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Understanding Medical Billing

Medical Insurance Billing for Holistic Practices

In today’s healthcare industry, staying on top of medical insurance billing and coding responsibilities is crucial for providers to maintain a financially healthy practice. Medical billing and coding are important to the revenue cycle and help ensure that providers are appropriately paid for the services they’ve completed for their patients. 

Learn more about how the medical billing process works, how your holistic practice could benefit from professional medical billing services and how to get started billing insurance.

What Is Medical Billing and Coding?

medical coding and billing services

Medical Coding

Medical billing and coding involve processing patient data as it relates to their insurance policies. Medical coders translate a provider’s diagnosis into a numeric or alphanumeric code, and request reimbursement from the patient’s insurance company.

For each type of injury, diagnosis and medical procedure, there are designated medical codes that correspond with them. These codes are used later to figure out the appropriate amount each patient should be charged. Medical coders use thousands of codes every day, and there are many code sets and subsets that they must be very familiar with in order to apply them correctly. Two highly important ones include ICD (International Classification of Diseases) and CPT (Current Procedural Terminology). ICD codes are used to classify a patient’s illness or injury, while CPT codes are used to identify specific services performed by their provider to help remedy their illness or injury.

These codes serve as a universal way to categorize illnesses, medications and services rendered for various areas of the healthcare industry, including insurance companies, physicians, hospitals, government agencies, and many others.
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Medical Billing

Once a medical coder associates the correct ICD and CPT codes with a patient, the medical billing process begins. First, the medical biller sends a claim to the appropriate insurance company for processing. The insurance company evaluates it and returns it.

A medical biller is also responsible for creating detailed legal bills for healthcare providers, which must be sent to insurance companies within specific timeframes.

All codes must correspond to each other, and it’s up to medical billers to confirm or deny that all services provided by a provider are covered by the patient’s insurance policy. Medical billers must also create claims that align with practice's rates, and send claims to the payer.

Payer adjudication is the next step in the medical billing process. Once completed, it’s then sent back to the medical biller, who reviews it for accuracy before processing a bill.

Benefits of Outsourcing Medical Billing

 

Many practitioners struggle with handling medical billing and coding appropriately, which can often result in lost reimbursements and increased risk of poor financial health. 

Using an electronic health record (EHR) can be helpful in streamlining efficiencies and improving workflows, but technology alone doesn’t always pave the way for long-term financial success. To maximize revenue performance, providers can benefit greatly from outsourcing their medical billing with experienced professionals.

Here are a few of the main benefits of outsourcing your holistic practice’s medical billing and coding:

  • Less Billing Errors – When there are billing errors, there can also be a significant loss of revenue for your practice. By outsourcing your medical billing to trusted professionals, you can ensure profitability and error-free billing.
  • Faster Reimbursements – When you start having less billing errors, you’ll have much more money coming in for reimbursements. Outsourcing can be a helpful way to reduce your billing errors and increase the efficiency of payments coming in.
  • Fewer Headaches – Medical regulations are always changing, making it hard for providers to keep up with. Outsourcing your holistic practice’s medical billing to experts (who are always plugged into the latest regulation changes), you can avoid many headaches associated with medical billing.
  • Reduced Costs – Hiring a medical biller in-house often comes with a laundry list of expenses, such as cost of training, employee benefits, medical insurance, and yearly salary costs. Outsourcing your medical billing can be a smart option to eliminate these expenses and receive the medical billing support you need.
  • Guaranteed Compliance – When regulations change as frequently as they do in the healthcare industry, it’s crucial that your practice is compliant. Outsourced medical billing services can help ensure providers’ claims are clean and that they’re always up to date.
  • Expert Consulting – Some outsourced billing and coding companies provide expert consulting services, ensuring providers have the answers they need to their medical billing questions.
  • Happier Patients – When you have more time to focus on treating patients, you can almost guarantee increased patient satisfaction. These are the customers that can provide positive testimonials and word-of-mouth recommendations for your practice.
  • Scalable Growth – By outsourcing your medical billing and coding, you have the potential to grow your practice exponentially, which is crucial for any practice looking to increase revenue, add new providers and drive in new patients.
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Medical Billing Practice Areas

Today’s healthcare system is continually changing and many practitioners are turning to professional medical billing and coding services to help manage their billing effectively.

For that reason, many leading medical billing companies provide services for a variety of practice areas.

Contact a Billing Expert

Holistic Billing Services

Medical billing companies are there to provide helpful services to ensure your practice is set up for success. However, it’s important to choose a company that understands billing insurance for holistic and integrative medicine practices is different than for traditional practices.

Selecting an experienced medical billing company who is well-versed in billing for holistic practices is essential. Here are some holistic billing services to look for:

  • Specialized consulting for massage, chiropractic and acupuncture practice management
  • Secure protection of private patient information
  • Insurance company credentialing and claim optimization
  • Expert consulting from trained CPAs, MBAs and certified coders
  • Real-time verification and claim status via a secure online portal
  • Practice management and performance analytics
  • Accounts receivable management
  • Denied claims follow-up
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Medical Insurance Billing FAQs

How Can I Reduce Patient Billing Problems?

Many integrative medicine practices lack the budget, manpower or time to assist patients with resolving billing problems. However, in order to maintain healthy, positive patient relationships, providing this kind of assistance should be prioritized. Use these helpful steps to resolve patient billing issues:

  • Ensure You Haven’t Made Any Errors – Patients commonly encounter problems with insurers, but there are many instances in which errors occur from the provider. Identify where your weak points are (these may include denial rates, limited timing, etc.) and ensure they are eliminated quickly.
  • Consider Revising Your Process – Another way to reduce patient-billing problems is to assess your current process. Ensure you have a documented billing policy that is followed regularly, and that you don’t skip verify insurance benefits, fail to communicate vital patient information, etc.—these problems may be confusing and frustrating patients. 
  • Evaluate Your Outsourcing Options – One of the most important things your patients need is an ally at your practice—someone who can intelligently explain expenses and address special issues as they come about. Consider outsourcing your medical billing to experienced professionals to help verify benefits, maximize revenue and lower claim denial rates.

Speak with an expert at Holistic Billing Services to learn more about a customized billing solution for your practice today.

 

What Can I Do to Simplify Payer Enrollment?

Participating with insurance company insurance plans is not always an easy task. Between denied claims, long processing times, payment disputes and more, there is a lot that goes on in addition to insurance credentialing. But, with the help of an initiative by the Council for Affordable Quality Healthcare (CAQH), your credentialing can be a lot simpler and with a lot fewer headaches.

Using CAQH ProView® (formerly the Universal Provider Datasource®)—an all-in-one platform where providers can submit, store, update and access the information they need—payers can easily download participating providers’ information into their systems.

Contact a payer to request its CAQH registration kit and follow their process online, or read more to learn about simplifying insurance credentialing. If you’d like assistance with working with payers, contact an experienced medical billing company to help streamline your practice’s processes.

 

How Can I Stop Underpayments From Happening?

According to the American Medical Association, there are many insurance companies that continually underpay providers—most only paying between 86–92% of the rates they’re contracted to.

For holistic practices, this loss can be significant—if not detrimental—to overall revenue, impeding on their potential for scalable growth. However, there is a solution to ending underpayments for good using these tips:

  • Review Contracts and EOBs to See What’s Owed – Review each contract to identify exactly what payers have agreed to pay. Listing out each payer’s contracted rates by CPT code will help prove underpayments as they come up. 
  • Gather Research – Once contract information is collected, you’ll then want to compile statements and reimbursement data for each payer into another document for a certain range of time (best practice is one to three months). After that time, compare the information to rates in your initial document. Major issues will be easy to identify if payers are coming up short, and if so, it’ll be important to summarize that information into a report.
  • Notify the Payer – When you’ve finished compiling your information, showing that underpayments have taken place, notify the payers by requesting a meeting with the individuals who are responsible for negotiating contracts. It’s best to come prepared to share what your reimbursement expectations are, should they agree to pay for their shortcomings. If they do not agree, taking legal action may be an appropriate option at that time.  
  • Stay Alert – The goal of these tips is for payers to provide more accurate reimbursements. However, if the preparation above doesn’t turn out positively for your practice, it’s a good idea to perform regular payment audits to check for underpayments.

Read more frequently asked questions about holistic insurance billing like this now! Or, if these steps seem more complicated than what you’re comfortable with, or if you’re unsure of how to appropriately compile this data yourself, you may want to speak with a medical billing expert to discuss a customized medical billing solution that works best for your holistic practice.

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