Ambulatory Surgical Centers (ASC) are outpatient surgical centers not requiring patient hospitalization or the procedure duration does not exceed 24 hours from the time of admission. ASCs are standalone centers as CMS regulatory does not allow ASC and other medical entities such as a medical practice or physician office to operate in one common space unless under certain conditions. As a distinct entity exclusive for outpatient surgical services, ASC must sign a written agreement with Center for Medicare and Medicaid Services (CMS) and be certified and approved by CMS as participating providers.
Abiding by the U.S federal government and HIPAA Privacy Rule, protecting and securing healthcare data has become crucial. Healthcare data security protection is of utmost importance due to several key reasons, however it is important to understand these clauses clearly and function accordingly to ensure safe and secure Protected Health Information (PHI). To know the importance of Healthcare Data Security and Protection read through the below points:
Maximum collection or collecting all due reimbursement is the fundamental requirement expected from any billing service irrespective of whether it is done In-house or Outsourced. Arranging all prerequisites to ensure the bottom line is achieved is clearly the basic reason to turn towards “Third Party Medical Billing Solutions”. Looking at the statics and trends, Medical Billing Outsourcing is a time-honored methodology for profitable Medical Billing Processing.
As a medical Billing and coding
company, we have experienced the importance of Medical Records management time
and again. And we have engaged ourselves in helping our clients manage their
medical records efficiently to help with easy retrieval of the same as and when
required and thereby improving patient services and medical billing quality.
Medical Billing and Coding is the backbone of US Healthcare and has become the need of the hour for many physicians and hospitals. The process of Medical Billing begins right from patient registration with a Doctor’s office and continues till the servicing provider receives all due reimbursements from the insurance company which is the primary requirement for any physician and healthcare. However, their primary focus on Patient care can take their attention from prioritizing Medical Billing affecting your financial bottom line. Additionally, the challenges and complexities involved in streamlining the medical billing process and getting them done with maximum payments for the physician mandate the role of Medical billing companies!
Medical Billing outsourcing services plays a crucial role in the healthcare industry, providing numerous benefits to healthcare organizations and medical billing companies. Outsourcing Medical Billing Services is considered as a boon in the Healthcare Industry as they help streamline the process, achieve targeted results with quality services and patient satisfaction, Increase collections and profits to the provider. Here are some key reasons why healthcare outsourcing services are important and how they are beneficial for the physicians and practices.
Reduce Overhead and Operational Cost
Healthcare outsourcing services can help organizations reduce costs significantly. By partnering with Outsourcing companies, healthcare providers can leverage economies of scale, access specialized expertise, and benefit from lower labor costs in different regions or countries. Outsourcing allows healthcare organizations to optimize resource allocation and streamline operations, leading to cost savings in areas such as staffing, infrastructure, software, and equipment.
Access
to Specialized Skills and Expertise
Outsourcing enables healthcare organizations to tap into a broader pool of specialized skills and expertise that may not be readily available in-house. Medical billing companies often have deep knowledge and experience in specific areas, such as medical coding and billing, revenue cycle management, clinical trial management, healthcare analytics, and IT solutions. By partnering with outsourcing providers, healthcare organizations can benefit from the expertise of highly trained professionals and access specialized services that enhance the quality and efficiency of their operations.
Improved
Efficiency and Productivity
Healthcare outsourcing services can enhance operational efficiency and productivity. Outsourcing Partners typically employ streamlined processes, advanced technologies, and best practices to deliver services. This can lead to improved turnaround times, reduced errors, enhanced accuracy, and increased productivity. By leveraging the efficiency and expertise of offshore outsourcing partners, Medical Billing Companies in US can optimize their workflows, improve patient flow, and provide better care and services.
High
Scalability and Flexibility
Healthcare demands can be
unpredictable and subject to fluctuations. Outsourcing services provide
healthcare organizations with scalability and flexibility to adjust their
operations based on changing needs. Your Outsourcing Partner can quickly ramp
up or down their resource and adapt to fluctuating patient volumes, seasonal
variations, or other market dynamics. This scalability ensures that
organizations can meet process demands efficiently without compromising
quality.
Process
Automation with Technological Advancements
Healthcare is increasingly reliant
on technology to drive innovation and improve patient care. Outsourcing Medical
Billing Services enables to leverage on the latest technological advancements
without incurring the full costs of implementation and maintenance. Outsourcing
partners often invest in state-of-the-art infrastructure, advanced software
solutions, cybersecurity measures, and other technologies. By partnering with
them, you can benefit from cutting-edge technologies, gain a competitive edge,
and stay updated with the rapidly evolving healthcare landscape.
Compliance
and Risk Management
Healthcare outsourcing providers are often well-versed in regulatory requirements and compliance standards specific to the healthcare industry. They have robust systems and processes in place to ensure data security, patient privacy, and adherence to legal and regulatory obligations. Partnering with reputable outsourcing vendors can help healthcare organizations mitigate risks associated with data breaches, compliance failures, and legal liabilities.
It is important to conduct thorough due diligence, establish
clear communication channels, define service-level agreements, and maintain
strong partnerships with outsourcing providers to maximize the benefits and
ensure seamless integration of outsourced services within their operations. To
know more about Medical Billing Outsourcing reach out to Ecare
Accounts Receivable Management in Healthcare is
the management of payments due by the insurance and patients to the physician
for the services provided. It is crucial to manage the due payments and
balances on time to avoid financial downfalls from revenue loss. Sustaining
regular cash flow from Insurance and Patients within the TAT from the date of
claims submission is mandatory to avoid AR accumulation affecting the financial
goal of the practice.
Gastroenterology clinic focuses on providing outstanding patient care with the most effective Gastroenterology services. Prior Authorization plays a crucial part in Gastroenterology Billing as most often the medical necessity of the medical procedure is evaluated by the insurance company to ensure payment of the claim. Prior Authorization and Insurance Eligibility Verification Services goes hand in hand when the medical specialty is Gastroenterology as many insurance companies have varied rules and policies which is mostly tied to the final reimbursement of the claim. Read below to understand Prior Authorization in Gastroenterology and the process involved:
Prior Authorization Requisition Process and Timeline:
Gastroenterology often requires the determination of medical necessity and timely authorization can reduce denials and increase revenue.
Best practice would be to obtain authorization 15 days prior to the appointment date to avoid rescheduling or canceling the patient appointment for lack of authorization from insurance company.
Medical Billing and Coding team have to note that majority of insurances have 15-day timeframes to process & approve prior authorization. Abiding by this timeline will benefit all parties involved such as the patient, physician and also the billing process.
For EGD procedures patient should be in medication at least 90 days before having the procedure this protocol in fact can cause delays and rejections in authorization approval.
Upon receiving authorization approval, e-care team will update the Authorization number in the software with a valid date along with any deductible remaining and copay to collect.
Diagnosis Code plays a major role in authorization requirements, therefore having quality coding is mandatory.
Prior Authorization Process Payer Specification:
Authorization requirements always depend on insurance type and patient plans.
Authorization requests for EGD, Colonoscopy, & sigmoidoscopy are initiated at the Ambulatory surgical center setting and outpatient setting as applicable
There are lists of procedures for EGD and Colon but some insurance will not accept multiple codes in the authorization request, as only one procedure can be requested as per the insurance guidelines. In such case, it is advisable to confirm with the insurance company on the possibilities to change the procedure with same authorization number after the service has been performed.
Most insurance do not require prior authorization for Colonoscopy screening except for diagnostic service which always depends on the patient’s health and diagnosis.
Medicare and Medicare supplements do not require authorization when service is done in ASC and outpatient settings. However, authorization requests are submitted for Medicare HMO, advantage, and replacement plans.
In case the authorization for EGD and Colon is denied due to not medically necessary, a peer-to-peer review with the doctor and nurse reviewer can be scheduled and processed accordingly.
Submission of an appeal or reconsideration for authorization denial with documents that support the procedure is possible in most cases.
