Description: Provider credentialing is the process of verifying the qualifications, education, and training of healthcare providers, including physicians, nurses, and other allied health professionals, to ensure they meet the standards set forth by insurance companies. The goal of credentialing is to ensure that healthcare providers are competent and qualified to provide safe and effective care to patients.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Aetna is one of the largest healthcare insurance providers in the United States. If you are a healthcare provider looking to enroll with Aetna, there are several steps you need to follow. The provider enrollment for Aetna can vary depending on the type of provider you are and the type of Aetna plan you want to participate in.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Before we list down procedure codes for RPM in pain management, let’s understand basics of Remote Patient Monitoring (RPM) in pain management and it’s reimbursement challenges.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Joining a reputable healthcare network is a crucial decision for any healthcare provider. Blue Cross Blue Shield (BCBS) is one such network known for its extensive coverage and high-quality care. However, provider enrollment with BCBS can be complex and time-consuming, requiring attention to detail and adherence to specific requirements.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Insurance prior authorization is a process that is commonly used by insurance companies to determine whether a specific medical service or treatment is necessary and appropriate for a patient’s medical condition. It is a process that is designed to control healthcare costs and ensure that patients receive the appropriate level of care.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: CPT code 99396 refers to a preventive medicine evaluation and management (E/M) service for patients aged 65 years or older. It involves a comprehensive annual wellness visit (AWV), including personalized preventive medicine planning. This code emphasizes the importance of preventive care and allows primary care providers to assess the overall health status of their elderly patients.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: As a healthcare provider, understanding the prior authorization process with Cigna is crucial in ensuring your patients receive the necessary coverage for their healthcare services and medications. Cigna utilizes technology-driven solutions to streamline the prior authorization process and enhance efficiency for healthcare providers and patients.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Telehealth has been considered as a revolutionary innovation in healthcare delivery. However, its adoption has been limited, with one of the main barriers being reimbursement issues. Despite its potential to save costs, there is limited evidence of managed care organizations (MCOs) using telehealth to control costs. Furthermore, Medicare reimbursement in the fee-for-service system is not generous, with restrictions based on location, institution type, and CPT codes.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Provider credentialing is a critical process in the healthcare industry, which involves the verification of a healthcare provider’s credentials, qualifications, and experience to ensure they meet certain standards set by the insurance companies.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Accounts receivable refers to the outstanding payments that a primary care practice is owed by patients, insurance companies, or other third-party payers for services rendered. Managing accounts receivable can be challenging for primary care practices due to various factors including, changing payment models, billing complexities, claim denials, managing unpaid patient balances, and high administrative costs.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Provider credentialing is the process of verifying and evaluating the qualifications and credentials of healthcare providers, to ensure they meet the necessary standards and regulations for their respective roles. Following provider credentialing best practices can ensure consistency and accuracy throughout the entire process.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Pain management is a specialized medical field that involves the diagnosis and treatment of pain-related conditions. As with any medical specialty, accurate and compliant coding is essential for proper billing and reimbursement. The use of proper coding categories and codes can help ensure that pain management practices receive appropriate reimbursement for the services they provide.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Provider credentialing is a process by which a healthcare provider is verified to ensure they meet the necessary requirements to provide healthcare services to patients. It is important to note that the credentialing process may take several months, so it is best to start the process early.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Pain management billing and coding requires a high level of expertise and attention to detail to ensure accurate reimbursement and compliance with regulations. Providers may consider seeking the assistance of specialized billing and coding professionals to help navigate these challenges.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: CareSource Medicaid is a health insurance program that is designed to provide affordable healthcare coverage to low-income individuals and families. The program covers a wide range of medical services, including hospitalization, doctor visits, prescription medications, and other healthcare services.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: When it comes to getting accurate reimbursement for physical therapy services, a lot of parameters are involved in it. That includes qualified clinicians; skilled level of care; proving medical necessity; and documentation when additional medical necessary services are required.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Pediatric audiology billing guidelines can be confusing as it varies from one insurance carrier to another. The following pediatric audiology billing guidelines includes commonly used diagnosis/procedure codes, and their billing scenarios. Procedure code guidance is based on the American Medical Association’s Current Procedural Terminology (CPT®) coding definitions.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Provider credentialing is the process of verifying and evaluating the qualifications and credentials of healthcare providers, to ensure they meet the necessary standards and regulations for their respective roles. Following provider credentialing best practices can ensure consistency and accuracy throughout the entire process. Provider credentialing best practices include standardizing the process, verifying all credentials, performing ongoing monitoring, and maintaining accurate records.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Insurance reimbursements are core to any practice’s successful day-to-day operations and Gastroenterology practices are no exception. However, Gastroenterologists are not trained for this business side of medicine i.e., medical billing and coding. They come out of training with the knowledge to treat patients but with little or no knowledge of how to get reimbursed for their services.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: In wound care, claim denials occur when a healthcare provider’s claim for payment is rejected by the payer, which may be a government program, insurance company, or other third-party payer. Claim denials can happen for various reasons, such as coding errors, missing or incorrect information, lack of medical necessity, and policy or regulatory issues. Claim denials can be costly for healthcare providers, as they result in lost revenue, increased administrative costs, and potential damage to their reputation.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Traditional medical practice owners handled their billing in-house. However, next-gen practice owners are outsourcing their complete medical services. As per a recent research report from ‘Grand View Research’, the global medical billing outsourcing market size was valued at USD 11.1 billion in 2021 and is expected to expand at a compound annual growth rate (CAGR) of 12.0% from 2022 to 2030.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: COVID-19 was declared a global pandemic in March 2020, resulting in social distancing mandates and a rapid transition from in-person to remote health care delivery formats.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Pain management billing and coding requires a high level of expertise and attention to detail to ensure accurate reimbursement and compliance with regulations. Providers may consider seeking the assistance of specialized billing and coding professionals to help navigate these challenges.Pain management billing and coding can be complex and challenging due to several factors
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Oncology billing and coding refers to the process of assigning the appropriate medical codes to the procedures and services provided to cancer patients, and submitting claims for reimbursement to insurance companies or government programs such as Medicare and Medicaid. It involves a detailed understanding of the medical terminology and procedures associated with cancer diagnosis, treatment, and management, as well as the rules and regulations governing medical billing and coding.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: A significant portion of your practice’s billable services are comprised of evaluation and management (E&M) services. According to CMS documentation guidelines, it’s critical for all entries in a medical record to be legible. Any nursing notes, orders, progress notes, and other entries in medical records that aren’t legible can result in misinterpretation or misreading, which could lead to medical errors. It’s possible for claims to be denied simply because E&M documentation was illegible and was not able to be correctly coded.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: As a healthcare provider, your prime focus is supporting your patients and meeting their healthcare needs. But while quality patient care is essential, you can’t run your practice without having sound administrative systems in place to keep the office operating efficiently.One of the most tedious tasks is collecting patient payments.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: In an effort to reduce the burden and improve payment for cognitive care, the American Medical Association along with the Centers for Medicare and Medicaid Services (CMS) have implemented key changes to office and outpatient evaluation and management (E/M) services (all other E/M services will remain unchanged) starting on January 1, 2021.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Evaluate the existing billing processes and identify areas that can be streamlined to reduce errors and improve billing efficiency. To streamline medical billing operations, list down all billing and coding activities starting from appointment registrations up to receiving insurance/ patient payments. Medical billing activities include patient registrations, charge capture, medical coding, claim submission, claim follow-up, payment posting, denial management, patient billing and collections, accounts receivable management, and reporting. All these billing activities needs to be streamlined and documented properly for staff reference.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Billing and coding for any medical speciality offers unique challenges due to billing guidelines and constantly changing reimbursement policies from various insurance carriers. Cardiology medical billing offers unique challenges as various sub-specialities of cardiology are involved. Different sub-specialties like interventional cardiology, echo-cardiology increases the need of expert coders and billers.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Bariatric surgery procedures are performed to treat comorbid conditions associated with morbid obesity. Two types of surgical procedures are employed. Malabsorptive procedures divert food from the stomach to a lower part of the digestive tract where the normal mixing of digestive fluids and absorption of nutrients cannot occur. Restrictive procedures restrict the size of the stomach and decrease intake. Surgery can combine both types of procedures.Bariatric procedures are performed for patients that have a diagnosis of obesity. While patients typically have associated comorbidities that should also be coded and reported, obesity remains the primary reason for the procedure. Payers may also require that a specific BMI be reported to meet coverage criteria.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Preauthorization is a process through which a request for provisional affirmation of coverage is submitted for review before a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) item is furnished to a beneficiary and before a claim is submitted for payment. Preauthorization helps ensure that applicable coverage, payment, and coding rules are met before supplies are delivered. Preauthorization may be needed before certain services can be rendered or equipment supplied. Every insurance company has its unique guidelines for preauthorization for DME, still, in this article, we shared the basics of preauthorization for general understanding purposes.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Sometime you might receive a claim denial while billing for evaluation and management (E/M) services and pulmonary diagnostic procedures provided to the same patient on the same date. Physicians has lot of confusion on how to billing accurately for Pulmonary Diagnostic Services. Pulmonary diagnostic procedures, such as spirometry, are commonly done in family medicine in conjunction with another E/M service.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Medicare under title XVIII of the Social Security Act, includes ‘traditional’ or ‘original’ Medicare benefits administered in Part A (hospital and other inpatient facility services) and Part B (physician and other outpatient facility services, and certain drugs); Part C (Medicare Advantage), and the optional prescription drug benefit administered by private plans under Part D. In this article we focussed on Part A and B Medicare coverage policies for chronic and acute pain.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Healthcare revenue cycle challenges exist at every stage of practice management, beginning with appointment scheduling and extending all the way through claims, billing, payment, and collections. Technology, regulations, changing contractual obligations and payer policies, people, processes, billing – each of these complexities add to the challenge. These Revenue cycle management (RCM) hurdles lead to revenue loss ultimately challenging the day-to-day activities of practice management. In this article, we will discuss how outsourcing can help overcoming revenue cycle hurdles.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Although treatment has advanced by leaps and bounds in the last few decades, heart disease remains the leading cause of death for U.S. adults. And with more than 20 million U.S. adults facing coronary artery disease, cardiology remains one of the busiest and highest-paid specialties.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Major challenge in successfully running wound care practice is receiving timely and accurate insurance reimbursements. Medical practices can efficiently manage overheads if they receive accurate insurance reimbursements on time. One of the key factor in receiving reimbursements for wound care practice is understanding payer requirements. If they are not known/met you are significantly increasing the chance the claim will be rejected (have an administrative or clinical error) or denied (deemed unpayable), resulting in extra office processing costs of $25–65 or more per claim.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Telehealth physical therapy has been highly adopted by the vulnerable patient population as well as those who prefer the convenience of care at home. During a pandemic, telehealth physical therapy has evolved and overcome its limitations. For example, the precise movements and exercises involved in physical therapy rehab are hard for a patient to accomplish remotely. A provider on a video call may seem about as valuable as a YouTube video. But there are new technologies and strategies that link patients, safely, to at-home physical therapy care that balances telemedicine with in-person visits. Many experts say this is the future of telemedicine: a hybrid of in-person and virtual care.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: On Nov. 1, 2022, the Centers for Medicare and Medicaid Services (CMS) released the final 2023 Medicare Physician Fee Schedule (MPFS), addressing Medicare payment and quality provisions in the coming year. Let’s understand how MPFS is changing pain management billing for 2023. Through CMS, federal government making efforts to effectively address pain management as a response to the nation’s overdose crisis,such as the National Pain Strategy and the HHS Pain Management Best Practices Inter-Agency Task Force (PMTF) Report.
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Tag: medicalbilling medicalbillingcompany medicalbillingservices medicalCoding medicare
Description: Accurate and complete documentation and communication by all members of the diagnostic ultrasound healthcare team are essential for high-quality patient care.
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Tag: Family Practice Billing FamilyPractice healthcare medicalbilling medicalcoding
Description: It’s essential to have in-depth knowledge of commonly used modifiers for global surgeries. Complete understanding of global surgery modifiers and their guidelines, ensures that you are billing as per coding compliance, not over-billing or under-coding. Understanding of modifiers for global surgeries, ensures that healthcare organizations are getting paid accurately while billing for all services and without fear of external payer audits.
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Tag: GeneralSurgery GeneralSurgeryBilling GlobalSurgery healthcare medicalbilling medicalbillingservices
Description: Billing for critical care visits is challenging due to various factors affecting billing scenarios and code selection. When you are billing for critical care visits, you should be aware of billing scenarios for single physician/ non-physician practitioner (NPP); concurrent service by different specialties; billing for same specialty and same group; split (or shared) critical care billing; and critical care visits and global surgery. Before going in details billing for critical care visits, let’s define critical care.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Any physician seeing a patient registered in the emergency department may use Emergency Department E/M CPT codes i.e., 99281 – 99285. It is not required that the physician be assigned to the emergency department. The ED codes require the level of Medical Decision Making (MDM) to be met and documented for the level of service selected. Note that, time is not a descriptive component for the emergency department levels of E/M services because emergency department services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: What will happen if you give a group of people all the work? The result is that their focus would divert, right? Correspondingly, won’t this will lead to a lack of expertise in work? Moreover, it will even cause delays in the end result. The same thing happens with a hospital, medical practice, or dental office. If the staff does the Medical Billing Process work with their regular office chores they are unable to focus on their core work. Moreover, it may take a lot of time, and the chances of error are high.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: As the name Evaluation and Management (E/M) suggest, E/M codes apply to visits and services that involve evaluating and managing patient health. Evaluation and management (E/M) procedure (CPT) codes ranges from 99202 to 99499 representing services provided by a physician or other qualified healthcare professional.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare Outsource medical billing
Description: Orthopedic Medical Billing systems are essential for regular movement in everyday life
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Before having detailed understanding about guidelines for chemotherapy administration codes, let’s define chemotherapy. Chemotherapy is a treatment of disease by means of chemical substances or drugs; usually used in reference to neoplastic disease.
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Tag: Chemotherapy healthcare medicalbilling medicalbillingservices medicalCoding oncologist
Description: Credentialing is the process to understand the capabilities of licensed clinical experts. Similarly, it also evaluates their experience and capabilities. This article points out the reason why credentialing is important. It also points out how a Credentialing Process Provider can assist a medical practice or hospital.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Pediatric audiology billing guidelines can be confusing as it varies from one insurance carrier to another. The following pediatric audiology billing guidelines includes commonly used diagnosis/procedure codes, and their billing scenarios. Procedure code guidance is based on the American Medical Association’s Current Procedural Terminology (CPT®) coding definitions. The pediatric audiology billing guidelines shared in this article mostly applies to Medicare.
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Tag: Pediatric Medical Billing PediatricAudiologyBilling PediatricBilling Pediatrician reimbursement
Description: Florida has one of the highest-ranked hospitals, medical practices, and dental clinics in the United States. They are one of the most sought-after ones because of the service they offer their patients. The sad part is that even though the state has one of the highest-ranked hospitals and medical practices, the condition of the payment is on a decline.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Mental health is emotional or physiological wellbeing. Mental health illnesses are depression, anxiety, PTSD, schizophrenia, bipolar disorder, etc. However, mental health is a taboo subject. In fact, there are many who believe that one can cure mental health without the help of a psychiatrist or psychologist. Moreover, there are many who live in denial of mental illness.
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Tag: Behavioral Health Biller Billing Codes For Mental Health Billing Companies For Mental Health Billing For Mental Health Services
Description: In a recent Revenue Cycle Management Virtual Summit, c-suite executives, revenue cycle directors, and other leaders from healthcare organizations discussed the most significant challenges and opportunities in revenue cycle management. These RCM experts pinpointed key revenue cycle challenges like patient financial experience, medical coding, and payroll expenses. We will discuss how outsourcing your medical billing services can help you get ready for revenue cycle challenges in 2023.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Durable Medical Equipment (DME) suppliers often confuse between repair and replacement, making errors while submitting claims to Medicare. For the purposes of Medicare reimbursement, repairs and replacements are not the same. To avoid claim denials and to receive an accurate Medicare reimbursement it’s important to differentiate between Medicare repair and replacement in DME. T
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Tag: Durable Medical Equipment Billing DurableMedicalEquipment healthcare medicalbilling
Description: Cancer has become one of the fastest-spreading diseases nowadays. It is even termed one of the deadly diseases. The study of cancer is called Oncology Medicine. On the other hand, Medical Oncology Billing is the process to convert these services into codes that an insurance company understands. This is an important factor to receive money from the insurance company for the services that an oncologist renders. This article focuses on what are the benefits of outsourcing Oncology Medical Billing.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Childbirth is a miracle for the very reason that the mother puts her own life on the line to bring forth her little one into the world. OB-GYN practitioners make this miracle possible through their flawless services. In this article, we will understand how OB/GYN Medical Billers and Coders help practices achieve better revenue. This is possible through better reimbursements from insurance companies. Moreover, the practice can levy the right out-of-pocket fees from patients.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Insurance reimbursements are core to any practice’s successful day-to-day operations and Gastroenterology practices are no exception. However, Gastroenterologists are not trained for this business side of medicine i.e., medical billing and coding. They come out of training with the knowledge to treat patients but with little or no knowledge of how to get reimbursed for their services. Plus, they want to spend most of their time in patient care rather than in such administrative activities.
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Tag: Gastroenterologist GastroenterologyBilling healthcare medicalbilling medicalbillingcompany
Description: People say that time heals all wounds. However, in reality, every wound, be it a small or large one, needs to be treated on time. If one fails to do so, it may lead to the wound converting into a major infection. Therefore, we need complete wound care management. In this article, we will understand how Wound Care Billing Services Providers can play a vital role in bringing in more income for the wound care management practice.
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Tag: wound care billing companies Wound care billing guidelines wound care billing services
Description: Hand surgery coding plays an important role in accurately determining the procedure performed and quantifying the amount of work done by the surgeon. American Medical Association (AMA) updates and maintains the Current Procedural Terminology (CPT) codes applicable to hand surgery coding. The CPT code range for surgical procedures on the hand and fingers is 26010-26989. Despite the importance of accurate hand surgery coding, studies find that billers and surgeons are often unaware of proper billing codes.
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Tag: HandSurgeryCoding healthcare medicalbilling medicalbillingcompany medicalbillingservices
Description: There are many different medical treatments. However, treatments that are related to cardiology are one of the most expensive. Right from the beginning, these treatments are costly. Even with the diagnosis of simple hypertension, which may lead to many heart and blood vessel diseases, the cost of the treatments is high. This article explains why CPT codes require special attention.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Running a profitable healthcare practice is a challenging task. Wage inflation, rising overhead costs, lagging patient volume, and COVID-19 pandemic-associated uncertainty continue to put enormous pressure on healthcare practices’ bottom lines. Timely and accurate insurance reimbursement is the only source that can assist practice owners in surviving in such challenging times.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Reimbursements are a significant source of revenue for healthcare practices. Yet, many of them don’t receive the full reimbursement for delivered services, even when the payer and provider mutually agreed on a rate. Unfortunately, keeping up with payer policy changes is difficult and most practices don’t have a payer contracting expert who regularly analyses payer contracts. To protect practices from surprise policy changes that lead to lost revenue, we shared essentials that will be required at the time of payer contract negotiations.
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Tag: ClaimDenials healthcare medicalbilling medicalbillingcompany medicalbillingservices medicalCoding medicare
Description: A number of insurance companies neglect podiatric services. In fact, insurance companies do not cover many important podiatric services. The main reason for that is that they handle and take care of illnesses that are concerned with the feet and other ailments. In a similar manner, a podiatrist also treats minor injuries. However, these podiatrists diagnose and treat many foot and leg-related diseases.
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Tag: Podiatry Billing Company Podiatry Billing Services Podiatry Medical Billing Podiatry Medical Billing And Coding
Description: Optometry is the branch of science that studies vision, its phenomena, and diseases. Optometrists are also known as ophthalmologists or doctors of optometry. In this article, we will explore what optometry is in medical terms and understand the role of an Optometry Medical Billing Services Provider. We will find out how they help an optometric facility recover payments in the form of fees from the patients and reimbursement from the insurance companies.
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Tag: Medical Billing and Coding For Optometry Medicare Billing Guidelines for Optometry Optometric Billing Solutions
Description: Pediatricians need to have calm and patient composure. The main reason for this is that they deal with children. These children are just born. Similarly, they can be children of very young dispositions. Moreover, they have to invest more time in their patients than other doctors to understand the sickness. The prime cause of this is that the patients are not mature enough. They are unable to make the pediatrician understand what they are going through. Therefore, the pediatricians have to rely on a lot of probing. In a similar manner, they have to rely a lot on the information that the patients’ parents or guardians provide.
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Tag: Pediatric Medical Billing Pediatric Medical Billing And Coding Pediatric Medical Billing Company
Description: Radiology is an important part of medication and medical processes. In radiology, as the name suggests, radioactive beams of rays are utilized to get photos of the patient’s body. This plays an important role in identifying the ailment. Let us understand how a radiology medical billing service provider helps a radiologist do his work in a better fashion.
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Tag: #Radiology #Radiologist #Radiologybilling #medicalbilling #medicalcoding #healthcare #medicare
Description: As per CMS definition, an emergency department is defined as an organized hospital-based facility for the provision of unscheduled episodic services to patients who present for immediate medical attention. The basic requirement for emergency department (ED) is, the facility must be available 24 hours a day. Emergency department (ED) Evaluation and Management (E/M) codes do not differentiate between new or established patients and they are typically reported per day.
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Tag: EmergencyDepartment EmergencyDepartmentBilling healthcare medicalbilling medicalbillingcompany
Description: Under medical and prescription drug plans, some treatments and medications may need approval from insurance carriers before being delivered care by healthcare providers. Prior authorization (or pre-authorization) is usually required if the patient needs a complex treatment or prescription. This list of medical treatments and medications is different for every insurance carrier. For example, some of the medical treatments and medications that may require prior authorization
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Tag: #PriorAuthorization #Pre-authorization #Medicalbilling #MedicalCoding #Healthcare #Medicare
Description: An important ambulance billing best practice is knowing how to code ambulance transport origins and destinations properly. When it comes to identifying proper origin and destination codes in medical billing, it is a common practice to follow the Centers for Medicare and Medicaid (CMS) guidelines for ambulance billing, given most commercial carriers have adopted these guidelines as well. That’s why we referred CMS document to explain origin and destination codes in ambulance billing.
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Tag: Ambulance Billing and Coding ambulance medical billing AmbulanceBilling AmbulanceBillingServices AmbulanceTransportation
Description: Managing claim denials is the most challenging part of revenue cycle management for any healthcare practice. As per one of the survey reports from the Center for Medicare and Medicaid Services (CMS), almost 30 percent of submitted claims are either denied, lost, or ignored. Even the smallest medical billing and coding errors could in claim denials resulting in denied or delayed insurance reimbursements.
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Tag: #medicalbilling #medicalbillingservice #medicalCoding #RCM #reimbursement #RevenueCycleManagement
Description: Accurate and complete documentation and communication by all members of the diagnostic ultrasound health care team are essential for high-quality patient care. There must be a permanent record of the ultrasound examination and its interpretation. Images of all relevant areas defined in the particular parameter, both normal and abnormal, should be recorded and stored in a retrievable format. Retention of the ultrasound images and report should be consistent both with clinical needs and with relevant legal and local health care facility requirements.
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Tag: Family Practice Billing Family Practice Billing Code Family Practice Billing Services Family Practice Coding
Description: Efficient revenue cycle management is essential for healthcare practice to operate successfully. Revenue cycle management includes all necessary functions starting from collecting patient information up to receiving accurate reimbursements for delivered services. Revenue cycle directly affects the practice’s bottom line and indirectly affects patient care.
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Tag: medicalbilling medicalbillingservice medicalCoding reimbursement RevenueCycleManagement revenuegrowth
Description: Dentistry is the study, prevention, diagnostics, and cure of the diseases or disorders that relate to teeth or oral health. Twice a year, It is advised to visit the dentist. A dental practice plays a vital role to provide the best oral care to people. In the United States, a majority of people have insurance cover for dental treatments. Dental Medical Billing and Coding are related to dental care. In this article, we will understand why a dental practice should take the help of a skilled Dental Billing Services provider.
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Tag: Dental Billing And Collections Dental Billing Companies Dental Billing Company In USA Dental Billing Outsourcing
Description: Medicare’s 8-minute rule is a stipulation that applies to time-based CPT codes for outpatient services, such as physical therapy. Introduced in December 1999, the 8-minute rule became effective on April 1, 2000. The rule allows practitioners to bill Medicare for one unit of service if its length is at least eight (but fewer than 22) minutes. A billable ‘unit’ of service refers to the time interval for the service. Under the 8-minute rule, units of service consist of 15 minutes each.
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Tag: medicalbilling medicalbillingcompany medicalbillingservices medicalCoding
Description: Heart disease is the biggest concern of today’s time. Heart disease is one of the most common diseases in the US. Therefore, the work of Cardiology Specialties is very crucial. A Cardiology expert treats all kinds of diseases that relate to the heart and blood vessels. A cardiologist’s work is complex. In a similar manner, Cardiology Medical Billing is also complicated. This often leads to the denial of claims.
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Tag: cardiology billing cardiology billing company cardiology billing guidelines
Description: Dermatology is the study of treatment and diagnosis of issues related to skin, hair, nail, or mucous membrane. A dermatologist is a doctor who treats the above health issues. In this article, we will deal with the aspect of how a dermatology practice can get a steady flow of revenue through the help of a reputed Dermatology Medical Billing Company.
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Tag: Dermatology Billing And Coding Dermatology Billing Company Dermatology Billing Services Dermatology Coding
Description: Telehealth physical therapy has been highly adopted by the vulnerable patient population as well as those who prefer the convenience of care at home. During a pandemic, telehealth physical therapy has evolved and overcome its limitations. For example, the precise movements and exercises involved in physical therapy rehab are hard for a patient to accomplish remotely.
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Tag: medicalbillingcompany medicalbillingservices medical billing PhysicalTherapy
Description: Do you have a chiropractic practice? If yes you would understand how difficult it is to take care of your patients. In a similar manner, it is difficult to check the finance and administration issues and run errands for the practice.
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Tag: Chiropractic Billing Chiropractic Billing Company Chiropractic Billing Guidelines
Description: Family Practitioners are the doctors who treat every member of the family. They treat them irrespective of disease, gender, and age. Family practitioners are also known as family physicians or family doctors. They have a special bond with all the members of the family.
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Tag: Family Practice Billing Family Practice Billing Codes Family Practice Billing Services Family Practice Coding
Description: You will be surprised to know that the medical billing outsourcing market was valued at USD 11.1 billion in 2021 and is expected to expand at a compound annual growth rate (CAGR) of 12 percent from 2022 to 2030. Receiving accurate reimbursement for delivered services is the unique challenge any physician is facing in the post-pandemic situation. Outsourcing medical billing services could be the solution.
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Tag: medicalbilling medicalbillingcompany medicalbillingservices medicalCoding medicare Outsource
Description: Medicare under title XVIII of the Social Security Act, includes ‘traditional’ or ‘original’ Medicare benefits administered in Part A (hospital and other inpatient facility services) and Part B (physician and other outpatient facility services, and certain drugs); Part C (Medicare Advantage), and the optional prescription drug benefit administered by private plans under Part D.
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Tag: AcutePain ChronicPain ClaimDenials healthcare medicaid medicalbilling medicalbillingservice medicalCoding medicare
Description: Doctors toil to listen to their patient’s concerns and identify the kind of medical issues patients face. And treat them. However, in some cases, doctors are unable to complete treatments because they require medical equipment. In cases of operations, the patients have to stay in the hospital for some time and require much different equipment.
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Tag: DME Billing Codes DME Billing Guidelines DME Codes In Medical Billing DME Coding And Billing DME In Medical Billing
Description: Emergency Billing Service helps ambulance companies maximize earnings with a minimum time-out. They specialize in preparing documentation to get checks paid, make sure payments take place on time, and do the necessary collaboration and follow-up when there is detention.
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Tag: Ambulance billing Ambulance Billing and Coding Ambulance Billing Company Ambulance Billing Guidelines ambulance coding
Description: At their core, Medical Billing Services and revenue cycle management solutions aim to facilitate the collection of financial data from healthcare providers. However, there are some major disparities between the two. This blog helps you understand these differences.
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Tag: Expertise In Medical Billing Services Healthcare RCM Providers Healthcare Revenue Medical Billing Medical Billing and RCM
Description: Physical Therapists (PTs) spend countless hours working with clients to rehabilitate and strengthen them after injury. It’s really important that they are paid for their hard work, expertise and time spent, also helping to stay in business and continue providing care. Receiving insurance reimbursements for delivered services is a challenging job due to the level of specificity required in physical therapy billing.
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Tag: PhysicalTherapist healthcare LegionHS medicalbilling medicalbillingservice medicalCoding medicare
Description: Pain management collection is a very dynamic field. The reason is that the ICD codes are complex. Moreover, the payer’s demands also change from time to time. Due to these reasons, it becomes inevitable that we have an effective Pain management collection system. This blog discusses in detail the ways you can improve Pain management collection.
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Tag: Pain Management Billing Pain Management Billing And Coding USA Pain Management Billing Codes Pain Management
Description: A significant portion of your practice’s billable services are comprised of evaluation and management (E&M) services.
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Tag: E/M Documentation healthcare LegionHS medicalbilling medicalbillingservice medicalCoding medicare physician
Description: Florida has one of the highest-ranked hospitals, medical practices, and dental clinics in the United States. They are one of the most sought-after ones because of the service they offer their patients. The sad part is that even though the state has one of the highest-ranked hospitals and medical practices, the condition of the payment is on a decline
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Tag: Florida Hospital Medical Group Billing Florida Medical Bill Assistance Florida Medical Billing
Description: Mental health is emotional or physiological wellbeing. Mental health illnesses are depression, anxiety, PTSD, schizophrenia, bipolar disorder, etc. However, mental health is a taboo subject. In fact, there are many who believe that one can cure mental health without the help of a psychiatrist or psychologist.
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Tag: Behavioral Health Biller Billing Codes For Mental Health Billing Companies For Mental Health Billing For Mental Health Services
Description: In this article, we will try to comprehend how Medical Billing Service Experts can help talented and skilled nursing facility run their administrative affairs and revenue cycle in a much better manner. However, before we get into why a Skilled Nursing Facility requires a medical billing service expert, let us understand what a skilled nursing facility is in the first place
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Tag: Medicare Billing Guidelines For Skilled Nursing Facility Skilled Nursing Billing Skilled Nursing Facility Billing Skilled Nursing Facility Billing Codes
Description: Basics of Polysomnography and Sleep Testing About 40 million people in the United States suffer from sleep problems every year. Not getting enough sleep for a long time can cause health problems. Many sleep disorders can be managed by primary care physicians; however, when abnormal sleep patterns are not easily explainable and further evaluation is necessary, expert opinion and sleep studies may be needed.
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Tag: medicalbilling medicalbillingservice medicalCoding medicare Polysomnography PrimaryCareBilling
Description: Acceptance of Telebehavioral Health During Pandemic COVID-19 was declared a global pandemic in March 2020, resulting in social distancing mandates and a rapid transition from in-person to remote health care delivery formats.
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Tag: medicalbilling medicalbillingservice medicalCoding medicare MentalHealthBilling reimbursement revenuegrowth
Description: Orthopedic Medical Billing systems are essential for regular movement in everyday life. The orthopedic billing substantially depends on proper attestation before, during, and after the case’s visit. A claim is most likely to be rejected if there’s an error, including deficient case demographics entry or indecorous case eligibility verification.
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Tag: Medical Billing and Collection Companies Orthopedic Billing and Coding Orthopedic Billing Codes Orthopedic Billing Companies
Description: Billing and coding for any medical speciality offers unique challenges due to billing guidelines and constantly changing reimbursement policies from various insurance carriers. Cardiology medical billing offers unique challenges as various sub-specialities of cardiology are involved.
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Tag: cardiologist, cardiology medical billing claim healthcare medicalbilling medicalbillingservices medicalCoding
Description: Dentistry is the study, prevention, diagnostics, and cure of the diseases or disorders that relate to teeth or oral health. Twice a year, It is advised to visit the dentist. A dental practice plays a vital role to provide the best oral care to people.
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Tag: Dental Billing And Collections Dental Billing Companies Dental Billing Company In USA Dental Billing Outsourcing
Description: Chemotherapy administration codes apply to parenteral administration of non-radionuclide anti-neoplastic drugs; and also to anti-neoplastic agents provided for treatment of noncancer diagnoses (e.g., cyclophosphamide for auto-immune conditions) or to substances such as monoclonal antibody agents, and other biologic response modifiers.
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Tag: medicalbilling medicalbillingservice medicalCoding oncologist oncology Oncology Billing And Coding
Description: Ambulance transportation involves various destination scenarios where beneficiary is transported from beneficiary home, an accident scene, or any other point of origin to nearest hospital, critical access hospital (CAH), or skilled nursing facility (SNF). Various destinations and Medicare & private insurance coverages makes it difficult to understand these ambulance transport coverage scenarios.
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Tag: AmbulanceTransportationBilling healthcare LegionHS medicaid medicalbilling medicalbillingservices medicalCoding
Description: People say that time heals all wounds. However, in reality, every wound, be it a small or large one, needs to be treated on time. If one fails to do so, it may lead to the wound converting into a major infection. Therefore, we need complete wound care management. In this article, we will understand how Wound Care Billing Services Providers can play a vital role in bringing in more income for the wound care management practice
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Tag: Coding for Wound Care wound care billing companies Wound care billing guidelines wound care billing services
Description: Family Practitioners are the doctors who treat every member of the family. They treat them irrespective of disease, gender, and age. Family practitioners are also known as family physicians or family doctors. They have a special bond with all the members of the family. In fact most of the time they know all the members of the family on a personal level.
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Tag: Family Practice Billing Family Practice Billing Code Family Practice Billing Services Family Practice Coding
Description: Pediatricians need to have calm and patient composure. The main reason for this is that they deal with children. These children are just born. Similarly, they can be children of very young dispositions. Moreover, they have to invest more time in their patients than other doctors to understand the sickness. The prime cause of this is that the patients are not mature enough. They are unable to make the pediatrician understand what they are going through.
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Tag: Pediatric Medical Billing Pediatric Medical Billing And Coding Pediatric Medical Billing Company
Description: The introduction of the electronic claim submission process has changed medical billing and the overall healthcare industry forever. The system of paper claim management was filled with inefficiencies and inaccuracies. For providers looking to eliminate these problem areas in their claims process, EDI enrollment is necessary. Electronic Data Interchange (EDI) is an innovative digital communication tool that is used to deliver data from a provider to a payer.
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Tag: medicalbilling medicalbillingservices medicalCoding medicare
Description: Do you have a chiropractic practice? If yes you would understand how difficult it is to take care of your patients.
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Tag: Chiropractic Billing Company Chiropractic Billing Guidelines Chiropractic Billing Services Chiropractic Coding
Description: The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) have finalized the coding updates for calendar year (CY) 2022. Overall, there are no significant coding changes impacting oncology, but it is important to be prepared and ensure that your coding team is well aware of these changes.
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Tag: medicalCoding oncologist OncologyBilling OncologyBillingAndCoding OncologyBillingServices
Description: Recently, CMS has proposed Medicare Physician Fee Schedule Proposed Rule for the year 2023. This proposed rule also includes billing for Opioid Treatment Programs (OTPs). These proposed billing guidelines for Opioid Treatment Programs include revising pricing for the drug component of the methadone
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Tag: medicalbilling medicalbillingservice OpioidTreatment OpioidTreatmentPrograms PainManagement reimbursement
Description: Childbirth is a miracle for the very reason that the mother puts her own life on the line to bring forth her little one into the world. OB-GYN practitioners make this miracle possible through their flawless services. In this article, we will understand how OB/GYN Medical Billers and Coders help practices achieve better revenue. This is possible through better reimbursements from insurance companies.
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Tag: Medical Billing OB/GYN Medical Billing