Medical Billing & Credentialing News

  Billing and Coding Partner for Healthcare Medwave is a premier provider of medical billing and coding services. But, exactly why are billing and coding so important and how can Medwave help your healthcare center perform these functions? It’s certainly no surprise that the healthcare business is thriving, and its growth is projected to endure well into the future. With a population exceeding 46 million Americans (ages 65 and older), which is predicted to double by 2060, the demand for healthcare workers will not disappear anytime soon. At initial glance, doctors and nurses would seem to be directing the show at medical facilities across the country. That’s a reasonable judgment, seeing as they’re the ones treating patients. However, there are numerous other individuals performing at hospitals, medical offices and similar healthcare locations that make those visits to these healthcare providers possible. Two such jobs are medical billing and coding These functions are among the mo...

  Are You Committed to Outsourcing Your Substance Abuse Billing? So, you’re determined to outsource your  substance abuse billing . That’s a smart move, since you’ll save time and ultimately money. After all, no one gets into the substance abuse field because they want to wade through the insurance industry bureaucracy. No, you became substance abuse specialists because you want to help people. Nevertheless, maintaining an in-house billing structure is not only expensive, it also prompts administrative tasks and responsibilities that you simply don’t have time for.  It’s never been more critical to work smarter and not harder in the substance abuse provider industry. Your team of substance abuse professionals have a lot on their plates. By outsourcing your billing services, you can reduce your practice’s overhead costs, increase reimbursements, and decrease claim denials and rejections. This can enable a practice like yours to be more proactive, to focus more on your pati...

  Outsourcing Toxicology Billing Maximizes Profit As a supplier of  toxicology testing , you’re well aware that medical billing for toxicology laboratory work is  highly complex and undergoes frequent and often unpredictable changes.  Further muddying the waters, lab testing work is an area of attention and scrutiny by agents for the Office of Inspector General and the U.S. Department of Justice. In order to make sure your lab receives proper reimbursements for toxicology billing and doesn’t draw the attention of these regulators,  you need to keep up with frequent guideline changes , both from government-sponsored and commercial payors, and be mindful on how to apply the existing rules. Nationwide, toxicology labs have turned to well-informed, medical billing companies. Those who fully understand the nuances of  toxicology billing . Those who’ll work hand-in-hand with your lab to pinpoint the proper billing guidelines and surmount any likely problem areas....

  Health Insurers and Prior Authorization Like sands through the hourglass, so are the days of prior authorization “This procedure will require prior authorization.” Words that no patient or healthcare provider wants to hear when they are ready to proceed with a  doctor-approved procedure for a medical matter. However,  it’s one of the utilization management tools that insurance companies have fostered  to decide if specific prescribed procedures, services and medications are medically required or whether there is an equivalent useful treatment existing for the patient. Healthcare.gov defines  prior authorization  as “approval from a health plan that may be required before you get a service or fill a prescription in order for the services or prescription to be covered by your plan.” Importantly, services (medications, imaging studies, etc.) that need prior authorizations require healthcare providers to acquire consent from the patient’s health insurance...

  Behavioral Health Billing Case Study Type of Practice:  Behavioral Health Group The Challenge: A successful  behavioral health   practice approached  Medwave  to manage their billing process. Up until now, they were performing their own billing in-house using various staff members who had had some formal training. However, they were finding that these staff members were spending an inordinate amount of time with billing, insurance regulations and collections than they were with patients. The process was ugly and it wasn’t streamlined very well. Additionally, they wanted us to address claim-related glitches that included a lack of follow-up on claims, delays due to coding errors, issues causing claim underpayments or no payments and claims denials due to lack of  prior authorizations . The Response: At the onset, our billing experts followed up on several of the client’s unpaid, underpaid and  denied medical claims . Next, we quickly fixed the cl...

  Allergy Immunotherapy Billing Options The complexities of allergy immunotherapy billing Allergy immunotherapy  (aka allergy shots) is the recurrent administration of specific allergens to individuals with immunoglobulin E(IgE)-mediated condition. The goal is to reduce or stop the allergy by diminishing the strength of the IgE response. These treatments, being patient specific, can have serum mixed for up to one year of usage. Put simply,  Immunotherapy involves injection of the exact things to which you are allergic, named allergens.  For example, if your skin test indicated that you are allergic to trees, small amounts of tree pollen extract will be utilized in your allergy vaccine. Allergy testing and immunotherapy have had a significance in reestablishing and preserving balance in the patient’s biochemical system while dealing with a variety of medical emergencies.  That’s why the field of immunotherapy has been demonstrating such an impressive growth....