Medical Billing and Coding service leaders often face major challenges with respect to compliance and documentation integrity. This task is more daunting for anesthesia coders because, unlike all physicians, anesthesiologists do not get paid based on the fee-for-service model but rather on start-up units, time units, modifier units, and any other additional procedure. This is quite a complex calculation to an extent where Medicare uses a National Anesthesia Conversion Factor to ease the calculation of reimbursements. The formula for calculating the reimbursement is (Start/base units + time units + modifier units) X conversion factor = $.
Having multiple vendors is a trend that has been picked up in most industries. The medical billing and coding services industry has been a cautious observer so far, but is slowly warming up to this idea too. Outsourcing and offshoring are not new ideas to healthcare service providers. In fact, most RCM service providers started outsourcing some or most of their processes from the 1990s. While outsourcing and offshoring were common, using multiple vendors was not, during that period. It was only after 2003 that service providers started cautiously approaching the idea of hiring more than one vendor to handle their billing and coding processes.
According to Industry research, one in seven claims get denied, amounting to over 200 million rejections each day. Did you know that 85% of claim denials can be resolved? The Process of sending appeals is very crucial for Revenue cycle management services. Appealing refers to the process of requesting the payer to review their decision against the denial of the claim. It is important to know that appeals can be made both by the patient and by the provider to the payer. The majority of the appeals are dealt with by the provider’s office, as the revenue cycle is handled by them.