Saturday, February 13, 2016

Billing With Good Utilization Management

By Barry Elseood

When you were in school, your teacher made medical billing sound so easy. He/She said to learn ICD-10 coding and then go out and land a client. After that, it sounds like success would just come to you. You could work from home in your pajamas getting clients to call you. The doctors made it sound like it was going to be so busy. In reality, you are now wondering why you don't have many clients. It is understandable why you are not having a lot of clients. For starters, it is extremely difficult to find physicians' offices to trust your services. This is mainly because so many people claim to know and understand ICD-10 coding. However, doctors are finding out that most billers do not understand or know how to do this work properly.

It takes a lot of education to learn ICD-10 properly. A person must spend years in training before they can call themselves and expert. Many billers today are expected to have at least a bachelor's degree and certification in ICD-10. Doctors, hospitals and medical practitioners expect you to understand utilization management as well. Utilization management is a process in which you have assistance with effective clinical documentation, an intensity in services and program scheduling. There are peer to peer reviews and eligibility verifications. Medical billing today also involves benefit verification and revenue cycle management.

A lot of thinking and planning must work hand and hand with billers and physicians. The fact of the matter is that without proper records, the physician and hospitals cannot make good money. Most doctors today are losing around 40% of the claims that they submit to the insurance companies. Insurance companies today are smarter and tougher. They will often send back claims because you spelled something wrong or because you did not document enough information. What makes this even harder is that ICD-10 is something that most billers are unfamiliar with. When it was released, most men and women in this field were shocked. You must learn 5 times and much information now then you did before in the past. In fact, most people in medical billing say that they do not understand how billing even works. For some, it is a complex system that never seems to change. Many people in billing say that they do not understand a lot of facts. They often cannot comprehend the future of what will happen next.

If you want to stay in business, make sure to work with the doctors that you represent. Doctors have to worry about using medical treatment for necessary ailments. Doctors can't just give people random blood tests for no reason and expect the insurance company to pay for it. Today, those day as over with.

It is important to know revenue cycle management and benefit verification as well. Most doctors will ask you questions about collections and billing as well. It seems like they have a scroll of information for you to understand before they hire you. Physicians today are a lot smarter when it comes to billing. In order to make yourself stand out, it is important to have good references from people that have worked with you before in the past. Make sure that you have your ICD-10 certification as well.

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