Medical Billing Blog

The Centers for Medicare and Medicaid Services (CMS) released a new ICD-9-CM code set that deals specifically with malignant neoplasms for medical billing. These updated dermatology codes become effective October 1, 2011.

The decision whether or not to outsource your billing is less complex of a decision than most physicians make it out to be.  Today’s medical billing takes a highly specialized set of skills and resources to be successful.  Billing has become an ever-changing complex field of codes, modifiers, rules and regulations.  So here are the top 5 reasons you should outsource your practice’s medical billing function:

We are taught from an early age that we should always return something that does not belong to us. As adults the rules are the same. This is especially important in our roles as billing agents and collectors; we are the stewards of our client’s finances. Just ask the Office of the Inspector General (OIG). In 1998, the OIG published its Compliance Program Guidance for Third-Party Medical Billing Companies, which included a list of risk factors the OIG identifies as “particularly problematic.” Bullet five on this list is “Inadequate Resolution of Overpayments,” otherwise known in the billing industry as resolution of credit balances. In essence, it says that providers may not keep payments that do not belong to them.

Years ago, billing was easier.  Billing was done to fill in time between scheduling patients and pulling charts.  Payers changed the regulations only once a year and denials averaged only a few percent.  In-house billing operations are faced with inherent collection problems, compliance issues, and time delays.

ICD-10 goes into effect October 1, 2013.  This is the biggest change in medical billing in years.  ICD-10 has fundamental changes in structure and concepts that make them very different from ICD-9. 

CMS has announced that some Medicare Providers will be required to revalidate their enrollment status in order to comply with Section 6401(a) of the Affordable Care Act.  Any provider who enrolled prior to March 25, 2011 may be affected by the requirement.  Beginning now and going through March 23, 2013, Medicare Administrative Contractors (MAC’s) will be contacting providers who need to revalidate their enrollment.  Only Providers who are contacted by a MAC need to revalidate their enrollment, and they must wait until after they are contacted.