Essential Do’s & Don’t Of Urology Billing Services! 2023 Guidelines

Urology is a unique and complicated area in the medical field and so is hard to manage urology billing services. There are only a few medical billing specialists who understand the nuances of this medical field and offer specialized medical billing solutions. Therefore, providers should understand the do’s and don’ts of urology billing services to execute their practice operations seamlessly. 

Urology is the specialty of the medical field that deals with diseases of the male and female urinary tract and male reproductive organs as well as checking if they’re able to make babies. 

Considering the significance and uniqueness of this field, one must understand that it would also be not easy to carry out billing tasks for urologists. Therefore, in this article, we have discussed the essential do’s and don’ts of urology billing services. 

Medical billing is a highly complex field that requires experienced-based expertise and experience to deal with insurance matters for urologists. Only professional personnel with specialized experience in the urology billing process world’s codes and legal requirements. 

As the cost of providing urology-related healthcare services increases, healthcare providers and urology practices can’t afford to lose revenue due to incorrect urology billing and coding services. In this case, a professional urology billing company comes in handy. 

A professional medical billing company with extensive experience in urology billing services can benefit your practice by helping you stay compliant with billing rules and coding regulations. In this way, your practice operations run smoothly without any hassle. 

Whether you’re deciding to keep an in-house or outsource urology billing services, there are some essential do’s that you should always integrate into your healthcare revenue cycle management and some don’ts that must be avoided in any case. Moreover, this article provides some helpful tips to improve the functioning of your urology billing services. 

Patients frequently have high balances, and complex explanations from their insurance payers, and they’re always in constant need to have someone who can help them to understand the invoices received from their urologists. 

Speaking of which, healthcare providers have so many tasks on their plate already that they can’t respond to every patient’s query. On the other hand, hiring professionals who help and guide patients about their healthcare dues results in ore money and happier patients for the urologists. 

Therefore, healthcare providers should opt for professional medical billing companies specialized in urology billing services and also offering customer support services. 

At CureCloudMD, we fulfill the staffing needs of medical facilities with a complete range of healthcare revenue cycle management outsourcing services including charge entry services, prior authorization services, insurance eligibility verification, urology billing and coding services, claim denial management services, account receivable (AR) recovery services, and payment posting services. 

Here’s a complete guideline about the essential steps that must be taken to adopt the best practices for urology billing services and avoid mistakes to ensure the smooth execution of your billing operations. 

Do’s for Urology Billing Services
Here are the essential do’s for the urology billing process; 

Collect Accurate Patient Information
The most critical step of the medical billing cycle is the collection and verification of patient’s demographic information which is also called protected health information (PHI). 

The data that is collected for the patient’s demographic consists of the patient’s name, insurance information, date of birth, and Social Security number as well as the patient’s residential address and additional information like email and occupation. 

It is the responsibility of the patient registration staff in the administration to collect this information and verify it with the patient’s records in EHR. It is important to validate the accuracy of the patient’s information in order to prepare clean claims (medical claims that are approved and reimbursed at the first attempt of submission). It helps urologists get paid by insurance companies and patients faster and easier. 

Prior Authorization
During the collection of patient’s demographic information, it is also the responsibility of the patient registration staff to identify and mention the true payer. For this purpose, the administration staff should collect the verified insurance data of the patient and make sure that the patient’s insurance plan covers the prescribed medical treatment, diagnostic services, and other medical care services.     

At this step, Prior Authorization must be your top preference. Prior authorization or pre-certification is the process of justifying the medical necessity of the prescribed medical procedure/ diagnostic service for the approval of the insurance company. 

If the patient doesn’t meet the insurance plan eligibility criteria then the insurance company won’t reimburse the urologist. Therefore, the patient registration staff should ask the patient to pay their financial dues before getting the medical care service. 

Go For Accurate &Efficient Urology Coding Services
Accurte medical codes are the building blocks of all medical claims, therefore, careful considerations should be taken into account to ensure clean claims (medical claims that are approved and reimbursed at the first attempt of submission). 

When performing CPT coding for urology, there are three major categories to consider: 

E/M Codes: 
The E/M CPT codes range between 99202 and 99499. The application of E/M codes are used for professional services other than medical care services delivered to the patient to ensure their well-being e.g, hospital visits, physicians and nonphysician clinic visits or consultations. 

Procedure Codes: 
These codes are used to describe the diagnostic and medical treatment services into standard billable CPT codes that range from 50010 to 58999. 

Add-on Codes:
These CPT codes are used to describe the additional services delivered to the patient along with the primary medical care. The Add-on codes are denoted by the “+” symbol. These codes are only payable if they are used with CPT codes of primary procedure. 

When urologists come across the broad categories of medical codes then they can easily pick up the most specific and accurate code that impacts the overall medical billing procedure significantly. 

There are several urology medical coding solutions that help practitioners ensure the accurate application of medical codes as follows; 

• EHR software
• Medical billing software
• Outsource urology billing services

 Outsourcing urology billing services gives you the freedom to get connected with the professional urology billing and coding specialists without going through the time-consuming and effort-requiring procedure of searching and recruiting professional medical billing specialists who are also well-acquainted with the field of urology. 

Don’ts for Urology Billing Process
There are some things that must be avoided during the process of urology billing services; 

Don’t Practice Billing & Coding Malpractices
Coding malpractices include undercoding and upcoding which may lead to dire consequences. 

Under coding is the practice of using medical codes that are used for less expensive procedures than the actual service delivered to the patient. Usually, healthcare providers or medical coders don’t practice undercoding because it increases their revenue loss and it also causes a skewed data pattern. 

Upcoding is a coding practice in which providers or medical coders use medical codes for more expensive procedures than the actual services delivered to the patient. 

It is the most observed coding malpractice in several healthcare fields. Because it enables providers get more money than the actual coverage plan. However, it raises a red flag for Medicare, which is actively looking for deviations to investigate. 

In order to prevent yourself from legal consequences and revenue loss, it’s better to avoid coding malprcatices in urology billing services. 

At some point in the process, the legislative institutes will audit almost every healthcare facility. The best way to proceed is to supervise and train your urology billing and coding team on best practices and document everything you do. 

Don’t Miss Out On The Guidelines Of Clearinghouses
Did you know? It is the responsibility of the clearinghouses that each medical claim is prepared using accurate medical codes and modifiers on the basis of accurate data only. 

If the clearinghouse detects errors or mistakes then it will reject your claim. If you don’t have a clearinghouse then there are chances that your medical claims will end up in denial when reached to the insurance payer. 

Therefore, always keep in mind that submission and resubmission require additional time and resources which results in a deficit in both time and money. 

Tips For Urology Medical Billing Services
In the dynamic landscape of healthcare, urology practices play a pivotal role in addressing a wide array of genitourinary conditions, from kidney stones to prostate issues. However, alongside the clinical complexities, there’s another intricate puzzle to solve: urology billing services. Accurate and efficient billing is not only essential for the financial stability of urology practices but also for ensuring that patients receive the care they need without undue financial burden. In this comprehensive guide, we’ll explore the tips and best practices to master urology billing services for a healthy revenue cycle.

Tips For Urology Billing Services
Before diving deep into the tips for urology billing services, lets gain a clear understanding of what makes urology billing services a complete and accurate method. 

The essential step involved in urology billing services are as follows; 

• Capturing patient’s information
• Prior authorization and insurance eligibility of verification
• Documentation
• Urology billing and coding
• Follow-up for adjudication
• Reimbursement collection and payment posting

It is essential to follow each step in the urology billing services for the streamlined functioning of your practice. Here are some few tips that can help get every minor task done with more expertise and smoothness. 

Always Stay Updated with Coding
As mentioned earlier, that medical codes are the backbone of the medical billing process. However, medical coding is the ever-evolving aspect of the billing field. Moreover, using outdated medical codes (that are no further recognized by the Medicare and insurance companies) results in excessive claim denials. 

Therefore, it is the paramount to always stay compliant with the latest Current Procedural Terminology (CPT), and International Classification of Diseases (ICD) codes. It helps you proceed with the preparation of medical claims with more precision and accuracy. 

If it adds on more burden to your work schedule then you should hire professional urology billing company for your assistance in the billing and coding tasks. 

Timely Claim Submission
Delays in claim submission leads to bottlenecks in payments and reimbursements. Implement efficient processes to ensure that your file accurate claims in the given timeline of your insurance company to submit them promptly. Efficient and timely submission of medical claims enables you to expedite your reimbursement process seamlessly. 

Ensure Compliance
1960 HIPAA (Health Insurance Portability and Accountability Act (HIPAA) provides the regulations to ensure the security of your healthcare information. It provides standards on how to protect your patient’s information from data breaches and unauthorized access. 

It is important that urologists should comply with these regulations to safeguard the patient information and mitigate legal risks. 

Utilize Billing Software
Urologists should evolve their IT setup to advance in their urology billing services. For this purpose, it is wise to invest in urology billing software that will streamline the billing process, reduce errors, and improve the overall efficiency of your practice’s healthcare revenue cycle management. 

Consider Expert Assistance
If managing urology billing and coding services becomes overwhelming or if your practice is experiencing rapid growth then it’s the right time when you should get assistance from professional urology billing and coding specialists. 

For this purpose, you can hire an entire team of medical billing and coding specialists or outsource urology billing services. If you’re running a busy practice then inculcating another team/ department in your facility will add more stress on your budget and operational expenses. 

Consider Expert Assistance
If it has become overwhelming for a provider to manage every task simultaneously then outsourcing urology billing services can be a go-to solution. Partnering with a medical billing company that also specializes in urology and understands all the nuances of your practice can help you streamline your billing process with great expertise.

In this way, the medical staff of your facility won’t have to micromanage all the administrative operations and they can pay more attention to their core capabilities to deliver high-quality patient care services.   

Outsource your Urology Billing Process!
Are you a urologist looking for reliable urology billing services? Is your medical organization unable to locate and maintain professional resources to handle urology billing and coding procedures? Then consider outsourcing urology billing services to an experienced and professional medical billing company is a great choice. 

CureCloudMD is a HIPAA-compliant medical billing company offering reliable and cost-effective urology medical billing and coding services. Also, we offer medical credentialing, prior authorization, insurance eligibility verification services, charge entry services and payment posting services.