What is Medical Coding? (Medical Billing Tip)

medical billing and codingIn general, people understand what medical billing is. However, many people don’t understand what medical coding is! If you are a healthcare professional, looking for a simple (general) answer, here goes:  

Medical billing is simply taking a medical service that a health provider offers (for example, a 45 minute psychotherapy session) and converting it into a code so that insurance companies can process the service, and pay the provider correctly (in this case, the code is 90806).

For some specialties, such as in behavioral health, there are very few codes that are billed. For example, a psychologist running a practice will bill (90801, 90806, 90847,90846, and a just a few more–under 10 in almost all instances). However, some general practitioners, or physicians that provide services for a multitude of conditions could bill many codes–that’s when someone with a lot of training and experience in medical coding is important in the medical billing process.

UPDATE 09/2014: To focus on providing excellent medical billing to Thriveworks franchises, we are no longer providing billing services to non-Thriveworks practices.

Learn more about the exciting benefits of opening a Thriveworks Counseling center in your area, here: Counseling Franchise.


Your Friends at Thriveworks Medical Billing

Medical Billing Tip: All Sessions Must be Authorized

medical billingAcross the USA, healthcare providers are stressing because they’re not getting their claims for services paid. And they should be! There are many practices that haven’t been paid for over a year, or who have outstanding Accounts Receivable in the hundreds of thousands.

While there are many reasons medical billing claims can be denied (we listed 17 reasons in a previous article), perhaps the most common problem realtes to “Patient/Client Authorization.”

Good Medical Billing starts with getting authorizations. This means, for every single patient, someone must contact the client’s insurance company, prior to his/her first appointment, and get the service authorized. 

Sound like a pain? It’s not fun, but it’s a small effort up front compared to the headache and heartache one can experience is authorization isn’t obtained. Claims will reject. Claims will need to be appealed. And often those appeals are declined for “Lack of authorization.”

You can do this yourself by calling each patients insurance provider! Or, if you’d rather focus on patient care, at Thriveworks Medical Billing, our billing experts will make sure each of your patients is authorized prior to their first appointment with you. 

Be well,

Your Thriveworks Medical Billing Team

Three Questions to Ask About Counseling Medical Billing

medical billerMedical Billing, for counseling practices, is either a strength and a huge asset that helps to shoot your practice to the next level–or it is a frustrating albatross that could lead to the demise of your practice. There is rarely an in between! The following article looks at important questions to ask your medical billing staff or company about how your receivables are measuring up.

Question Number One: Are you receiving payment for your claims?

Obviously, the point of medical billing is to get paid for your work. But what is reasonable to expect?

A: You are doing well if you receive between 96 to 99 percent of claims, or better said, percentage of money from claims. I make this distinction because if you’re billing for different services, and you’re getting paid on your small claims, but not your high-fee claims, you could potentially have a high percentage of claims paid, but a lower percentage of total money in the door.

A quick note: having 100% of claims paid is always what you’re aiming for–that would be ideal. But in the imperfect system you’re working with (healthcare), be satisfied if you’re receiving 98%.

Consider it a Red Flag is you’re receiving under 95%

If you’re at 94%, don’t panic, but its time to look closely at your reports, and determine where you’re losing 6%, so that you can make changes.

If you are under 90%, now it’s time to hit the panic button. It is time to seriously evaluate what’s going wrong.

The thing is, many practices collect less than 90% of what’s owed to them, and don’t even know it because they don’t have reliable reporting. Being able to run reports, to determine where your money stands, is a must—even for a small practice.

This leads us into question number two:

Question Two: Do you know what has been paid or not paid, and why?

Counselor Medical Billing: Read On

Medical Billing for Counselors: 17 Reasons Why Claims are Denied (intro)

17 Reasons Why Insurance Companies Deny Claims

Medical billing is a frustrating process for counselors who are often juggling lots of business tasks, as well as trying to provide excellent clinical care. In fact, many counseling practices collect less than 80% of the monies that they’re rightly owed from insurance companies. However, with good planning, and a smart billing staff, your practice can reasonably expect to collect between 96-99% of claims.

Look out for these pitfalls. There are many reasons that claims can go unpaid, including: –to view, See our blog at http://medicalbillingtherapy.com !

Mental Health Medical Billing: Why Claims are Denied (reason 17 of 17)

The Patient Has an Unmet Deductible

Even if the patient’s insurance card says that their copay is $10, if he or she has not met their deductible, you might receive $0 from the insurance company when you file your claim. In addition, be on high alert in January, when deductibles often reset!

Mental Health Medical Billing: Why Claims are Denied (reason 16 of 17)

The Patient has an Out of State Insurance Plan

If your patient has an out of spate insurance plan, even if the company is a company that you work with (such as Blue Cross Blue Shield), you might find that your reimbursement rate is less, and (depending on the patient’s specific plan) your claims can even be denied.

Mental Health Medical Billing: Why Claims are Denied (reason 15 of 17)

The Service was Already Rendered

With Behavioral health, insurance often covers an intake appointment (90801) only once per 3 month period.  If your clients went to see a therapist prior to you, and the previous therapist billed a 90801, your claim could be denied.

Medical Billing: Why Claims are Denied (reason 14 of 17)

The client’s Out-of-network Benefits Differ from In-network Benefits

Out of network benefits often differ from in-network benefits. For example, with out-of-network benefits, insurance companies often place a greater amount of the payment responsibility on the patient, including the potential for additional deductibles that need to be met. Fail to identify the actual amount owed by the patient for out-of-network services, and you may never retrieve payment for services.

Therapy Insurance Billing: Why Claims are Denied (reason 13 of 17)

Services Rendered at the Wrong Location

When a counselor is paneled with an insurance company, they list one (or multiple) practice addresses. It is important to make sure that providers have all the places they serve patients registered with all the insurance companies they work with. Provide services at an unregistered location, and the claim could be denied.

Therapy Billing Insurance: Why Claims are Denied (reason 12 of 17)

The Provider isn’t Paneled

If a provider sees a patient, but isn’t a paneled provider with the patient’s insurance company, the claim will be denied. This sounds like common sense, but with insurance companies changing names and merging, this happens somewhat frequently. Also, if a provider was working for a larger clinic, he or she might think that he is a paneled provider, when really he was working under his employer’s contract with the insurance company.