Medical billing books are no longer available only at bookstores and by ordering from the internet. You can now download many medical billing books directly to your computer instantly. New technology has made it extremely easy to get medical billing information immediately by ordering with a credit card and downloading the book or "ebook" as it is now called directly to your computer. You can then save and store it or print it out.

Th ebook can provide a great solution to a problem when you need specific answers to questions immediately. If you are working in a new field such as the need to complete a UB04 form and all your experience is with CMS 1500 forms you may welcome the immediate download as you are not always willing to wait for the information. It is convenient to be able to look up the required information immediately rather than holding up the mailing of a claim form for a week waiting for the book to arrive.

The subject of medical billing books can range from books on medical billing and coding to books on how to start a medical billing business to specific instructions for medical claims billing. Books are now available for billing claims in many medical specialties.

Because both CPT codes and ICD9 codes change every year it is necessary to keep up with these changes. So new code books are introduced each year for both diagnosis codes and procedure codes.

In recent years there are many new books available on the beginning stages of starting a medical billing business and finding new clients and building the business. You can also find specific instructions for billing specialty medical fields such as mental health, chiropractic, physical therapy, optometry, etc. These books make it much easier for the beginning medical biller to learn new specialties quickly and less painfully than by trial and error.

As these new books become available it makes it easier for the person new to the field of medical billing to find the information they require. Whether you prefer your books in hard copy or to download them to your computer as an ebook you can find some great information on medical billing.

Alice Scott and Michele Redmond own and operate a Medical Billing Service and are responsible for billing for over 60 providers across the US. They've written several books on medical billing and starting a medical billing business. To read more about what a billing service offers, to see the books they have written or to sign up for their free monthly newsletter, visit their websites at Medical Billing Live and Solutions Medical Billing They also offer a forum where you can find the answer to many billing questions or leave your own question at Medical Billing Live.

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Rejected medical claims come from many sources. The most common is likely keystroke error. That is usually a relatively easy fix and for our business it is also one that is easy to catch. The best method of catching some of these simple mistakes is to use a good scrubber for your claims.

Once the claim batch has been created, as it is processed through the intermediary software, it looks for little inconsistencies. Like an ending date that precedes a beginning date, just little things that can easily get entered out of sequence when you are processing a lot of claims.

Another easy one to get incorrect is term date for procedures and/or diagnosis codes. Once you have used a code in your medical billing system, you should not be able to remove it because of the relational database algorithms. Resultantly, it is easy to use an old code without intending to. Again, this is where a good scrubber comes into play. It can catch those pesky errant codes before the claim gets out the door. By using the scrubber, you are able to quickly get claims corrected, usually within a few hours, depending on how often you drop claims.

Issues with patient and insurance information should be taken care of before you see the patient. I repeat, before you see the patient. Your front office should know in great detail the probability of whether you are going to get paid on this patient. They should have done all of their homework by verifying each and every piece of information.

Some payers are particularly peculiar about not allowing more than one E&M visit in a day. Again, these are questions that can be covered prior to seeing the patient. Once it has been determined the patient may have already seen another provider, the front office can check the insurance company and get the applicable rules.

Coding issues should be non-existent, as the provider and staff should have an in-depth knowledge of what is current, what supports what, and should any modifiers be used to clarify the claim.

Do your homework before filing the claim and you will see better results.


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E&M medical necessity denials, what can that mean?

On the surface, what could not be right about an E&M code?

A lot of the rejections come from an office visit and another procedure performed on the same day. In many of the practices where we take over the medical billing, the physicians have lost money by not following the right protocols and/or not challenging the EOB. If the visit results in the second procedure, there is a modifier that is supposed (tongue in cheek) to tell the insurance company that this is a separately identifiable service and both services are to be paid. That being said, it does not mean you will get paid. Other denials often come from "we do not pay for two of these on the same day". It is important for the front office to ask if the patient has seen another physician on this same date. If so, unless it is emergent care, find out the policy of the patient's insurance company before seeing the patient. Otherwise you may just be giving away your services. The point here is to one; do your homework, and two; don't simply take the EOB at its face value, challenge it! Most physicians do not and the insurance companies love them because the insurance company gets to keep more of the physician's money in the process.

I have been told that every time an insurance company touches a claim, it costs them $150.00. Now just imagine for a moment if every time a physician got a rejected claim each and every physician challenged that claim, what do you think would happen? If you answered fewer rejected claims go to the head of the class! So don't just take their word for it, challenge it.

When the Correct Coding Initiative (CCI) was implemented, we were assured that everyone would have to abide by the same rules. The reality is significantly different.

Lately, Blue Cross of Georgia has changed its review policy. In the past for a pediatric patient that presented for a sick visit and needed a well check visit, we could bill both and get them paid. BC of GA now says they are using Anthem BCBS edit rules and will reject one or the other, and the rejection usually depends on which of the claims pays the most. We are still in the process of sorting it out but the physicians are looking at the contracts to see what recourse is available.

The sad part is that once again, it is the physician who must jump through all the hoops, follow all the rules and then not get paid.



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For a process that can be so simple, many make it so hard.

Let's start at the beginning. What software are you using to process your claims? That decision alone can solve a litany of problems. There is not enough space available to analyze all and it would not be fair to promote only one.

Is the software easy to understand? Does it allow you to make additions, corrections, subtractions, and other modifications on the fly? If you have to stop at one spot and back up to go to another just to make a simple change, it is not efficient and will cost you money. How much time does it take to get someone proficient on that software? This is where the old adage of KISS (Keep It Simple Sweetheart) really comes into play. Once you have selected an appropriate software, you need an interface between you and the insurance companies so you will be able to transfer your claims. Most claims now go electronically, but a few still drop to paper. You must have the correct address for the paper claim. That should come from the patient information. The electronic transfer should focus on a connection that is as direct as possible to the payer. Most software companies will attempt to get you to use a clearinghouse from an approved list. They want to continue making money from you after you purchased the software and that may not be what is best for you. It may be quick and easy, but it may not be as reliable as it is made out to be. I prefer to have direct connections with as many of my payers as is practically possible.

Next, your billing staff, are they adequately trained? I get a lot of applicants right out of technical school, and yes they have a smattering of knowledge, but they are not ready to begin keying data. I usually train them for at least another six months before they get their own accounts. Once I am confident they have an understanding of the basic architecture of the software, I then put them with a mentor while they work on their first account.

It is not easy to tell someone every nuance necessary to key every claim. They just have to be taught as the situation arises. Some things happen so seldom that you cannot cover every single aspect of what has to go into what spot. You must have someone on your staff who has spent several years keying data into a particular software before they are fully versed in the needs of filing each and every claim.

Now that we know we have software and data entry that can handle the day to day of filing claims, we need to focus on the front office. Are they adequately trained in getting the information necessary to get the claim paid? The front office must control the encounter with the patient. The patient profile form and releases must be complete to the extent that all information necessary to identify this patient is provided. The form must ask for and retrieve all of that data. The patient must fill it out. Do not allow a patient to skip over a portion or leave a portion blank.

If the patient does not have a secondary or tertiary insurance, require that they state so on the profile form. Have them write NONE on the space for secondary or tertiary. Many patients will object to having to give you all of the information, but you need to make a decision as to whether you are in the charity business or a practice that will sustain itself and provide a profit for you and your family. I have had patients come up to me and say "I don't have to give you all this information." I do not object, I simply agree and say "You are absolutely right, you do not have to give me all of that information if you wish to pay cash for today's visit. There will be deposit of $300.00, will that be cash or check? However, if you wish for me to file your insurance, you will need to provide me with the information on the form." They always back down and begin to fill out the form.

While we are on the subject of the form, make sure it is legible. If your front office cannot decipher what is written down, rest assured that the medical billing office will not be able to either. Make copies of all supporting documents (front and back); insurance cards, drivers license, and any other documents. Again, make sure those copies are legible. There is no better time to do that. You have everything right in front of you right now! If the copy is not legible have the front office physically write the numbers and identification information from those cards onto the copy paper and adjacent to the copy of each pertinent card.

Next, call the insurance company or go on-line and verify the coverage. What is the start date, what is the term date, is there a co-pay, is there a co-insurance, is there a deductible, what is the deductible and has it been met? Never trust the information on the card-verify. While you are verifying the payment information get the correct address to mail a paper claim. Even if you do not intend to file a paper claim, this is the time to get that information. You never know when you might need it. Your patients are asking you for credit and you must verify that they are creditworthy! Develop protocols and insist that your staff follow them. If they cannot follow them, you have the wrong staff. Try going to WalMart to buy an item with an expired card and see what happens. Their staff will not let you slide and neither should your staff.

Now that we have all the pertinent information, the task rests with you, the physician. Do your part; document, document, document. When you are filling out your encounter form, write down everything you do. Leave nothing out. If you do not ask for it, you will not get it paid. Your staff should know whether a modifier needs to be applied, but I encourage you to understand them as well. Today I saw a fee ticket where the provider put down an after hours code but had not listed an E&M procedure. After hours codes are in addition to the service performed. The current code under consideration was 99050. Next, put down a diagnosis code that supports the procedure(s) you performed. Make sure it is to the greatest degree of specificity. Give your staff copious ammunition to get you paid.

Once you have completed your task, turn the paperwork over to that well trained medical billing staff utilizing that efficient software and you are as good as paid.


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