakes. 

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Getting Started – The Basics (part 2)

In the last post I made, I briefly explained how the billing system works among the three parties: the MD, the insurer and the patient. I spoke in some detail about the importance of having a team that are experts on this part of your healthcare clinic/hospital/setup. I also mentioned the fact that it isn’t too hard to understand or use. It’s just time consuming.

The main form mentioned was the HCFA 1500 and I broke down the different fields in it and the uses of it.

As an extension on that thought, I will now talk about another claims form, the UB 92 form. This is used for billing services which are being provided at a facility or hospital. Main use of it, is billing technical services. In the UB 92 form, there are 83 fields within it. One of which are the: types of health insurance coverage.

The major types of health in insurance coverage have two basic categories:

  1. Federal
  2. Commercial

The process of sending forms such as HCFA 1500 or UB 92 to medical insurers is called medical insurance billing.

Next up, I’ll be talking about some issues in the medical billing industry (such as denied claims) and the importance of the front desk hitting the ground running.

If you have any questions or would like to discuss something, feel free to contact us.

Getting Started- The Basics (part 1)

In this blog post what I want to do and achieve, is set a really strong foundation on medical billing. This article is going to be more generic (so not focused on dermatology) as there are many things that are going to be talked about, that anyone in the healthcare industry can benefit from. So I’ll be getting into some terminology, some basic concepts and kind of sketching out a vocabulary booklet that we can always refer to, in the future.

First of all, let me just say that in order to do your billing, you obviously will need to use some kind of software. There are many great companies out there that will monitor the billing for you, in exchange for a percentage of your revenue. So you don’t necessarily need to do everything yourself. You could have an employee working on this – a billing expert, or even your receptionist (if he/she isn’t that busy…) In any case, I would never suggest you do everything on your own as a medical doctor. You have spent a solid number of years in medical school and gone through all that training for one sole purpose: to treat patients. So leave the bureaucratic boring billing things for someone else to do – unless you are a great multitasking person. Having said that, you always want to understand how the billing process works and you want to get an in-depth, inside view of what’s happening. This way you can always monitor the people working on this much better. Plus, it’s an interesting field of its own.

Continue reading Getting Started- The Basics (part 1)

You just landed on our new website. Welcome!

Hey guys! Welcome to this brand new website called Dermatology Billing Experts that will be discussing everything related to medical billing in the great specialty that is dermatology. I’ll be making some posts in the next couple of days and I may even get a comprehensive one conducted later today.

In any case, thank you so much for reading and stay tuned!