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MEDICAL BILLING :

MEDICAL BILLING

Attributes:

Attributes Every doctor has to bill someone to get paid. Every doctor has to bill a third party. Doctors either do it in-house or outsource to medical billing companies. Every Doctor needs what you are selling.

The Model is Simple:

The Model is Simple Doctor treats Patient Third Party is Billed Money is collected The rest is all details If you do sales the Devil is NOT in the Details of Medical billing – rather it is in the details of perseverance,................ 3

The Model is Simple:

The Model is Simple If you do sales the Devil is NOT in the Details of Medical billing – rather it is in the details of perseverance ,................ While we deal with this much later in the presentation, you will see that our marketing approach is that IT’S ALL ABOUT YOU

Introduction:

Introduction The goal of this series of instructional presentations is to demystify medical billing, explain the opportunity, and allow YOU to decide if this is a good fit for YOU While we deal with this much later in the presentation, you will see that our marketing approach is that IT’S ALL ABOUT YOU

What this series should answer:

What this series should answer How are you going to make money in medical billing. How soon, how difficult, and the skills and commitment, support and knowledge you need you make money in medical billing.

Why this training is Important :

Why this training is Important You need to know the process from a 10,000 ft altitude. You need to know the terminology. You need to be ready for the many questions you will probably never be asked so that you have confidence in yourself. You need to understand enough of the process to KNOW that you are offering a value proposition. Please do not contact any connection/Doctor/prospect before you fully understand the VALUE PROPOSITION you offer-you never get a second chance to make a good first impression.

IMPORTANT TO REMEMBER:

IMPORTANT TO REMEMBER That every piece of information given to you. To one of the stages: Communication between Doctor and Patient. Communication between Doctor and Biller. Communication between Doctor and Payor. Communication between Payor and Biller. Communication between Payor and Doctor. These communications may relate to billing and or regulatory compliance. 8

Let’s get a graphic in here with the circle of communication:

Let’s get a graphic in here with the circle of communication Doctor Payor Biller Patient

Communication between Doctor and Patient :

Communication between Doctor and Patient Patient calls for an appointment. Patient must give all personal and insurance information “DEMOGRAPHIC INFORMATION”. DEMOGRAPHIC INFORMATION includes patient’s name, personal information, DOB, gender, address, contact number, SSN, Insurance information. DEMOGRAPHIC INFORMATION is part of PROTECTED HEALTH INFORMATION (PHI). PH I will be discussed in greater detail later. 10

Communication between Doctor and Biller, (1) :

Communication between Doctor and Biller, (1) Obviously, the doctor has to give information based on which the biller can submit for payments. Doctor has to submit the following” Demographic information of the patients. A description of the procedure/service provided. A reason - DIAGNOSIS for the procedure/service. 11

Communication between Doctor and Biller (2) :

Communication between Doctor and Biller (2) Submitting the diagnosis and procedure/service must ultimately be reduced to a set of diagnosis and procedure codes. The diagnosis codes are a standard format of 3 alpha numeric characters followed by a decimal point, identified from 001.0 through V82.9 , which is part of a universally recognized system currently called ICD -9. The question is how the Doctor communicates the ICD-9 codes. 12

Communication between Doctor and Biller, (3) :

Communication between Doctor and Biller, (3) The procedure codes are 5 digit numerical codes and are also called CPT codes. Doctors typically have a form with the most common ICD-9 & CPT codes and they check off the appropriate diagnosis and procedure for a particular encounter with a patient. These preprinted forms are called “SUPER BILLS” If the diagnosis or procedure is something out of the ordinary the doctors staff will have to determine the appropriate code. 13

PowerPoint Presentation:

Sample Super Bill

Communication between Biller and Payor:

Communication between Biller and Payor Per Encounter (Super Bill) Demographic Information ICD -9 and CPT Codes Important The ICD -9 Diagnosis and the CPT procedure has to match There can be more than 1 ICD -9 and/or CPT per encounter Insurance Information should match with Demographics and coverage must be current

Common Reasons why Billing gets Fouled up:

Common Reasons why Billing gets Fouled up Missing or invalid Practice or Service Location Name M issing referring physician’s Name & NPI (National Provider Identifier) information Typo in Patient’s name or Insurance information Insurance not active Provider not eligible to render the procedure as the specialty is different. Provider not board certified to render the service Missing or invalid procedure or diagnosis code 16

Reverse Communications:

Reverse Communications Reverse Communications are not good Payor contacts the Patient to send EOB Sometimes they send check to Patient if they don’t sign the Assignment of Benefits form Deductible Co-Pay Co-Insurance 17

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