Can an insurance company exclude services for pre-existing conditions?
Then answer is both yes and no.
When you sign up with an Employer Group Health Plan (EGHP) during the initial enrollment period (usually the first 30 days of employment) then they take you the way you are, warts and all. Your family members are also covered without restrictions as well. If you enroll during this period, an insurance company cannot exclude any conditions from your coverage or care.
However, if you do not enroll within this initial coverage period, then the insurance company has the right to ask for either a health check up, or to review medical records (often times both) and can exclude any condition they think they may be held liable for.
Common pre-existing conditions are: chronic back problems, cancer, heart conditions, and carpal tunnel. The list can be endless.
If you purchase a private policy, this rule does not apply. With a private policy (including disability policies) they can exclude any condition they wish. It would then be up to you if you choose to purchase the policy or not. Other conditions within the polcy may be too restrictive, or may not provide the coverage that you need.
The lesson here is to ask questions, know your insurance coverages, your policy limitations and exclusions, and your rights. Understand what you are looking at, and what you are signing. A policy is no good if it doesn't cover the things you need it to. Otherwise you are just flushing money away.
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/
Showing posts with label insurance. Show all posts
Showing posts with label insurance. Show all posts
Friday, February 4, 2011
Sunday, January 30, 2011
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/
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/
Sunday, January 23, 2011
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/
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/
Saturday, January 1, 2011
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
Both available on http://www.amazon.com/
Check out the Kindle eBook editions!
Subscribe to:
Posts (Atom)