Outsourcing Medical Billing and coding

  Billing and coding in mental health care are often more complex than in other specialties. Providers must manage multiple procedures in a single session, adhere to payer-specific rules, and ensure accurate facility fee reimbursement—all while maintaining compliance. These challenges can lead to claim denials, underpayments, and delayed cash flow, ultimately affecting the financial health of practices. However, with the right strategies, mental health providers can simplify billing, prevent errors, and achieve accurate reimbursements. This blog explores effective approaches to coding multiple procedures correctly and optimizing facility fees to strengthen revenue cycle management. Coding Multiple Procedures Correctly Coding accuracy is critical in mental health billing , especially when multiple services are performed during one encounter. Here are key steps to improve reimbursement and reduce denials: 1. Prioritize the Primary Procedure Always list the most complex or ...

  Managing medical billing and coding efficiently remains one of the biggest challenges for healthcare organizations, especially with rising claim volumes, evolving payer rules, and tighter compliance standards. A well-structured Full-Time Equivalent (FTE) model offers a scalable solution to manage workloads, improve staff productivity, and streamline the entire revenue cycle. By analyzing daily tasks, establishing measurable productivity benchmarks, and allocating resources effectively, the FTE model reduces claim errors, accelerates reimbursements, and maintains financial stability. This blog explores how healthcare providers can integrate the FTE model into their billing and coding operations to achieve sustainable growth and long-term process optimization. Steps to Integrate the FTE Model in Medical Billing and Coding 1. Assess the Current Workload The first step to FTE model integration is understanding your current billing and coding workload. Measuring claims process...

  Ambulatory Surgical Centers (ASCs) face ongoing challenges with manual billing systems—delays, claim errors, and administrative burden often hinder reimbursement timelines. As healthcare billing grows more complex, ASCs must adopt efficient technologies to stay compliant and financially sound. Electronic Data Interchange (EDI) and Electronic Claims Processing (ECP) have emerged as key tools for optimizing revenue cycles, improving accuracy, and accelerating payments. What Are EDI and Electronic Claims Processing? EDI is the digital exchange of healthcare documents, such as claims and remittances, between providers and payers in a standardized format. This technology eliminates paper-based processes and meets HIPAA compliance requirements. Electronic Claims Processing (ECP) uses EDI to automate the entire claims workflow—from claim submission and status tracking to payment posting and denial management. Together, EDI and ECP transform ASC billing by reducing manual errors,...

  Skilled Nursing Facilities (SNFs) must navigate complex billing processes to ensure proper reimbursement and sustainable operations. Accuracy, consistency, and compliance are essential when preparing institutional claims, and two of the most important formats used are the UB-04 form and the EDI 837I electronic file. In SNF billing , choosing the right submission format—and completing it correctly—can make the difference between timely payments and costly delays. While the UB-04 form remains in use for certain payers, the industry is shifting toward the EDI 837I due to its speed, accuracy, and built-in validation features. UB-04 vs. EDI 837I: Key Differences Both formats are used to submit institutional claims, but they differ significantly in method and efficiency. The UB-04 , also known as CMS-1450, is a paper form that can be mailed or scanned to payers. It is still accepted by some insurance providers but is slower to process due to manual handling and a higher risk of...

  Chiropractic Manipulative Treatment (CMT) is a hands-on therapeutic procedure used by chiropractors to improve spinal alignment, restore joint function, and relieve nerve pressure. It’s especially effective for treating neck pain, back pain, headaches, and musculoskeletal issues. To ensure accurate billing and compliance , chiropractors must understand and correctly use CPT codes that correspond to the number of spinal regions treated during a session. This blog breaks down CPT codes 98940, 98941, and 98942, outlines Medicare billing rules, documentation best practices, and offers a solution for streamlined chiropractic billing. Understanding CPT Codes for CMT CPT Code 98940 Used when one or two spinal regions are treated. This might include the cervical and lumbar areas for neck and lower back pain or cervical and thoracic for headaches and upper back discomfort. CPT Code 98941 Applies when three or four spinal regions are manipulated during a session. Common in cases ...