3 Essential Steps for Medical Billing
Medical billing is most people’s least favorite part of working in healthcare administration. Typically, there is a team of individuals who can handle this task in larger businesses. However, if you work in a small practice, you may find yourself needing to at least learn the basic ins and outs of medical billing so that you can assist with the process if need be. Here are 3 essential steps for proper medical billing.
1 – Checking A Patient’s Insurance Coverage
Checking insurance is one of the first steps when dealing with the medical billing process for a patient. The question isn’t as simple as if they have insurance or not, and it also isn’t as simple as seeing if you take their insurance or not. What you need to perform is a verification of benefits. If you’re at all familiar with insurance policies, you know its very possible for your patient’s insurance company to cover one thing and not the other.
In other words, you may have a patient that wishes to receive services or care and some services are covered and others are not. This can really affect the total cost of treatment and will also determine if and how the patient will want treatment administered.
2 – Keep Up to Date on CPT Codes and Changes
As you may know, CPT codes have a tendency to change. If the code changes and you don’t know, you’re potentially in for some trouble since you’re technically using the wrong code from there on out thus causing medical billing errors and issues that prevent the clinic from getting paid.
This is especially true in the mental health billing and coding space where definitions and disorders are rapidly changing as they undergo scientific and medical scrutiny to further reach better means of treatment. A side effect to that is mental health CPT codes can change or be redone altogether due to a trick down effect from changes in the DSM.
3 – Double-Check Your Information
You’ve got all of the information gathered and you need to submit a claim, what do you do next? Before you submit the claim, you should make sure all of your information is accurate, and as error-free as possible. Prudence is the essence of the job for medical coders and billers. A job well done is one in which we do not think about, it’s only the claims with issues or errors do we become aware of once they’re rejected.
Not every insurance company uses the same billing format, if you happen to talk to them during verification of benefits or for some other reason, you should ask them what their preferred billing format is. Eventually, you’ll gain experience as a medical biller and you won’t have to ask, you’ll simply just know!
Professional Remote Medical Billing Company
At Mental Health Billing Utah , we just know too. With years of medical billing and medical coding experience, you can leave all of the small details to our professional team for all of your medical billing and clerical needs.
Contact The Mental Health Billing Utah today so you can reduce the administrative bloat in your office and focus on what’s most important for your business!
Medicare Reimbursement for Pre-Diabetes Screening
Pre-Diabetes Screening involves the testing of asymptomatic, high-risk individuals to assess whether they meet the criteria for either prediabetes or type 2 diabetes. Screening for prediabetes and diabetes is more frequently done in health care settings than in community settings. The process used to target and test patients may include a team approach, employing various health care professionals such as medical assistants, nurses, physicians, diabetes educators, or others.
Health care providers in a variety of practice settings can consider the use of standard ordering protocols for glucose testing, which may be approved by physicians upfront but carried out by other team members when at-risk patients are identified. In addition, provider teams can look for opportunities to screen for pre-diabetes while managing a patient’s other conditions. For example, when screening for hyperlipidemia, fasting glucose may easily be added to a standard fasting lipid test panel.
Reimbursement for Pre-Diabetes Screening
Medicare recommends and provides coverage for diabetes screening tests through Part B Preventive Services for beneficiaries at risk for diabetes or those diagnosed with pre-diabetes. When filing claims to Medicare for diabetes screening tests, the following Healthcare Common Procedure Coding System (HCPCS) codes, Current Procedural Terminology (CPT) codes and diagnosis codes must be used to ensure proper reimbursement.
HCPCS/CPT Codes
HCPCS/CPT Codes |
Code Descriptors |
| 82947 | Glucose; quantitative, blood (except reagent strip) |
| 82950 | Glucose; post glucose dose (includes glucose) |
| 82951 | Glucose Tolerance Test (GTT); three specimens (includes glucose) |
| 83036 | Hemoglobin A1C |
Diagnosis Code
Criteria |
Modifier |
Diagnosis Code |
Code Descriptor |
| DOES NOT MEET | None | V77.1 | To indicate that the purpose of the test(s) is diabetes screening for a beneficiary who does not meet the definition of pre-diabetes. The screening diagnosis code V77.1 is required in the header diagnosis section of the claim. |
| MEET | -TS | V77.1 | To indicate that the purpose of the test(s) is diabetes screening for a beneficiary who meets the *definition of pre-diabetes. The screening diagnosis code V77.1 is required in the header diagnosis section of the claim and the modifier “TS” (follow-up service) is to be reported on the line item. |
The Centers for Behavioral Health Billing Utah monitors the use of its preventive and screening benefits. When submitting a claim for a diabetes screening test, it is important to use diagnosis code V77.1 and the “TS” modifier on the claim as indicated in Table 2 above, along with the correct HCPCS/CPT code (Table 1), so that the provider/supplier can be reimbursed correctly for a screening service and not for another type of diabetes testing service.
Medicare beneficiaries who have any of the following risk factors for diabetes are eligible for this screening benefit Hypertension; Dyslipidemia; Obesity (a body mass index equal to or greater than 30 kg/m2); Previous identification of elevated impaired fasting glucose or glucose tolerance. Medicare beneficiaries who have a risk factor consisting of at least two of the following characteristics are eligible for this screening benefit:
Mental Health Billing for Non-Profits
If you are responsible for Behavioral Health Billing Utah for a non-profit, you’ve got to avoid two layers of challenges – people who come from billing for what some consider a non-traditional healthcare service, and people from addressing the special needs and processes of non-profits companies.
For this reason, it is often important to outsource billing to a professional third party like Medical Billers and Coders to handle your medical billing. We have worked with many non-profits, and that we understand that you simply can’t afford to wait for weeks to get reimbursement from insurance companies. We’ll assist you to code your claims correctly, avoid the issues that insurance
companies cite to avoid paying you and hunt those unpaid or rejected claims to form sure your non-profit gets the reimbursement what it deserves.
Therapist Billing
As a therapist, you’ll often find the requirements and concerns of your patients overwhelming. You do not need to worry about various insurance payers and dealing out which billing codes they’re going to accept. Our billers can help you to find and input billing codes easily and we’ll work with the insurance companies so you’ll focus on providing care to your patients.
Readmore What Constitutes Behavioral health Billing Services?
What Constitutes Behavioral health Billing Services?
You might be already aware of how behavioral health billing is different from medical billing, you’ll wonder what falls under billing for behavioral health services with reference to the services we offer at Behavioral Health Billing Utah the kinds of behavioral health billing we will assist with include:
Behavioral Health Billing
To successfully bill for behavioral health, you would like a good understanding of the varied codes that behavioral health treatments fall into. Billing errors can reduce your collection as well as lead to rejections and cause delays in payment. We’ll ensure your behavioral health billing claims are submitted correctly and on-time.
Psychologist/Psychotherapy Billing
If you use billing software that does not properly consider psychology creates challenges in billing which can lead to a loss in the collection. Finding the correct codes and keeping track of reimbursed claims are often difficult. In healthcare industry practice management software companies design Behavioral health medical billing software by keeping all psychologists and psychotherapists in mind, so finding procedure codes, managing billing, and keeping track of different claims are easy and straightforward.
Psychiatry Billing
Psychiatric billing is usually more like traditional medical billing than mental health medical billing because psychiatrists are medical doctors. However, there are still challenges to face and pitfalls to avoid when billing as a psychiatrist and Medical Billers and Coders have the experience to address all the challenges.
