sofia112

Failure to Prevent Out-of-Network Fees for Patients
Most patients are not experts on insurance policies or the procedures for filing medical claims of dental billing company. Patients who receive care from a provider outside of their network may pay a price in the form of higher deductibles or coinsurance obligations. Some insurance plans completely forego paying for out-of-network procedures, leaving the consumer to foot the bill.
Providers should create office policies that specify how out-of-network patients are to be billed in order to safeguard patients from this scenario. Prior to every appointment, you should also confirm the patient's insurance benefits and go over the provider's expectations for the patient's copayment, deductible, and coinsurance obligations. (The patient's insurance card will typically contain information about liability.) Go to Chapter 6 for a quick review of the many types of insurance plans.

Not Checking for Prior Authorization
Some procedures call for the physician to obtain prior authorization, or the payer's approval to treat the patient, before they may be carried out. The claim could be rejected if the required authorizations or referrals weren't obtained (when a primary care doctor refers a patient to another provider for treatment or tests). Then, depending on the terms of the patient's plan, either the physician or the patient is responsible for paying the billed charges.
To make sure that the provider abides by the terms of his agreement with a payer and gets paid the agreed-upon amount for the service he performs, it is crucial to determine whether planned treatments require prior authorization. Always ask the doctor to record any and all potential operations and make sure each one doesn't need prior authorization. It is preferable to obtain authorization up front than to discover after the claim has been submitted that it was necessary. Refer to Chapter 11 for more information on referrals and prior approvals.

Patient Confidentiality Breach
Both the patient's clinical information and personal demographic data, such as their Social Security number, date of birth, address, etc., are accessible to you as the coder. You should obviously protect this information as you would your own, not only to avoid identity theft but also to avoid penalties for breaking the Health Insurance Portability and Accountability Act (HIPAA). HIPAA regulates who can see patient information, when it can be shared, and what kind of information can be shared. Violators are liable to heavy fines and may even go to jail. Visit Chapter 4 for further details on HIPAA and methods for preserving patient anonymity.

Taking the Lead from an Unreliable Manager
Most coding supervisors are aware of and follow proper coding procedures, and they anticipate that you will do the same. Unfortunately, you can run into a management who is unaware of the proper coding guidelines or who, if informed, likes to ignore or bend them. When reporting services, for example, these coding managers may view modifiers as a tool to enhance reimbursement rather than a tool to promote specificity, and they may question the coding of claims when reimbursement is low.
Don't give in if your manager or another superior urges you to code improperly. Do what you believe is right and inform a leader of the office about the situation so they can take further action. You could annoy the shady manager, but at least you'll sleep better at night! When you're under pressure to code in problematic or immoral ways, Medical coding services discusses options you can use.

Ten Abbreviations You Should Learn
One enormous bowl of alphabet soup is how one may describe the world of medical billing and coding. Every word you encounter in everyday life has an acronym that corresponds to it. Every office learns the acronyms unique to that particular practice, however some abbreviations are well-known and understood by everyone who works in the healthcare sector. I go over a few more of the most popular acronyms and abbreviations used by medical offices in this chapter.
The clinical acronyms and abbreviations used in medical documents are regulated in several states. According to these state requirements, each acronym must typically have just one meaning and be listed on a list that is accessible to all clinical staff. However, since acronyms and abbreviations aren't often controlled for administrative personnel, you might find even more internal acronyms circulating around the office, which isn't necessarily a negative thing. Consider this: Why say "Health Insurance Portability and Accountability Act" when you can just say "HIPAA" all day long?