Physician billing guidelines refer to the procedures and processes in place to ensure that doctors receive payment for services rendered. Billing protocols are essential for operating the business aspects of medical practices. Guidelines should consist of well-documented rules and procedures that are not only designed to collect payments and prevent errors, but . keep the practice in compliance with Medicare rules, regulations and fee schedule.
Billing Procedures
Generally, physician billing guidelines cover the billing protocol for all types of payers, including individuals, private insurance companies and government payer programs. Collection procedures must take into account any rules and regulations as well as many different components involved with billing for the practice. The workings of a successful physician billing system must have processes for handling billing individuals for deductibles and co-payments.
However, the primary focus is on government payers, such as Medicare, which has specific guidelines for billing. Processes are in placed for handling patient demographic entry, charge entry and Current Procedural Terminology (CPT) and International Statistical Classification of Diseases and Related Health Problems (ICD) or ICD-9 coding.
CPT and ICD-9 are the coding guidelines, which physicians must follow when submitting claims forms to receive payment for their services from Medicare. The procedures must also encompass pre-certification, insurance verification, claims submission, payment posting, account receivables follow-up and denial of claims.
The majority of private insurance payers follow these basic steps. To ensure accurate and prompt payment, many physicians must effectively manage the business of billing. Most physicians establish their primary billing protocol in accordance with the Medicare , which states that there must be a medical reason for the service; you must have performed the service for which you are billing and there must be thorough documentation of the medical necessity for the service.
Most doctors have little to do with the billing process. To maximize the processing of claims for payments, the function is usually handled by experience medical billers and coders. Some of the smaller physician practices handle their own billing in-house. One or two people may be trained to handle the billing tasks and other administrative functions. Generally, large medical centers may have a staff of billers and coders who are specially trained to handle all aspects of the physician billing process.
Like any set of office procedures, physician billing guidelines must be up to date, especially as they relate to changes in billing and coding. There is also a need to stay current on legislation that can have an effect on the billing process. To avoid this burden, many physicians outsource the billing function to third-party companies that specialize in medical billing.
Typically, medical billing firms know the latest rules and regulations and apply them. They also have staffers properly trained on correctly coding the diagnosis, treatments and other services rendered by physicians to ensure payments arrive in a timely manner. Many small practices submit claims on paper but larger offices and third-party medical billing firms perform the function electronically. Although there is still some billing of claims by paper, health care providers are moving toward industry-wide compliance with electronic billing.
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