Get Your Finances In Order With Professional Urology Billing Services in 2023

When urologists find it hard to manage sustainable revenue growth for their business and accomplish on-spot complex urology procedures to correct the urinary system’s dysfunctions and the male reproductive system. Therefore, they need seamless urology billing and coding services by understanding the essence of required codes and terminologies for accurate medical billing. 

Having said that, it requires specialized experience and expertise to execute accurate urology billing and coding procedures. Usually, a urologist has to collaborate with other providers as well i.e. oncology, gastroenterology, andrology, pediatrics, endocrinology, and gynecology. Therefore, urology billing and coding specialists should understand the nuances of urology practice and other specialties involved in the urology procedure. 

It will help medical billers and coders to make well-informed decisions and streamline their healthcare revenue cycle management. However, such medical billing professionals who are well-versed in the core obligations of urology billing services, usually charge huge salaries and are very rare. So in this struggling economy, it could be another challenge for healthcare providers. 

What Is The Most Cost-Effective Urology Billing Solution?

Although, there are plenty of cost-effective medical billing solutions that can help healthcare providers to get their billing tasks done accurately and efficiently. For example, when you outsource urology billing services to a medical billing company then you can get connected with a professional billing team at a fraction of your existing IT expenses. 

How Do Medical Billing Companies Charge For Their Services?

Because usually medical billing companies charge in the three following ways; 

1. Charge a fixed percentage from the revenue they collect on your behalf after filing your medical claims. 
2. Charge a fixed amount to file and submit each claim. 
3. Get paid every hour while delivering their services. 

Paying only a fixed percentage of your capital investment is comparatively more cost-effective than the expenses of the whole office-based medical billing team and their office accessories. 

Moreover, it also helps urologists to pay undivided attention to their core responsibilities (medical obligations) while a professional urology billing company takes care of your healthcare revenue cycle management. They also assist healthcare providers in keeping track of reimbursements, non-payments or underpayments for the medical and diagnostic services rendered by the healthcare providers in order to ensure the well-being of patients. 

An in-house medical billing team can also be helpful for healthcare providers but if you’re still struggling with billing errors and payment issues then opting for an outsourced urology billing solution can give you a competitive edge over your counterparts. 

It also allows you to get assistance and guidance from subject-matter experts and insights into your medical billing system. 

What Are The Best Practices For Urology Billing Services?

Whether you want to outsource urology billing services or hire an office-based medical billing team, you need some key performance indicators (KPIs) to gauge the performance of your medical billing team and healthcare revenue cycle management. 

Here are the best practices of urology billing and coding services for 2023; 

Prior Authorization

As Urology procedures are costly, the provider must obtain prior authorization from the insurance company before rendering the services. Prior Authorizations help the organization understand the submission guidelines better, submit the claims on time, and get reimbursements instead of denials.

Medical Necessity

The urology service provider should hire a well-experienced administration staff at the front desk who should collect and verify if the patient’s insurance plan covers the prescribed urology medical and diagnostic procedures. 

After verification of the patient’s coverage plan, the healthcare provider should be able to justify the medical necessity of the course of treatment to be able to charge accordingly for the most expensive services. 

Without prior authorization, several health insurance companies deny the reimbursement of medical claims. Therefore, urologists should deploy efficient prior authorization solutions to streamline their business workflow. 

Verify Patients’ Eligibility & Benefits Denials

It is essential to verify if the patient meets the coverage plan criteria and gets the benefits for a particular service at least 48 hours prior to medical claim submission. 

Sometimes patients are not fully aware of the eligibility criteria of their coverage plan, therefore, it is the responsibility of the medical office administration office to check out the requirements of the patient’s eligibility and verify if they meet the criteria. 

For example, when patients change their jobs and they aren’t aware that their new employment plan may have different eligibility criteria and coverage plans. So when they meet their regular doctors/physicians then without even realizing they expect their new coverage plans to work the same way. 

Therefore, the front desk staff should collect the updated patient’s demographic information (name, address, insurance ID, phone number, residential address, etc.) and verify if it is updated or not. In fact, the administration staff should not verify eligibility criteria of the new patients but also old patients everytime your healthcare office. 

Verify Missing/Invalid CLIANumber: 

Clinical Laboratory Improvement Amendments (CLIA) number is a ten-character alpha-numeric code on the CLIA certificate. This number is used to identify and track the laboratory throughout the patient’s history. 

A CLIA number is used to make inquiries to the State Agency and CMS about your lab tests and diagnostic procedures. Healthcare providers should update the CLIA number whenever billing for the lab test. 

In case of a missing CLIA number, healthcare providers won’t get any coverage for the lab tests by CMSor any State Agency. 

Check Out Non-Covered Codes:

A codes like A4357, A4334, A5114, A4340, A4331, etc., are used to define non-covered services by Medicare. So if your medical bill features an A code then it will be most probably denied by Medicare as Non-covered Services. However, there are secondary inusance companies as well who will pay for the Medicare non-covered services. 

Medical Coding for Maximum Benefits: 

Urology coding specialists should apply accurate CPT and ICD code units while considering specific codes and modifiers to represent specific procedures for particular insurance payers. 

For example, an insurance company will deny a urology procedure if the CPT codes  51700, 52300, 52310, 55876, and 77263 are used in the same bill for more than one unit. 

Urology coding specialists should not report 51701-51703 in addition to any other procedure that includes catheter insertion as a component. 

Speaking of Modifier 59, healthcare providers should apply it when they are billing for two urology services together. 

Abide By LCD Guidelines:

LCD (Local Coverage Determination) guidelines are introduced by Medicare Administrative Contractor (MAC) on whether a particular service or item is reasonable and necessary. Therefore, Medicare will cover the medical procedures and items used for patients’ healthcare within the specific jurisdiction that is overseen by the MAC. 

Read out complete LCD guidelines for urology supplies from the following link: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33803

Remember, it is important to comply with LCD guidelines in order to make sure that your medical claims are approved and reimbursed by Medicare. On the contrary, your claim will be denied as not reasonable and necessary/incorrectly coded.

When you follow the best practices for urology billing services then you can increase the first-pass resolution rate (when your claims are approved and reimbursed by the payers at the first attempt of submission) of your medical billing cycle. In this way, you can reduce claim denials and account receivables to boost the productivity of your practice’s healthcare revenue cycle management. 

In this way, you can improve your finances, increase cost savings and reduce your bad debt for a streamlined growth of your business. 

Feeling overwhelmed due to billing challenges and stringent legal regulations for urology billing services? Then outsource medical billing services to a professional urology billing company. 

A professional medical billing company can assist you with all billing-related tasks and work as a virtual extension of your office-based team. In this way, you can enjoy reduced work stress and experience the much-wanted work-life balance. However, you should follow a complete checklist to make sure you’re partnering with a reliable and professional urology billing company; 

How To Outsource Urology Billing Services In USA? 

There are several healthcare practitioners in the USA who tend to outsource medical billing services to a third-party. It helps them relieve excessive workloads and streamline the functioning of their business operations. 

According to Outsource Management Group, there are 292 medical billing companies in the USA in 2023. Selecting the top-notch medical billing company among the flooded market of billing agencies could be another challenge in itself. 

For this purpose, we have sorted a comprehensive checklist which will help analyze and select the best urology medical billing company in the US. 

Step 1: Make The Billing Company Is HIPAA-Compliant

1960 Health Insurance Portability & Accountability Act also stands for HIPAA provides the regulatory guidelines to protect the security and integrity of delicate patient healthcare data also known as protected health information (PHI). 

In case of a breach, a healthcare provider or any relative prospect will face legal penalties and dire consequences. Therefore, always opt for a urology medical billing company that complies with HIPAA policies and guarantees to protect your information according to federal rules. 

However, there is no official certification of HIPAA compliance, therefore, you have to assess the security measures of medical billing companies. For this purpose, you must ask them how do they deploy HIPAA policies in their medical billing companies. 

For example, CureCloudMD is a HIPAA-compliant urology billing company that provides regular training to its employees and utilizes well-encrypted communication channels to ensure the integrity and security of patient’s healthcare data. 

Step 2: Count The Experience Of the Medical Billing Company

It is important to make sure that the medical billing company has considerable experience and a significant client retention rate to justify its credibility. There are several billing companies that are popping out on the internet but make sure you can get started with an experienced one. 

For this purpose, you can check out their online presence and how long they’ve been branding on the internet. Their social media presence, testimonials on the website, and authentic feedback platforms like Google reviews can help you assess the credibility of the urology billing company. 

Step 3: The Urology Billing Company Should Provide Best Prices

As mentioned earlier, medical billing companies charge in three ways (you can learn more in the “How Do Medical Billing Companies Charge For Their Services?” section). However, when you decide to outsource urology billing services then make sure that the medical billing company understands the obligations of the specialty and offer the best prices for urology billing services. 

For example, CureCloudMD performs a full-fledged medical billing audit of your entire healthcare revenue cycle management to offer you custom-tailored urology billing solutions at the best prices. 

We only charge a fixed percentage (based on your practice’s size) from the revenue we collect on your behalf after submitting your medical claims. In this way, we get paid only if you receive your reimbursements. 

Therefore, our medical billing team strives beyond basic billing tasks and follows up with your insurance payer until you receive your reimbursements, so we can create and achieve mutual business success opportunities for healthcare providers. 

Step 4: Inquire about The Expertise Of the Urology Billing Company 

It’s important to consider that the medical billing company has enough staff to meet the staffing needs of your medical office. Also, make sure that the medical billing company takes the responsibility to expand its resources in order to contribute to your business growth in the long term. 

Also, if you prefer a particular medical billing software/ practice management technology then make sure that the medical billing company offers you expertise for that as well. 

Just like CureCloudMD adopts a flexible approach for every healthcare practice. Our urology medical billing specialists are well-experienced and fully trained with the use of all popular medical billing software e.g. CareCloud, CureMD, Kareo, WebMd, eClinicalWorks, NextGen, CollaborateMD and much more. 

Therefore, we don’t ask you to set up a new IT infrastructure or buy new medical billing software for urology. We simply integrate our urology billing solutions into your existing healthcare revenue cycle management and practice management.   

So we don’t add a burden on your operational expenses and streamline your business operations seamlessly. 

Want to outsource urology billing services to CureCloudMD? You can get connected with our medical billing company and request a free demo of our urology billing solutions from the following link; https://curecloudmd.com/contact-us

Contact us at: +1 205 947 3264

Email us: [email protected]