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Medical Billing Receptionist

ROLE SUMMARY:
The Medical Billing Receptionist is responsible for a variety of billing functions that support all departments and performs a variety of duties under general supervision.

ESSENTIAL DUTIES:

  1. Primarily responsible for supporting the Posting and Claim Center departments to include but not limited to.
    1. Posting the payment and non-payment remittances of all patient and insurance transactions both electronic and paper, as instructed.
    2. Research of items in efforts to post with 100% accuracy may require extensive online and phone communications.
  2. Responsible for other department support as needed which may include but not limited to sorting mail, calling on patient balances, assisting credentialing and following up on paperwork, filing, indexing and working collections correspondence. All will require a high level of documentation recorded within our online systems.
  3. Answer phones and resolve calls accordingly. This will include, but not necessarily limited to, negotiating payment plans with patients, accepting payments over the phone, updating patient demographics, rebilling insurance and sending tasks to others for further review and follow-up.
  4. Complete all tasks received via the Onpoint dashboard, daily.
  5. Abide with HIPAA and PHI guidelines at all times.

SKILLS, KNOWLEDGE, AND ABILITIES:

      1. Excellent verbal, written and interpersonal communication skills.
      2. Proficient with Windows, MS Office, Outlook and Internet Explore
      3. Computer and keyboard skills are a must.
      4. Excellent organization skills and attention to detail
      5. Demonstrates an independent work initiative, sound judgment and strong work ethic.
      6. Ability to handle multiple tasks simultaneously
      7. Experience with AMD practice management software a plus but not required.

MINIMUM REQUIREMENTS:

    1. High school diploma or GED
    2. Two year of experience in a health care setting, preferably with accounts receivables.

The above statements are intended to describe the general nature and level of work performed by people assigned to this job.  They are not intended to be an exhaustive list of all responsibilities, duties and skills required of personnel and employees may be required to perform other duties as assigned.

MGMA COVID-19 Medical Practice Reopening Checklist

Do you know what it will take to open your medical practice?  Recently, the Medical Group Management Association (MGMA) provided a COVID-19 MEDICAL PRACTICE REOPENING CHECKLIST that is a great tool to help you navigate this next phase.  Many providers may think that as soon as you announce the re-opening that the patients will come but that may not be true.  So, it is best to plan ahead.  This is a great resource to help you determine your reopening readiness. 

The MGMA has been a leading association for medical practices, administrators and executives since 1926.  They are a national organization representing more than 40,000 medical practices of all sizes, types, structures and specialties.

There is a Cure to Medical Necessity Denials

Did you know that claims for services that do not meet the requirements of medical necessity are getting denied instantly? Payers are increasingly more focused on the issue of medical necessity.

Medical necessity is difficult to define, since there are so many interpretations and they vary from payer to payer. Most typically incorporate the idea that healthcare services must be “reasonable and necessary” or “appropriate” based on the patient’s condition and current standards of care.

DENIALS, RECOUPMENTS, PENALTIES

Sadly, the decision as to whether services are medically necessary are made by someone who has never seen the patient. Most payers use automation to review and deny claims. These are called claim edits. The edits ensure that payment is made based on a specific diagnosis related to specific procedure codes. Diagnosis codes identify the medical necessity of services provided.

CMS has the power, under the Social Security Act, to determine whether each situation is reasonable and necessary. Even if it is that they later determine do not meet medical necessity the scope of the service can be limited.

To make matters worse, if a carrier pays for services that they later determine to no meet medical necessity, they will recoup those payments. They can demand a refund or just deduct the amount directly from a future reimbursement check. They also have the right to charge interest.

If they determine that the provider has a pattern of billing for medically unnecessary services, the provider may face monetary penalties, exclusion from the Medicare program, and criminal prosecution.

HOW TO AVOID MEDICAL NECESSITY DENIALS

According to the American Academy of Professional Coders (AAPC), there are 8 key steps to follow:

  1. List the principal diagnosis, condition, problem, or other reason for the medical service or procedure.
  2. Assign the code to the highest level of specificity.
  3. For office and/or outpatient services, never use a “rule-out” statement (a suspected but not confirmed diagnosis); a clerical error could permanently tag a patient with a condition that does not exist. Code symptoms, if no definitive diagnosis is yet determined, instead of using rule-out statements.
  4. Be specific in describing the patient’s condition, illness, or disease.
  5. Distinguish between acute and chronic conditions, when appropriate.
  6. Identify the acute condition of an emergency situation; e.g., coma, loss of consciousness, or hemorrhage.
  7. Identify chronic complaints, or secondary diagnoses, only when treatment is provided or when they impact the overall management of the patient’s care.
  8. Identify how injuries occur.

If your claim is still denied your billing company should appeal the denial. This will require additional work on their part. It takes a lot of work and time to appeal a denied claim. It is tedious work and billers don’t like doing it. It is hard-earned money and one of the many ways a good billing service earns its money. It also requires that the medical note supports the coding. If the appeal is handled correctly there is a good chance the denial will be reversed, and the claim will be paid.

“Tiger” Focus by Scott Ballard

2020 is well underway. I don’t know about you, but I found myself juggling my ‘to-do’ list.  Every day, it seemed I was jumping from one thing to another and adding more things to my already robust list.  I had so many projects, micro-enhancements, things that would make the staff more efficient and be value added to our clients.

I make lists and I’m pretty organized but even with that I seemed to come up short.  I’m always looking for a better way for something that will help me focus on what is important and pursue it with maniacal intensity.

And then I read an article called “Tiger” Focus by Confidence Coach Scott Ballard.  I shared it with a few colleagues, and they had the same reaction I did.  It leaves you with a sense of ‘wow’ so simple but often over-looked.  And now when I seem to stray, I think ‘Tiger Focus’.  It is a quick read but one that you can apply to your business and personal life.

Meet Dr. Ashley Keays

Sr. Ashley Keays
Sr. Ashley Keays

In 2015, after 11 years of family practice, Dr. Ashley Keays ventured into subspecialty care focusing on fibromyalgia management and the treatment of resistant depression. Dr. Keays made the shift because she was looking for a more rewarding and fulfilling career. She found it… and it absolutely changed her life.

Over the next four years, Dr. Keays and her team molded Keays Medical Group into a practice of multidisciplinary care, which uses different modalities of treatment to customize and individualize care plans for patients with a diagnosis of fibromyalgia and/or chronic resistant depression. When treating fibromyalgia patients, Dr. Keays and her team use a holistic approach, looking at their emotional health, sleep patterns, and their nutritional and dietary history. The Keays team utilizes physical rehabilitation, pain management with trigger point injections and osteopathic manipulations. In addition, they perform genetic testing to identify appropriate medications and supplements which assist in creating patient-driven goals, and the identification of triggers that create fibromyalgia flares. Keays Medical’s ultimate goal is the development of a functional flare plan that helps break the pain and associated symptoms when they present as well as to provide overall knowledge and awareness to our patients.

Chronic resistant depression is a diagnosis in patients that have failed one antidepressant medication. In 2017, Keays Medical Group adopted Transcranial Magnetic Stimulation (TMS) to treat resistant depression and has seen amazing results since its adoption. TMS was approved by the FDA in 2008 as a non-drug/non-invasive method of treating depression. Keays Medical has partnered with NeuroStar Advanced Therapy to bring care to this population. TMS uses a targeted pulsed magnetic field, which utilizes the same technology as an MRI (magnetic resonance imaging). While the patient is awake and alert, TMS Therapy stimulates areas of the brain that are underactive in depressed patients.

As a doctor, one of the most important aspects of delivering care is creating the right physician–patient relationship. It is vital to the success of an individual’s care plan. Dr. Keays has worked hard to develop an environment where patients feel that they are heard and involved in shared decisions that drive their own healing. After years of searching, it wasn’t until developing Keays Medical Group that Dr. Keays finally found a rewarding and fulfilling career.

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