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Current BOD Members

Current BOD Members:

Mohammed Moizuddin MD, President

M. Taruj Ali MD, Secretary

Gulam Akhter Noorani, Treasurer

Gulam Ali Akhter Noorani MD MPH

Mujahid Ali Syed MD

Baseer Qazi, MD

Dolly Devara, MD

Mohammad Sajed, MD

Afshan Khan. MD

Aparna Mahakala, MD

Fawad Khan, MD

Shaista Safder, MD

Afreen Shariff, MD

Mohd. Shakeel Ur Rehman, MD

Altaf Aman, MD

Bacharach Khan, MD

Former BOD Members:

Wase Qawi, MD

Khaudeja Bano, MD

Iqbal Kapadia, MD

Raza Khan MD, Past President

Qutub Khan MD

Aijaz Khan MD

Yasmin Ansari MD

Jabeen Taj, MD

Farha Ikramuddin, MD

Ismail Shakaib MD

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Medical Billing Mistakes Independent Healthcare Practitioners Must Avoid

Medical coding errors cost independent medical practitioners a large part of their revenue. Many times, the wrong coding and billing have severe consequences on corporate reputation, prompting clients to withdraw their patronage. The American Medical Association also considers that medical coding errors fall into the categories of possible fraud and abuse.

This classification further stresses the legal consequences of medical billing mistakes. Considering the complexities of medical coding and billing, mistakes are not exactly rare or unusual. Even the most diligent of medical coding partners experience a fair share of claim denial and eligibility cancellations.

As an independent medical practitioner, watching out for these errors helps you maintain the reputation of your brand. The team at XyberMed has highlighted 5of the most common medical coding and billing mistakes responsible for claim denial.

  1. Failure to Properly Verify Insurance Status

The failure to properly investigate and verify the insurance status of your client pool is perhaps the biggest reason for claim denial. Oftentimes, patients are expected to fulfill some requirements if their insurance status must stay active. This explains why insurance status changes even for regular patients. Insurance claims are denied for clients without an active status. To avoid revenue leaks, make sure your billing partner consistently updates every patient’s insurance status. This is in addition to copayments, deductibles, coverage period, and status dates. 

  • Incorrect Patient Information

Payors require that billing companies submit the correct patient identification information before claim processing. Identifier information matches a patient on the Payor’s database, generating important payment records required for legal coverage. Submitting the wrong information might cause claim denial and a resultant revenue leak. To avoid this, make sure your billing company captures the right specifics for sex, name, social security number, and policy number. Be sure to list the primary insurance. Also, make sure the diagnosis code correctly matches the care service delivered.

  • Wrong Coding or Duplicate Billing

Insurance companies invalidate duplicate billings and deny payment on this basis. There is also a huge problem with medical billing companies using outdated codebooks. Using outdated coding books, including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and the International Classification of Diseases (ICD-9), might result in claim denial. In addition to using outdated coding books, inadequate documentation or missing bill documents also contributes to claim denial. To avoid these, it is recommended that you perform periodic chart audits, making sure your billing partner is correctly billing all services rendered.

  • Delayed Claim Filling

Not filling a clam on time can invalidate its payment. Depending on the insurance provider, the claim-submittal period differs and determines how claims submitted are handled. The Affordable Care Act put the claims-submittal period at 12 months, with the start date pegged at the date the service was provided. It is also important that claims be filled properly with all the supporting documents. Your billing partner must understand the different guidelines for timely filings.

  • Ambiguous Coding System

Operating an ambiguous coding system is another reason why claims get denied. Each diagnosis and procedure performed must be coded with specific code integers. There might be variables describing differentials under the same specialty; however, the coding system must be specific for each. Payors request specific coding for claims to be processed.

The reasons discussed here are important is you must understand why insurance providers deny claims. To help keep coding errors within minimal range, consider using the XyberMed comprehensive billing system designed for independent medical practitioners.

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Protocols for Managing Claim Denials

For many independent healthcare providers, claim denial is part of the business and occurs frequently. On average, the claim denial rate in the healthcare industry is between 5 and 10 percent of all claims filed. Only a few billing partners can boast of a near-zero claim denial record. More importantly, only a handful has a flexible protocol designed to handle claim denials.

To maximize your revenue and achieve your financial projections, your billing partner must adopt an effective protocol in this regard. The first step to designing a system for managing claim denial is to understand the most common billing mistake leading to claim denials (embed a link to the second blog here). At XyberMed, we have researched the most effective protocols to minimize claim denials in a bit to optimize your earnings.

  1. Collate Data on the Current State of Denials

What are the most common reasons for denials? Collating the denial data from Payors helps you monitor why most of your claims were denied in the first place. The most frequent reasons under this category include duplicate billing, wrong coding, wrong filing, and expired insurance eligibility. Identifying the most common reason in your practice helps you structure an effective management plan to correct these errors.

  • Create a Workflow for Denial Reporting and Appeals

How should denials be immediately treated? Creating a standard workflow for reporting claim denials. Your workflow should list a stepwise approach for reporting denials, checking for errors, and filing an appeal. This approach provides an action plan mandating employees to create a manual record of denial management and attend to the clients’ inconvenience. Also, medical billing companies using a digital network for denial management are more efficient with this.

  • File Appeal Applications Within a Week

Submitting an appeal swiftly after correcting a billing error is important in denials management. Quick appeals work better for providers with a short claim-submittal time. However, appeals must be carefully modified and properly filed to prevent another denial. Most importantly, your workflow protocol should be fast enough to process an appeal within a week after a denial is recorded. Insurance providers have different guidelines on appeal submission; understanding these guidelines also helps your management process.

  • Track Appeal Submissions

Yes. You should follow your appeal through the system to ensure they are swiftly processed. For Medicare providers, appeals submitted after the clam-submittal period are invalidated. Commercial providers also have strict guidelines on appeal submissions. Tracking the appeals through the systems eliminates the possibilities of technical error or human error in filing, indexing, and resubmission.

  • Monitor Progress and Report Outcome

While tracking the appeal, be sure to monitor the progress level and report to the workflow. In case formal modifications are needed in the appeal, getting a legal team involved might be helpful. An appeal letter can also be written to document the clients’ experience and include clinical logic supporting any additional or previously rejected bill item on the claim. Documenting your outcome is important for optimizing the denial management workflow.

Bill automation using innovative technology in medical billing help reduce the error denial rate for independent practitioners. This is why the XyberMed Front Desk Solutions are designed to properly handle medical billing and coding for independent healthcare providers across the globe. 

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Checklist to Evaluate and Choose a Medical Billing Company

To Outsource Your Billing or Not?

Over the last decade, the number of medical practitioners venturing into independent practice has surged significantly. Since the effort to solve the global healthcare problems requires many inputs, this increase is justified. However, for many independent medical practitioners, integrating medical practice with the technical know-how of medical billing is a huge task to handle.

When it comes to medical billing, preventing claim denials, improving the eligibility pool, managing appointment scheduling, and electronic processing payments are the crucial processes requiring expert attention. The entrepreneurship side of independent medical practice is not without its challenges.

Underpaid, rejected, and denied claims cost independent medical practitioners as much as $100,000 every quarter. So, as an independent medic, choosing an excellent medical billing company is your best solution for revenue leaks.

Before you select medical billing company as a financial partner, here are the most important criteria to check for;

  1. Comprehensive Billing System in Specialty Practice

Demand to check their billing algorithm and coding system for services offered in specialty care. Healthcare providers are constantly experimenting with new service models, making it hard for a single billing system to properly code for bills and handle their payment collections. Any medical billing system on your list must have an algorithm that codes differently for laboratory services, geriatric services, out-patient care, in-patient care, and other …. Of your specialty. Getting a comprehensive billing system reduces the risk of administrative and billing errors.

  • Updated Compliance with Existing Regulations

Your revenue cycle management receives the needed boost if hands by a medical billing company complying with the existing regulations on medical billing. To safeguard your financial outlook and avoid legal problems, your selected billing partner must be HIPAA-compliant. An ISO-certified company complying with the provision of the Health Insurance Portability and Accountability Act makes sure your finances are safe and expertly handled.

  • Tech Solutions and Software Suite

With over 70% of all admitted patients currently banked and tech-savvy, you would expect your favorite billing partner to have invested adequately in technology. The best medical billing companies out there use patient-centered billing software with features that allow appointment booking, referral requests, electronic medical data storage, and flexible payment methods. A one-stop billing software manages your client pool better and improves your turnover rate.

  • Responsiveness and Personnel Training

A responsive billing partner prioritizes your client pool, solving technical problems arising as bugs, software crashes, and errors in procedure coding. Speed and availability are factors determining if your selected partner can handle a large pool of clients as your business expands. Responding on time to client complaints and the capacity to swiftly solve these problems boosts the reputation of your business.

  • Denial Management Protocol

How do companies on your list structure a protocol for denials management and handle underpaid claims? In cases of emergencies and failed eligibility verification, teaming with the right billing partner reduces your losses and plugs any weakness in your RCM. Support offered in cases of claim denials also impacts your financial projections in the long term.

Outsourcing Your Billing and Coding Service to XyberMed XyberMed provides an efficient representation to independent medical practitioners, handling coding and billing with a suite of HIPAA-compliant tech solutions. We offer your client pool flexible payment options, making sure your revenue projections remain intact every quarter. With over five years of specialty billing representing more than 1,000 independent practitioners, we lead the global assembly of medical billing companies you should consider.

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Why It’s Important To Understand Medical Billing

Knowing how to do something doesn’t mean you have to do it. Many people know how to ride a bike, put a puzzle together, move furniture around the house, or mow the lawn; but you don’t necessarily do these things yourself. This same logic applies to medical billing and coding.

Let’s face it, medical billing and coding can be a time-consuming, repetitive process that you don’t want to do. In fact, it would not be in your best interest to do medical billing, as your time would be better spent doing something else (for physicians, this would be seeing and treating patients). However, if you are a medical professional, it is in your best interest to understand medical billing and coding, since, after all, it affects your bottom line.

Xyber Med specializes in oncology Medical Billing, orthopedic medical billing, physician, and hospital medical billing, and freestanding emergency services medical billing. Below, we will detail the reasons why you, as a physician, need to understand medical billing and coding.

REASONS TO UNDERSTAND MEDICAL BILLING
Bottom line money. The vast majority of services provided by physicians are paid for by insurance companies. The process of collecting claims from insurers is known as revenue cycle management or medical billing. Understanding how to bill for services is crucial to the survival of medical practice, whether you do your own billing or outsource medical billing. If you underestimate the coding of services (a common occurrence in specialty practices, such as oncology and orthopedic surgery) for fear of overcoding, you could be leaving money on the table. In addition, not knowing what services you offer to charge for (e.g., office visit versus a quick 10-minute consultation at the hospital) can also greatly affect your revenue.
Your practice is a business. Most physicians do not enter the medical field to achieve financial freedom. They enter the medical field to care for people, help them, and ultimately make their lives easier. Even if you enter the medical field for altruistic reasons, you have to make a profit to survive. You have to pay your staff, a fund for your facilities, and probably a family to support. Plus, you can help more people when the lights don’t go out due to unpaid electric bills. Maximizing your practice’s revenue cycle is the key to keeping your doors open.

TIPS FOR MAXIMIZING YOUR REVENUE CYCLE FOR PHYSICIANS

Perform medical coding yourself. Entrusting medical coding to your staff, who may not be committed to your practice and could change positions, often results in underbilled services and errors in medical billing submissions. In addition, only you and the patient know exactly what happened in the exam room. You should have some role in the medical billing process, either as a general supervisory role at the end of the day or by assigning codes yourself for services.
Familiarize yourself with the Current Procedural Terminology (CPT) for Evaluation and Management (E&M) Services. The CPT manual explains in detail how to determine the difference between coding procedures, such as the difference between a patient visit and a consultation. Knowing how to determine the level of service, how to document it, and how to code it is key for physician practices, especially when it comes to Medicare and Medicaid billing. Invest your time in online courses and webinars. There is a wealth of information on the Internet about medical billing practices and articles. Take advantage of newsletter subscriptions, articles, and even online books to learn more.
Take courses. Probably the last thing you want to do is go to school anymore. But when it comes to financial solvency, a short class here and there will pay off in the long run for the long-term viability of your medical practice. You can take short seminars or attend classes as an alternative to full classes to gain a basic understanding of medical billing and coding.
Learn about authorization practices and prescription drug coverage. While it can be very frustrating to meet authorization requirements for procedures (especially in the fields of oncology and orthopedic surgery), as well as knowing which prescription drugs are covered by which insurance, this knowledge is important to the patient. The patient is concerned about his or her costs. Physicians can get carried away with the best treatment options. However, if there is a treatment that is a step below the best but considerably cheaper, this is knowledge the patient needs to know.
Read your reports. A professional medical billing company such as CHRM provides monthly reports on your revenue cycle. Details are provided such as what procedures were submitted, how many claims were denied, how many claims required additional information, as well as the total amount collected and what is outstanding. This information is vital for medical practices looking for ways to maximize their revenue cycle. These reports can tell you the overall health of your business, as well as give you insight into your own productivity. You can learn which office practices are efficient and which can be tightened.
A physician has to be interested in the business side of his or her practice, despite any doubts. Ultimately, the physician(s) are responsible at the end of the day for the success or failure of the practice. When a physician learns how to code effectively so they can charge for the legitimate services they provide, the revenue cycle will be much more efficient and timely.

Xyber Med offers support to our clients in the medical billing and coding process. We can visit your practice and help train and educate your staff on the entire revenue cycle management process. In fact, we encourage an initial training session to help your staff understand our processes and how to make communication between our team and yours seamless. We are always open to our client’s questions and/or issues about their medical billing. CHRM wants to partner with you in the success of your practice and ultimately be considered an extension. When your focus is on your clients and not on billing issues, we have been successful. Contact us today to get started with all your medical billing needs.

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How to simplify the Medical credentialing process? 10 Things you need to know

The medical accreditation process has been a key requirement for healthcare professionals, as it ensures that they are qualified and experienced enough to provide patients with proper care. For this, hospitals will ask you all the necessary questions about your experience, which you must answer from an appropriate source before being admitted to any hospital or clinic.

Medical credentialing includes verification of education, training, certification or licensure to ensure that practitioners meet the standards set by their specific profession or organization. It also verifies credentials, such as licenses or certificates of registration issued by government agencies such as state medical boards or other regulatory bodies. Credentialing can be done in person or electronically, and the result is a credentialing decision that can be shared with others.

The medical credentialing process typically requires verification from sources such as

Schools and universities
Professional organizations
Government agencies
Licensing boards in addition to periodic checks of practitioner qualifications, it is sometimes necessary for a hospital or other healthcare organization to periodically re-credential its providers. This may occur due to mergers, acquisition of new hospitals and clinics, changes in healthcare systems, or changes in laws affecting practice. Healthcare organizations often have an accreditation system in place to help them streamline the accreditation process.

1. Medical credentialing improves patient trust on chosen healthcare provider

Medical credentialing is the process of verifying that a healthcare provider has the necessary qualifications to provide patient care.

Credentialing ensures that patients receive treatment from qualified and experienced professionals who have passed formal training and testing in their field of medicine. This process also assures patients of the merit and experience of healthcare professionals, allowing them to have confidence in their chosen providers. Credentialing can be done through hospitals or agencies, depending on the type of service needed. Hospitals typically offer services such as cardiology or orthopedics, while agencies often offer services such as home health care or nursing staffing.

  • Medical credentialing improve patient trust in physicians
  • Credentials allow patients to feel safe with their chosen healthcare service providers
  • Credentials offer a reliable source for patients that need to verify the qualifications of their medical professionals
  • Patients, who have been given poor service from a hospital or medical agency in the past, can avoid repeating this experience by requesting an Authorization to Release Information form from credentials.  This form will allow them to verify that their chosen medical professional has passed the necessary tests, qualifications, and experience needed for their particular field.

2. Prevent healthcare organizations and hospitals from losing revenues

Medical credentialing is an important factor in trust, especially for patients that are looking to select a healthcare professional.  It is not uncommon for patients to be faced with the question of whether they should pursue treatment from someone without medical credentials or wait until more information can be found on someone who has been properly credentialed.

Properly credentialed professionals will provide you with the evidence needed to put your mind at ease and give you peace of mind when it comes time to make a decision about your health. By understanding what this process entails, you’ll have all the necessary tools in place so that if and when such a situation arises, you’ll know exactly what steps need to take place in order to ensure that your well-being is taken care of by a properly credentialed professional.

3. Lowers the risk of medical errors

The American Medical Association says that every year, about 98,000 Americans die from medical errors. That’s why industry leaders are campaigning for improved standards of competency and exposure to disciplinary actions against healthcare workers.

Credentialing healthcare providers is one way to reduce the risk of medical errors caused by incompetent providers. Electronic credentialing employs automation tools, so there is no room for human error or fatigue associated with the manual evaluation process.

If you work in medicine or know someone who does, this blog post will be helpful! Here are 8 of the worst bad habits that could be holding you back every day:

  • Doctors should not try to create and evaluate at the same time
  • Doctors should not use different screening tools to evaluate a single patient
  • Doctors should not work long hours without sleep or rest
  • Medical practitioners should start using Electronic Credentialing via the Internet
  • Initiate a change of culture in your workplace and stand by it!

4. Fewer restrictions

The healthcare industry has been actively changing over the past few years, and one of those changes happens to be a major shift in how we practice medicine. In an effort to combat high rates from denying coverage or charging more based on pre-existing conditions as well as prevent patients from missing out on necessary care because they cannot afford it due to lack of employment status (or any other reason), all insurance companies are prohibited from doing so now – meaning that nobody can deny them their right for treatment no matter what type you have!

This ensures increased access while also decreasing the likelihood by which people will needlessly go without needed medical attention simply because there aren’t enough specialists working at local hospitals who work with employers’ benefits networks.

5. Ensures the doctor remains fit within the network

Credentialing is one of the most important aspects in a physician’s career.

It ensures that their history and practice will be reviewed before they are allowed to join a network. However, it does not end there. The insurance provider may continue to review the credentials on a routine basis to confirm the professional’s fitness to remain within the network.

Here are three key points you should know about credentialing:

  • Ensures that physicians have no malpractice suits or criminal records
  • Allows doctors with different levels of experience to work together without the risk of liability for more senior professionals
  • Provides information on how many hours per week doctors spend practicing versus seeing patients or performing administrative.

6. Improves practitioner’s business

Medical credentialing is a requirement for medical practitioners to accept patients with health insurance. The vast majority of Americans have health insurance, and when a practitioner accepts new patients, they will likely see them again in the future.

In order to be eligible for Medicare reimbursement or state licensure, all licensed physicians must meet certain criteria set by the federal government and their respective states. In addition to meeting these qualifications, it’s also required that providers complete an application process with specific agencies. This includes passing a criminal background check which ensures patient safety as well as completing other forms such as verification of educational degrees and licenses from the state board where you are practicing medicine.

Medical credentials can improve your business in two ways: more clients because people want to be treated by a doctor who has been checked and approved, and more clients because insurance companies want to offer your service to their clients.

7. Improves the reputation of health practitioners

How to get more patients through your door?

It’s clear that healthcare professionals are in a tough spot these days. With the advent of online reviews, it has become crucial for them to manage and take control of their own online reputation to be able to retain their clients.

One important step they can take is undergoing credentialing with Medical Credentialing Services (MCS). A practitioner who has undergone this process is permitted to treat all patients regardless of their insurance plans – something which will probably lead them to earn a reputation from every corner of the world as well as make it easier for you, as a patient, when deciding where you want your care provided!

8. Protects healthcare organizations from potential lawsuits

Doctors and patients are often at odds with each other. When doctors want to treat, patients often want to be treated. This is a natural human response that can have dangerous consequences for both parties. Doctors need to understand the patient perspective in order to provide them with better care, and patients should heed what their doctor has recommended so as not to put themselves or others at risk of harm.

We’ve compiled some tips on how physicians can learn more about their patient’s perspectives:

  • Doctors should take time before prescribing treatments they aren’t sure will work because it may lead the patient down an ineffective path.
  • Doctors should listen carefully when giving advice, explaining why something is the best course of action instead of just telling them what they need to do.
  • Doctors should try to tailor advice to their patient’s varying circumstances and needs.
  • Doctors need to know when to investigate a symptom further, especially when it is alarming even if all the test results from the initial visit are normal. These alarm bells can go off in a doctor’s mind if their patient has been diagnosed with something in the past, if their patient has a family history of the disease they are presenting with, or if something seems out of place.
  • Doctors should know that patients have likely already done some research into what is wrong themselves and are just looking for someone to affirm their theories after finding conflicting opinions online. If doctors do find this to be true, they should offer to look into the patient’s concerns and see if they can come up with a solution together.
  • Doctors should always ask a patient for their understanding of what is going on, as well as what they hope will happen from the upcoming treatment. This allows doctors to both make sure that the language used is easy to understand and lets them address any concerns they might have.
  • Some patients may not think that all doctors are as qualified as a specialist, requiring a certain level of understanding for the subject matter being discussed. A patient going to see their family physician is more likely to have this mindset than one going to see a cardiologist or an allergist. Doctors should know when to send their patients to someone more qualified for the procedure or diagnosis.
  • Doctors should be aware of any specialized terminology they are using and how it will be received by the patient. If a doctor used a specialized medical term on a patient with a history of brain damage due to an accident, the doctor is likely not going to get as much out of the patient as they would if the same term was used with a medical student or another doctor.
  • Doctors should take time to explain procedures or tests that will be done and what the possible results could be, including any potential side effects of these results. Understanding why something is necessary can prevent patients from feeling like their doctors are just trying to push an unnecessary procedure on them.
  • Doctors should not recommend treatments that are unlikely to benefit their patients, even if it would be beneficial for other populations of people. If a treatment won’t help the patient, they aren’t likely to follow through with it.
  • Lastly, doctors should remember that sometimes, no matter what you say or do, the patient is not going to do what you suggest. Even if they are sick, sometimes even life-threateningly so, patients will go their own way and trust their own judgment over that of their doctor. This is natural human behavior that doctors can’t really change very much. The main thing for them to remember is that the patient has the right to do this.
  • Doctors should remember that patients have autonomy, so they can’t force them to take a specific course of action if it goes against the patient’s wishes.

9. Cost savings

We know that you are busy, but we would like to take a minute of your time to talk about Electronic Credentialing.

Electronic credentialing allows these facilities to migrate from a paper system to a cloud-based computing solution, thus lowering costs without affecting the health and safety of people. This is important because, with the current strains in the healthcare budget, healthcare organizations are under increasing pressure to lower their costs of operation and streamline hospital processes.

Here are 7 reasons why electronic credentialing is so beneficial:

  • Eliminates paperwork
  • Increased security
  • Faster processing
  • Streamlined data entry
  • Improved accuracy
  • Less storage space needed
  • Lower cost

10. Used by medical providers and medical groups as part of the hiring process

Doctors and patients alike are faced with an increasing amount of credentialing requirements for medical providers. The process of credentialing involves a thorough examination that evaluates the qualifications, career history, and proven skills of a health professional including their education, licenses, residency, and training.

This process is generally performed whenever a new doctor or physician is hired to ensure that the professional they end up hiring is completely qualified for the position.

Furthermore, the credentialing process is required by insurance companies to allow the provider to operate within both in-network and out-of-network settings. Professionals that are hired are thus required to abide by standards set by accreditation organizations to ensure that the top quality of service is provided to patients.

Doctors are required to have all training and degrees verified, not just for themselves but also for their employees, including nurses. As a result, it has become necessary for medical providers to undergo credentialing.

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How to find medical billing services near you?

Physicians have to provide high-quality healthcare to meet the needs of their patients. In addition to their busy schedules, physicians have to fulfill necessary administrative responsibilities, such as medical billing, coding, and credentialing. Physicians usually have two options: outsource medical billing services, medical coding services, and physician credentialing services to a trusted company that knows the trade or do it in-house (which undoubtedly comes at a higher cost).

Medical billing requires a lot of effort and valuable time, and over time, you find it difficult to collect all the data to prevent it from affecting your revenue. It is also crucial to hire people who are trained to handle and maintain medical billing properly. In addition, if the process becomes slow or results in errors, it will also affect your credibility.

This is the reason why doctors turn to medical billing companies to manage their claims and take care of their revenue. If a simple query on your search engine “medical billing companies near me” has brought you to this page, then you are in luck. Read on to discover all about medical billing and how to find medical billing companies near you.

What are medical billing services?
To save your time and the energy of your staff, you should seek the help of professional medical billing companies like XyberMed. An independent medical billing company offers its services to develop, submit, and consult health insurance claims, which ultimately saves a lot of time for your staff.

These professional medical billing companies hire trained staff members for different medical needs to provide the best of their services according to their experiences. The designated staff members are highly trained and knowledgeable about each company’s policy.

A medical billing company will also assist you in following up on your denied claims and negligent accounts.

What’s the difference between medical billing and medical coding services

In medical billing and coding, both require your patients’ medical records. Medical coding is providing Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes to procedures and physicians, respectively, so that they are prepared to submit claims. On the other hand, medical billing is actually the process of submitting and tracking claims.

Medical billers use specially designed software for billing. By entering patient codes and information, insurance claims can be easily submitted. With both services, medical billers have more opportunities to communicate with medical staff and patients directly.

Some companies offer both services. However, others prefer to offer the medical billing service exclusively.

Why do physicians outsource medical billing services?

Hiring a medical billing service provider can provide you with several advantages. However, the advantages depend on the type of business you run and how you manage your workflow.

When your work grows over two or three years, to this point, it becomes almost impossible to manage claims by your office staff. In this case, partnering with a medical billing company will ensure that all your claims are no longer pending and are submitted on time and accurately, without hitting the line

Some of the main benefits that outsourcing to medical billing companies can provide include:

Improved workflow and stress-free practice with office staff.
Relief from confusion when dealing with payers regarding company payment policies.
Faster claims processing
Reduction of errors
Access to trained specialists for contact
Improved profitability
Reduced costs
Timely claims processing
Patient satisfaction
In addition, to stay focused on the practice, physicians need to reduce stress levels: using the services of medical billing companies can help physicians focus on the practice.

How much do the medical billing services cost?

The costs of medical billing services vary from company to company. These costs are based on the total number of claims submitted, a set-up fee, collection percentage, and monthly charges. You can contact your local service provider to find out the pricing model individually; you can also search for medical billing companies near me on the web to find results quickly.

Of course, the best pricing model for you depends on how large or small your business size and experience is. If your practice is small, having fewer claims, then the costs of the entire package may come affordable. Although many practitioners prefer the percentage charging model, where when a claim is settled, practitioners get paid first before the medical billing company is paid.

Some common methods for billing the medical billing services are:

Hourly: Medical billing companies can perform work at hourly rates but in specific areas such as workflow setup and compliance.

Per month: Medical billers can charge monthly flat fees for their services – as, for software companies, they can also charge per user account with monthly charges.

Per claim: To give away services for claims, medical billers may charge a small fee per claim.

Per provider: Claims are typically handled by provider number. For example, if a medical practice has 6 health care practitioners, that means it has seven providers. Many medical billing companies specify charges by the provider and by month.

Collection Percentage: If your billing management company handles your revenue cycle – such as AR collection, then you are expected to charge a percentage of the total collection.

It is common for a billing company to charge you more than one of the above pricing options. For example, you may have to pay a monthly fee along with the percentage on revenue collection.

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8 Reasons You Need a Medical Billing Service

Are you getting the most out of your in-house billers or billing service for your ophthalmology practice? Choosing the best end-to-end medical billing and revenue cycle management (RCM) service is more than just finding someone to process claims.

If you’re considering outsourcing your medical billing and revenue cycle management tasks and still aren’t sure whether to take the leap, here are eight quick reasons to help you decide.

Reap the rewards of positive daily cash flow. Insurance claims are processed daily, payments are typically received within 2 to 3 weeks instead of 60 to 90 days, and remittances are posted daily. Billing services can help you reduce rejections and increase coding accuracy.

See an average of 99.7% of claims paid. Choose a billing service where you only pay for what you actually collect from insurance companies.

Get peace of mind with “uninterrupted” daily service during business hours. Don’t worry about late payments, staff vacation scheduling, unplanned sick days, staff turnover, or costly retraining.

Focus on your patients and other important parts of your practice. Eliminate the need to spend hours on the phone with insurance companies. More patients = more revenue.

Get three billers for the price of one. At Fast Pay Health, your dedicated optometric biller files claims posts insurance payments, and investigates non-payment, all for the price of one biller.

Ensure data privacy and security with HIPAA-compliant services. Eliminate the PHI worry factor. Choose a billing service that complies with document and workstation security, email security, fax security, data security, and document disposal and destruction.

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COVID19 and the Need for Health Care Reform

The outbreak of the COVID-19 pandemic has transformed the face of healthcare around the world, highlighting the need for major healthcare reforms that will ultimately promote universal access to affordable care.

The U.S. healthcare sector has faced incredible challenges in the wake of this pandemic and is expected to encounter more. The way U.S. providers deliver care and the way patients pay for it is especially crumbling at this crucial time. This, in turn, leaves millions of people vulnerable, requiring strict and swift coordinated policy action to ensure access to affordable care.

Prior to the pandemic, approximately half of Americans enjoyed employer-sponsored health coverage. However, with the record number of unemployment insurance claims, millions of Americans have been left without health insurance in the midst of the severe crisis. And even those lucky enough to maintain insurance coverage are struggling to find affordable care.

Research suggests that more than half of Americans with employer-sponsored health insurance tended to delay or postpone their recommended treatment prior to the pandemic, primarily because of the associated costs[1]. With the outbreak of the pandemic, the entire situation is expected to worsen further, due to job and health insurance losses. A recent survey found that 68% of adults identified that the out-of-pocket costs they might have to pay would be perhaps the most important factor affecting their decision to seek medical care if they had symptoms of COVID-19[2]. Ultimately, failure to undergo testing and treatment for cost reasons will only exacerbate the already adverse impact of the pandemic.

Congress has passed two major pieces of legislation to address the myriad issues raised by the COVID-19 pandemic. And more are expected. For example, the Families First Coronavirus Response Act (FFCRA) requires all private insurers, Medicare, Medicare Advantage and Medicaid to cover COVID-19 testing, as well as eliminating all costs associated with testing services, including co-payments, deductibles and co-insurance payments.  Also, $1 billion has been designated for the Public Health and Human Services Emergency Fund to cover testing for uninsured Americans in Medicaid plans. Although the FFCRA eases the costs of testing, patients are still vulnerable to the costs associated with treatment. Hospitalization costs are their biggest concern, especially until they receive the annual out-of-pocket maximum, which ranges from $8,000 for an individual to $16,000 for a family.


The $2.2 billion Coronavirus Assistance, Relief, and Economic Security (CARES) Act is another important piece of legislation that requires all private plans to cover COVID-19 testing and future vaccines. However, it does not eliminate cost-sharing for COVID-19 treatment. Nevertheless, many private insurers have agreed to waive cost-sharing for plan members. These include Humana, Cigna, UnitedHealth Group and Blue Cross Shield. The CARES Act has allocated $100 billion to healthcare providers and hospitals, with the condition that providers agree not to bill insured patients more than their cost-sharing amounts. In addition, they are required not to bill uninsured patients for COVID-19 treatment. The federal government will reimburse providers for Medicare fees for treating uninsured patients. In addition, the CARES Act also offered significant tax credits, loans and emergency grants to help businesses keep their employees on the payroll, while increasing unemployment benefits for those who lose their jobs due to COVID-19.


While these pieces of legislation offer crucial help, additional thoughtful policies are needed to ensure that Americans continue to have access to affordable, quality care in the midst of the public health emergency. In my view, first and foremost, policymakers should freeze people’s insurance status as of April 1, 2020 to keep as many people as possible in their current plans. People who were previously in employer-sponsored plans should be able to continue with their plans during the crisis, even if they lose their jobs or are unable to pay their premiums. The first step in this direction has been the introduction of grace periods in several states for the payment of premiums for all insurance[3].  For example, the Ohio Department of Insurance has extended a 60-day grace period for premium payments to help insurers retain employees and their health benefits[4].


Second, ensuring coverage must be a priority for policymakers, especially for people who have already lost their jobs in the wake of the pandemic. Eleven states and the District of Columbia have introduced new enrollment periods in their state ACA marketplaces to encourage enrollment[5]. Individuals who have lost their jobs in the past 60 days or who could lose their jobs in the next 60 days can enroll in an ACA marketplace, despite President Trump’s announcement not to open enrollment in the 38 states with ACA plans.


Nearly all states have received 1135 Medicaid waivers in response to the pandemic in order to meet the medical needs of their most vulnerable residents[6]. Most states applied for such waivers to reduce COVID-19-related cost-sharing and to facilitate health care providers while encouraging patient enrollment. In addition, many states that had already applied for and received a Medicaid waiver will stop disenrollment to receive a higher federal match rate, as determined by FFCRA. Finally, no state is currently enforcing work requirements to maintain Medicaid eligibility.


State or federal governments may also implement plans similar to the Disaster Relief Medicaid (DRM) program put in place in New York following the 9/11 incident. These temporary public health insurance programs can be tailored to the size and scope of the pandemic in different states. The DRM allowed nearly 350000 people in New York to easily and quickly access Medicaid benefits through increased eligibility thresholds and the use of abbreviated applications. Under this program local residents were provided with 4 months of emergency Medicaid coverage and then gradually transitioned to other coverage plans. A similar emergency program in other vulnerable states can plausibly increase eligibility thresholds beyond Medicaid expansion levels to ease people through the crisis period.

The third intervention strategy could be designed around state and federal officials continuing to address out-of-pocket costs, including surprise medical bills and cost-sharing. The shortage of reimbursement to hospitals and providers can easily be covered by CARES Act appropriations.


The COVID-19 pandemic has also created unique challenges related to the affordability factor associated with surprise medical billing, which can occur when a patient receives treatment from an out-of-network physician at an in-network facility. Such situations arise from other challenges such as staffing shortages and triage protocols. In addition, provider shortages can force providers to fill care gaps for many medical conditions other than COVID-19, which ends up expanding the possibilities for out-of-network care and surprise billing in periods of crisis such as this. Policymakers must necessarily eliminate out-of-network provider billings that exceed in-network cost-sharing limits for all medical treatment received during the public health emergency.


Comprehensive protection planning requires intervention at the federal level as states strive to lead on COVID-19 policies. The Employee Retirement Income Security Act of 1974 (ERISA) prohibits state laws governing health insurance from applying to self-insured employer plans. As a result, nearly 60% of Americans with employer-sponsored health insurance will be deprived of current state surprise billing protections, cost-sharing prohibitions and coverage mandates. Thus, ERISA leaves millions of Americans without the protection of state health reforms. However, states can avoid some of ERISA’s challenges by directly prohibiting healthcare providers from charging cost-sharing fees for COVID-19 treatment, as well as surprise billing.


One thing that has become very evident over the course of this global pandemic is the fact that healthcare, finance and the social fabric are closely intertwined and interdependent. Never has it been more evident than today that health reforms are the need of the hour in order to ensure universal access to affordable care for all Americans. As such, our health policies must necessarily reflect this reality, both during and after the pandemic.