Move over ICD-10, here comes ICD-11

ICD-9, ICD-10, and now the ICD-11.  What are they?  Who uses them?  And what are they for?
Good questions...
Right now here in the US we us the ICD-9.  It stands for International Classification of Diseases.  It is the book full of thousands and thousands of codes for every disease, condition, pre-condition, injury, post-injury, or medical circumstance that you could imagine.  (For example:  pedestrian vs. cow... no kidding!).  We use the codes that are assigned to these medical conditions for billing on our claims.  The ICD-10 actually came out a few years ago, but we (as a country) are still using the ICD-9.  Why?  My inquiring brain could not fathom this, so I did some checking.  What I found was interesting.
The ICD-9 was not even created here in the US.  It was created by the WHO, World Health Organization, to track global epidemics such as pandemic flus, Ebola Virus, and AIDS.  Other countries use it for reporting purposes, whereas we use it for actual billing.  Here in the US, the Department of Health and Human Services actually owns the copyright for the printed materials that we use, but the content is available worldwide.
Since we use it for billing, conversion to the ICD-10 is massive.  To complicate things even further, the new ICD-10 will also contain procedure codes for the first time (outpatient).  Conversion on a national level is massive and has proven to be so daunting that we have yet to have it implemnted.
So, since the ICD-11 is slated to be out in 2015 for use globally, and we have not yet implemented the ICD-10... I say we just hold off a few more years and jump straight to the ICD-11.  What could it hurt?  We've held on to the ICD-9 for so long, what's a couple more years?
It gives new meaning to the phrase "that's the way we've always done it."

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/

What do I need to know? CPT

Today we will tackle Part II of the big question... What do I need to know?  We will start with the reference materials that will be utilized in the business.

First, we will cove rthe CPT.  Short for Current Procedural Terminology, it is an essential reference book.  The good news is that it covers most of the procedure codes that you will ever use for most billing.  The bad news is that a new one is published each year and they run close to $100.00 each (for the professional versions).  And before you ask, yes, you need a new to buy a one each year.  There are many changes, new codes, deleted codes, updated descriptions, and other changes that you need to be familiar with.  So, not only should you buy a new one yearly, but you also need to read it.  I have to tell you in advance, that it is a lot like reading Encyclopedia Brittanica.  It is, however, essential to what you will be doing.

The CPT book is  divided into two main sections; tabular and alphabetical.  So, if you know the name of the procedure you can find it in the alphabetical section (in the index), or if you know the code, but not the description, you can look it up in the tabular section.  The numerical section (tabular) is divided by body organs.  You can also look things up by that method. 

For the most part, the billing codes should be given to you by the medical professional that you are billing for, however you will need to be familiar with the codes for billing purposes.  If you are not familiar with the codes or the book, I would suggest that you contact a local physicians office and ask for a copy of an old, outdated book.  This can get you familiar with the layout of the book and the information, without paying out the money for a brand new copy.

So how many codes are in the CPT?  Well the last figure I heard was 28,000, but I am not sure if that is still accurate.  Suffice it to say there are a lot.  Do you need to memorize them?  No.  Just learn how to find them in the book.  The rest will come with practice.

So there you go.  Procedures in a nutshell.  There is a lot more to learn than this, but for an overview, I hope you get the picture.

Send me your questions.  I'll get them answered as soon as I can in a post.

Until next time,

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/

Copies of HCFA-1500 and UB-04 forms posted

Hi all:

In my previous post I promised to post examples of the HCFA-1500 and UB-04 universal billing forms.  That link is up and available at:

http://www.sinclairinkspot.com/forms

Please let me know if you have any questions or problems with the link.

Thanks,
Lori

http://www.sinclairinkspot.com/
Loretta Sinclair
Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/

Can I really do this?

Can I really do this? 
This is by far the most common question I am asked, and my answer is always the same.  Yes! 
Will it be easy?  Probably not.
Does it cost money? Some.
The good news is that this is a field that is open to anyone and everyone.  There is no degree required, and a business can be opened relatively cheaply.  You can spend as little or as much on start up costs as you can afford, or desire to.  There are some basics that you will need to have, and need to know.  In the next few blog posts we will cover those requrirements.  To start with, we will begin with the biggest burning question:

What do I need to know?
To start with you need to have a good strong understanding of what this field is, what it does, and exactly what your function in it will be.  As a billing expert, your job will be to coordinate between your patient, your client (the medical professional), and the insurance companies to submit the proper paperwork and collect the payments.  There are two forms for this.  They are the HCFA-1500, and the UB-04.  Some other forms will be required, but these are the main two.  One is for professional fees (the doctor's portion) and the other is for facility fees (the hospital or clinic portion).  Examples of both are posted below:

Hopefully these forms will come across for the Kindle readers.  If not, I will post links on my web site at:
http://www.sinclairinkspot.com/forms
There will also be directions on how to fill each of them out.  The directions are far too lengthy to post here.  The HCFA-1500 contains 33 boxes for information, and the UB-04 86.  Now before you start to become intimidated, let me tell you that it is not that difficult.  We will go through all of the information that you will need to know in the next few posts.  Also, realize that most, if not all, of this information will come from either the patient, the doctor,  or the insurance company.  You just need to have a good understanding what what it is, and where to put it.  We will cover all of that.  For now, just take a few moments to review the forms, and the web site. 

In the next post we will dig a little deeper into the processes and begin to cover the specific information you will need to know.

Happy new year to my new subscribers!  I hope that 2011 will be the year that all your dreams come true.  Send your questions and comments to:  lori@sinclairinkspot.  I will do my best to answer them within my next few posts.

Thanks,
Lori

http://www.sinclairinkspot.com/

Author, Medical Billing, Coding and Reimbursement
How to Run Your Own Home Medical Billing Service
Annotation Press, 2007, 2008
Available in print and on Kindle

Medical Billing, Coding, and Reimbursement
Supplemental Workbook
Sinclair Publications
copyright 2009

http://www.medicalbillingservice.blogspot.com/
http://www.faithfriendshipandfood.blogspot.com/

New Kindle Subscribers...

Welcome to all the new Kindle subscribers this week.  Thanks for dropping by.  I know it's not Christmas anymore, but we are still giving away copies of our free Christmas eBook,

Ho, Ho, Hey!  What Just Happened?
Holiday enlightenment from an overworked Santa and his testy crew.

If you would like a copy (.pdf format, compatible with all eBook readers), just email me at:

Lori@sinclairinkspot.com

I will email you a copy within 24 hours.

Happy New Year everyone!  May this be our best year yet.

Lori

What is Medical Billing?

What is Medical Billing?

Medical billing is the process of sending invoices to insurance companies and collecting monies owed to medical professionals for the services provided to their patients.  It is a specialized bookkeeping process utilizing the unique codes and diagnosis information assigned to these patients.  There are customized software packages and required universal billing forms available to streamline this process.   Medical billing encompasses far more than just the traditional physicians offices.  With new practitioners starting up every day, the possibilities are limitless.  Chiropractic, physical therapy, ambulance, dental, psychiatry, psychology, rehab therapy, nursing facilities, and a host of other practitioners all require specialized billing to collect from insurance companies the monies that they charge.

This blog will cover all aspects of medical billing.  We will delve into what it takes to run a business of this type, how much it will cost, exactly what you will need to know, and how to get started.  If you have ever been interested in pursuing a career in this fast-paced and ever-changing field, then stay tuned.  There is a lot of information to come.

Lori Sinclair

Author, Medical Billing, Coding, and Reimbursement

How to Run Your Own Home Medical Billing Service

Annotation Press

Copyright 2007, 2009

Medical Billing, Coding, and Reimbursement Supplemental Workbook

Sinclair Publications, 2007, 2009

http://www.sinclairinkspot.com/

Both available on http://www.amazon.com/ 

Check out the Kindle eBook editions!