Is Medicare and Medicaid Billing different from Commercial Medical Billing?

In order to ensure timely payments, practices need well-trained billers and coders who can understand the difference between Medicare and Medicaid billing claims.

Medical Billing ServicesWhy you need expert staff for Medicare billing?

A large number of providers, including institutions and licensed individuals get majority of their income from treatment of Medicare beneficiaries. Since this program is composed of four parts, covering a broad range of medical services, billers and coders need to be expert in Medicare billing which is very similar to commercial medical billing. They need to be trained in assigning correct codes and interacting with Medicare programs to gain appropriate payment for services.

Compared to a standard insurance company, Medicare has more specific processes, rules and regulations that must be followed by the in-house coders and billers. Training will also be required for them in Medicare medical billing for answering patient queries.

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Medicaid billing and coding requirements:

There are over 50 Medicaid programs in America due to which your staff require proper training in Medicaid coding and claim submission.

  • All Medicaid programs are required to implement the NCCI (National Correct Coding Initiative) edits for claim submission
  • Even though state agencies implement the edits, coding methodologies can still be interpreted beyond NCCI. This has made it essential for coders to be aware of the state program requirements before providing codes to billers
  • Billers should be trained for assigning the right modifiers to procedure codes which will help in accurate description of services as per the guidelines set by Medicaid payers
  • Claims should pass audits conducted by MICs (Medicaid Integrity Contractors) that many state Medicaid programs have instituted. This will guarantee clean Medicaid claim submission and timely payment      

How safe is your practice from fraud and abuse cases?

With the rise in Medicare fraud and abuse cases, it has become important for practices to ensure accuracy in coding and documentation. This is also being considered important for eliminating any chances of fines, imprisonment or injury to your reputation.

For this reason, practices need to hire expert coding and billing staff or invest time and money in training in-house coders and billers to make them proficient in Medicare and Medicaid billing. They need to be given special training in complying to the statutes and regulations that govern Medicare and Medicaid reimbursement.

Due to rise in number of patients and reforms, workload has increased for physicians, leaving them with less time and money to implement these measures that can ensure accurate medical billing. Many practices are seeking assistance from medical billing specialists like Medicalbillersandcoders.com for their Medicare and Medicaid billing woes.

MBC is the largest consortium of expert coders and billers who are well-trained in handling billing requirements for both programs. We can also help boost your RCM by replacing old technology with new ones, modifying old lengthy processes and providing training to your staff in coding and billing techniques. We work with the aim to reduce claim denials and maximize reimbursement while you focus on quality patient care.

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