Comprehensive Revenue Cycle Expertise across Medical Specialties
ABA Therapy Billing Services
ABA therapy is a transformative approach for children with autism spectrum disorder, focusing on improving their communication, social skills, and daily living abilities. Recognizing the intricacies of ABA therapy, we offer specialized billing services that cater to the unique needs of this treatment method. Our goal is to manage your billing and coding efficiently, ensuring accurate and timely payments for your valuable services.
Seasoned Team on ABA Therapy Billing
Our team, comprised of certified coders and billers, boasts extensive expertise in ABA therapy billing. We are adept at navigating the complexities of this specific billing process, including the nuances of various codes and modifiers essential for precise billing. Our proficiency extends to ICD-10, CPT, and HCPCS coding, all grounded in CMS and AMA guidelines. Our certification from the American Academy of Professional Coders (AAPC) stands as a testament to our competence and dedication.
Key Areas of Expertise:
Assessment and Treatment Planning: Ensuring each step of patient care is accurately documented and billed.
Direct and Indirect Therapy Services: Comprehensive billing for both direct intervention and indirect services.
Supervision and Training of Therapy Assistants: Accurate billing for supervisory and training roles.
Parent Education and Training: Ensuring these critical components are included in the billing process.
Progress Reporting and Documentation: Meticulous documentation to support all billing claims.
Best Practices for ABA Therapy Billing
We are committed to adhering to the highest standards of compliant coding and billing in ABA therapy services. Here’s how we ensure excellence in our billing processes:
Accurate Clinical Documentation: Our focus on detailed and compliant documentation reduces errors and regulatory issues.
Utilization of EHRs: Leveraging electronic health records to enhance documentation quality and reduce mistakes.
Precise Use of Codes and Modifiers: Expert knowledge in the application of ABA-specific codes and modifiers to minimize claim rejections.
Ongoing Training: Regular updates and training for our team on the latest billing guidelines and practices.
Proactive Claim Follow-Up: Diligent tracking and follow-up with payers to expedite claim processing and resolution.
Partner with Us for Optimized ABA Billing
Embrace the full potential of your ABA therapy practice by partnering with a billing service that understands and addresses the complexities of your specialty. Let us handle the intricacies of billing, so you can focus on delivering life-changing therapy to those in need.
Allergy and Immunology Billing Services
Navigating the complexities of Allergy and Immunology billing requires specialized knowledge and precision. The landscape of insurance policies varies significantly, with different insurers having distinct protocols for allergy testing and treatments. Moreover, Medicare’s guidelines add another layer of complexity.
In the realm of Allergy and Immunology services, the stakes are high. Timely reimbursements are crucial for the financial health of your practice, but more importantly, failure to adhere to the specific billing regulations can lead to litigation, posing a significant risk.
Our team of proficient billers and coders can help you deliver medical services as they focus on complying with different insurance companies’ norms and obtaining timely reimbursement for you.
Our Expertise in Allergy and Immunology
Our billing and coding personnel understand the nuances of billing for Allergy and Immunology services, and our client base includes healthcare practices, hospitals, and medical billing companies across the 50 states. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC).
Applying best practices for Allergy and Immunology Billing
We understand the challenges and issues in allergy and immunology billing, including serum caps and differences in the build-up and maintenance dosages. We assign the right codes for each treatment. We have expertise across the following disciplines of immunology billing, including:
Classical Immunology
Clinical Immunology
Developmental Immunology
Immunotherapy
Diagnostic Immunology
Evolutionary Immunology
Reproductive Immunology
Anesthesia Billing & Coding Services
Anesthesiology deals with the total perioperative care of patients before, during, and after surgery. The specialty’s core element is the use of anesthesia and anesthetics to support the vital functions through the perioperative period safely.
An anesthesiologist administers the right dosage of drugs to the patient so that’s he/she does not feel any pain or regain consciousness during surgery. They are also responsible for waking the patient post-surgery. They monitor the patient’s vitals keenly during surgery and alter the dosage administered accordingly.
There are different levels of Anesthesia providers – the Anesthesiologists, Certified Registered Nurse Anesthetists (CRNA), and Anesthesiologist Assistants (AA). They take on a critical role in understanding the patient’s history & conditions. But unfortunately, they are justified that they get billed correctly for their services and get reimbursement to the maximum.
Components of Anesthesia Billing
Anesthesia billing can become complicated as it requires documentation of a high number of records, such as:
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Pre-operative Review. The pre-operative review consists of the patient’s and their family’s medical history, drug, or tobacco habits that have to be taken into account while calculating the required dosage of anesthetics.
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Anesthesia Sheet. The Anesthesia sheet involves the documentation of the following:
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Base Units: The base units reflect the complexity and the skills required for the anesthetic service provided. The CMS publishes the base units once every year.
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Time Units: This is the time spent with the patient administering the anesthetic or monitoring the patient’s condition before, after, or during the surgery. Time units are calculated by dividing the total minutes of service by 15
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Modifiers: Anesthesia “provision/supervision” modifiers (-AA, -QK, -QY, -QZ, and -QX) explain the role of the anesthesiologist and CRNA. These modifiers are essential for clarifying whether an anesthesia procedure was personally performed, medically directed, or medically supervised by an anesthesiologist.
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Formula: (Base Units + Time Units + Modifiers) x Conversion Factor = Anesthesia Reimbursement
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Bundled services: Do not bill the following procedures along with anesthesia procedures.
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Do not bill for the Injection of diagnostic or therapeutic substances along with anesthesia procedures (62320 – 62321 and 62324 – 62325)
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Nerve Blocks (64400 – 64530)
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Transesophageal Echo (TEE) (93312 – 93318)
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Laryngoscopy (31505, 31515, 31527)
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Bronchoscopy (31622, 31645, 31646)
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Post-operative Review: The post-operative review consists of records that state that the patient has not suffered any complications due to the anesthetic administered.
The success of an anesthesiology service largely depends on its ability to generate & collect revenue. The ingredients for successful anesthesia billing include an experienced and trained revenue cycle team, specialty-specific billing software, and compliant billing practices. Outsourcing your billing & coding needs will help shift your focus to offering improved patient care. Zono RCM consists of a team of experts who receive specialized training in billing for anesthesiology services.
Zono RCM’ Expertise in Anesthesia
At ZONO, we have a client base that extends over 50 states covering a wide range of hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS codes based on CMS and AMA guidelines and certified by the American Academy of Professional Coders (AAPC). It would be fair to state that we have a decade of experience in pediatric billing & coding.
Applying best practices for Anesthesia Billing & Coding Services
By obtaining authorization and validating the patient’s eligibility and benefits before the surgery. We are also aware of the services that can or cannot be bundled together with the anesthesiology service offered. In case of the absence of a valid medical reason for the necessity of a drug administered, we follow-up with the physician, clarify the medical necessity for the procedure, and state it clearly to claim rejection. Our expertise in Anesthesiology billing & coding includes but is not limited to:
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Topical infiltration
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Local anesthesia
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Metacarpal/Metatarsal/Digital blocks
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Regional anesthesia o Peripheral Nerve Blocks o Epidural or Spinal Anesthesia
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Monitored Anesthesia Care
Process Rigor
We bring nothing less than excellence, knowledge, and accuracy while building a revenue cycle devoid of defects for your practice. Our team strives to introduce a friction-free billing, coding, claim submission, and payment posting process. To help achieve maximum reimbursements, we ensure that.
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Consistent accounts receivable follow-up is performed.
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Prior authorization is performed regularly.
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The anesthesiologist is credentialed and eligible to be reimbursed in a regular man.
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Our denials team focuses on shifting your focus from denial management to denial prevention.
Bariatric procedures play a pivotal role in helping individuals achieve significant weight loss and improve their overall health. The intricate nature of bariatric treatments demands specialized billing and coding services to ensure healthcare providers receive accurate and timely reimbursements for their essential services. At ZONO, we understand the unique challenges of bariatric billing and have developed tailored solutions to streamline the process and enhance financial outcomes for your practice.
Our Experience in the Bariatric Revenue Cycle
Our team of certified coders and billers has experience working with several bariatric practices. We recognize the complexities involved in coding for weight loss surgeries and related treatments, and our expertise covers a range of coding systems, including ICD-10, CPT, and HCPCS. With certifications from reputable organizations and a commitment to staying abreast of industry changes, our team ensures that your bariatric billing is handled with precision and compliance.
Key Areas of Expertise:
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Procedure Coding: Accurate assignment of codes for various bariatric procedures, ensuring compliance with industry standards.
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Insurance Verification: Thorough verification of patient insurance coverage to minimize claim denials and delays.
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Preauthorization Assistance: Facilitating the preauthorization process to ensure smooth approval for bariatric surgeries.
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Patient Education: Billing services that encompass patient education, an essential component in bariatric care.
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Postoperative Care Billing: Comprehensive billing for postoperative care and follow-up services
Best Practices for Bariatric Billing
We adhere to the highest standards of compliant coding and billing in the bariatric field, employing best practices to optimize your financial processes:
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Patient Education and Pre-authorization:
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Educate patients on insurance coverage, costs, and financial responsibilities.
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Verify insurance benefits and obtain pre-authorization to prevent claim denials.
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Accurate Documentation:
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Ensure precise records, including medical necessity and BMI details.
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Coding Compliance:
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Stay current with CPT and ICD coding guidelines.
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Accurately code procedures reflecting complexity and specifics.
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Charge Capture:
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Implement effective processes to avoid missed charges.
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Regularly review and align charges with services provided.
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Timely and Accurate Billing:
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Submit claims promptly to minimize reimbursement delays.
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Utilize electronic billing systems to reduce errors.
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Denial Management:
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Establish a robust process to promptly identify and address denials.
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Analyze denial patterns and implement corrective actions.
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Behavioral & Mental Health Billing Services
Behavioral health is the study of emotions, biology, and mentality causing a person to behave a certain way and how it affects their day-to-day life. Behavior & mental health billing is complicated due to the type of care offered to patients and the funding provided for the treatment.
The current epidemic of opioid abuse, involving both prescription pain relievers and heroin, has a significant impact on the US healthcare sector. Services for the prevention and treatment of substance misuse and substance use disorders have traditionally been delivered separately from other mental health and general health care services.
Counselors & Psychiatrists treat patients using various methods such as therapy, drugs, meditation, etc. These treatment methods take varying amounts of time based on the type of patient and the illness. A patient with disabling behavior issues needs additional job training, literacy training, rehabilitation, etc. Unfortunately, insurance providers’ timing for each treatment method differs from the actual time taken, causing discrepancies while billing for the services. It is essential to be conscious of the issues that cause delayed reimbursements and denials. Some of the common causes of denials are:
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Prior Authorization. Most Behavioral/Mental Health procedures require that the provider obtain prior authorization before the treatment.
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Documentation Errors. CMS recommends specific documentation, including timesheets, encounter notes, time and place of service, and evidence that a professionally led care team that included the patient and their family developed the plan. It is essential to establish the medical necessity of the procedures/treatment, and detailed documentation can help you reduced denials.
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Coding Accuracy. Time spent on therapy is an essential factor as billing for treatment is based on the number of units. Appropriate medical codes based on the time spent can avoid errors involving the number of units billed.
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Policy Violations. CMS specifically identifies typical policy violations that occur in billing for behavioral/mental health treatments. These include:
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Failure to record progress notes promptly
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Billing for services that require prior authorization without receiving prior authorizations
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It is necessary to bill accurately and submit clean claims for the services provided to run a profitable practice/billing operation. Outsourcing your billing process takes the load off your back and allows you to use your staff for better purposes. It can also save a large amount of money lost to billing & claim submission errors. Our team of behavior & mental health billers implement best practices to increase your revenue and decrease claim denials.
Zono RCM’ Expertise in Behavioral & Mental Health
Our team of behavior & mental health billers & coders have trained specialty specifically and can offer data-driven solutions for improving your revenue cycle. We have a client base that extends over 50 states covering a wide range of hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC).
Applying best practices for Behavioral & Mental Health Billing
Our team stays updated on the HIPAA regulations for behavior & mental health billing & coding. We ensure prior authorization of the patient’s eligibility & benefits with mental health insurance to avoid denials in the long run. Our team of medical billers & coders instantly know the ICD codes for behavior & mental health, which allow us to submit clean claims. We recommend the following best practices.
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More information is better. Our team obtains full information from the patient, including their alternate phone numbers, addresses, insurance type, social security number, etc. Ensuring that we have all information before calling an insurance company saves the time it takes to check on claims.
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Specialty specific solutions. Our team’s experience in handling the nuances of Behavior & Mental health billing helps you avoid unwanted complexities or delays.
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Claim Follow Up. Our team keeps a regular track of submitted claims to catch and resolve denials’ issues without exceeding the time limit.
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CPT & HBAI codes. We stay on top of the yearly changes in the CPT codes and have a deep understanding of HBAI codes’ usage while billing for mental health services offered to reduce impact while treating a physical health problem
Cardiology Billing Services
With rapidly evolving technologies and complex diagnostic protocols, cardiology billing is best done by experts. Constant advancements in the specialty are leading to complex, ever-changing codes for almost all procedures. In addition to this, the physicians do not have the time to manage billing and coding of cardiology services they deliver.
In cardiology billing, there is always a chance for upcoding or under-coding a procedure. As frequent changes in codes occur in procedures such as iliac repair, angioplasty, stent replacement, ECG recording, etc., cardiology practices lose a large amount of revenue to erroneous billing.
Our experts are certified, trained coders and billers informed with the recent advancements and developments in cardiology billing. They are technically sound and are aware of the complicated MACRA rules. We are capable of identifying and fixing issues in your billing system and increasing revenue.
Our expertise in Cardiology includes but is not limited to:
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Peripheral Studies
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Diagnostic Cardiologic Procedures
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Cardiac-Periphery interventions
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Pediatric Cardiology
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Nuclear Cardiology
Zono RCM’ Expertise in Cardiology
Our medical billing and coding professionals team are consistent, knowledgeable, and believe in creating friction-free billing functions for our Cardiology clients. We have a client base extended over 50 states covering a wide range of hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC).
Applying best practices for Cardiology Billing
Our team understands the list of codes and suitable modifiers given by CMS for cardiology billing and ensures that we stick to it. We apply different billing processes depending on whether the patient was an inpatient, outpatient, treated on the same day, or another day. Our specialists are aware that cardiac surgery preauthorization is essential to avoid authorization denials. We recommend the following best practices.
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Use of Electronic Health Records. The use of EHR systems can help you ensure high-quality clinical documentation and can avoid wrong documentation. Cardiology, in particular, can and does see a lot of changes in procedures, and robust clinical documentation processes can help you be compliant.
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Combo Codes. ICD-10 uses a lot of combination codes for different cardiology conditions. Our coders receive training on using these combination codes.
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Compliant coding is critical. By providing regular training to both coders and clinicians, you can stay updated on the constantly changing coding and billing guidelines and ensure compliant coding.
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Code for Diagnosis, not for Symptoms. Avoid coding for symptoms when they are not part of the treatment. Be sure about the Diagnosis and only code for the procedures performed and ailments treated. that are included.
Empower your cardiology practice with Zono RCM.
Our team not only guarantees expert billing solutions but also ensures a quick turnaround in credentialing cardiologists with specific payers. With us, you experience enhanced revenue, reduced costs, and operational excellence, allowing you to focus on what matters most – patient care.
Dermatology Billing Services
Dermatology billing can be intricate and complicated as it has evolved immensely over the years. It requires a clear description of skin lesions, including the size, the number, and the precise location. Dermatology billing also requires detailed information on the biopsy, excision, and lesion destruction.
In addition to the constantly changing patterns of insurance and reimbursement policies, dermatology has also changed rapidly. Dermatology has expanded beyond medical and surgical. It now includes a variety of cosmetic surgeries.
A dermatology practice requires implementing technology, seamless processes, and performance against several service lines to avoid being under-compensated or deal with audits & fines. Outsourcing to a seasoned service provider gives you access to a team of professionals trained in end-to-end billing for dermatology.
Zono RCM’ Expertise in Dermatology
Our team of medical billing and coding professionals is competent in understanding the unique attributes of dermatology billing. We have a client base that extends over 50 states covering a wide range of hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC).
Applying best practices for Dermatology Billing
Our team understands global surgical packages for Dermatology, including a preoperative visit on the day before significant surgeries or the day of minor surgeries, intraoperative services, postoperative care, supplies, wound care, and postoperative complications. We are also well-versed in the CPT codes provided by CMS for each procedure and their global periods.
Our expertise in Dermatology includes but is not limited to:
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Medical Dermatology
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Surgical Dermatology
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Pediatric Dermatology
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Cosmetic Dermatology
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Dermato-immunology
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Dermatopathology and Oral Pathology Laboratory
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Photomedicine (Phototherapy & Photopheresis)
Our Value
We employ our extensive experience gained over decades of supporting Dermatology practices. Zono RCM can reduce your staffing and administrative expenses, increase revenue, and ensure compliance with all standards with additional benefits.
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Certified by The American Association of Professional Coders (AAPC) and has received training in most common Medical Coding Software
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Successful in processing medical claims with most commercial insurance companies including UHC, WellPoint, Aetna, Humana BCBS, and Anthem, and government payers such as Medicare
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Successful in working with Medicare and understand state-specific Medicaid Policies
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We reduce costs and help you achieve improved clinical and operational efficiency
Billing & Coding Services for Emergency Departments
An emergency department, also known as an emergency room, is a medical treatment facility specializing in emergency medicine. Emergency medicine is the acute care of patients who present without a prior appointment, either by themselves or by an ambulance. One can find an emergency department in a hospital or primary care centers.
Due to the patient flow’s unplanned nature, the ED department must provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention.
Typical Issues in getting reimbursed for ED services
Emergency medicine billing services are highly unique compared to other forms of medical billing. The complexity is due to the unpredictable nature of patient intake. It relies heavily on the patient care report prepared when the ambulance picks up the patient from where the need arises.
Typical issues with ED billing are:
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Missed Charges or high incidence of DNFB(Discharges not fully billed) is due to emergency departments’ fast-paced nature, further compounded by a lack of understanding of clinical documentation responsibilities.
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Finding great ED coders. ED coders have dual responsibility for accurate coding and identifying DNFB cases. They need to work with physicians to reduce DNFB, and possessing the ability to understand trends and patterns in clinical documentation and charges is essential.
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Credentialing issues. Often, Emergency Departments require specialist physicians. Ensuring the credentialing of most of the regular specialists with common payers in the region will improve the reimbursements you receive.
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Life Support Systems. A slight error in the specific terminologies for the service provided, such as service provided for Basic Life Support (BLS), Mileage documentation, Advanced Life Support (ALS), leads to denials
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Modifiers. Misuse of the modifiers used to code for the place of origin and destination of the ambulance trip can delay the claim processing time.
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Medical Necessity. The coders must understand the criteria that determine “medical necessity” to code for the various levels of ground and air ambulance services used.
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It is essential to stay updated with the rules of emergency room billing as it changes frequently
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Many insurance plans pay unexpected benefits as per a plan and majorly do entertain contracting ER doctors.
Medical Billing & Coding Services Expertise in ED Billing & Coding
At ZONO, we have a client base that spans across all 50 states, covers a wide range of hospitals, physician practices, and medical billing companies. We employ our experience and knowledge acquired through a decade of working with ED doctors in fixing & improving your revenue cycle. Our coders are proficient in ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA, and are certified by the American Academy of Professional Coders (AAPC).
Applying best practices for ED Billing & Coding Services
At ZONO, we recognize ED billing & coding challenges, such as high out-of-pocket expenses and the prudent layperson rule. We work with your group to solve them as a business partner.
Our certified coders work with you 24/7 to prevent problems caused by incorrect use of modifiers, as well as educate your in-house billing specialist on how to avoid them. We also look for discharges not fully billed to identify unbilled procedures and improve reimbursements. Our services cost is often covered many folds by the additional reimbursements for services that Emergency Departments leave on the table. We do this by focusing on efficient, streamlined processes that decrease the amount of time needed to bill emergency department services correctly.
We have built our approach using modern technology, and the team focuses on providing data-driven solutions that help reduce denials and increase revenue.
Shifting the focus to Denial Prevention
We bring excellence, knowledge, and accuracy to ED billing and coding services while building a revenue cycle devoid of defects for your practice. With patient demographics entry, insurance verification, insurance authorizations, coding, billing, and reconciling of accounts, our medical billing process can add value to your organization. Our team strives to introduce a friction-free billing, coding, claim submission, and payment posting process. We ensure consistent accounts receivable follow-up and prior authorization to avoid claim denials. Our denial management team’s #1 priority is shifting your focus from denial management to denial prevention.
Gastroenterology Billing & Coding Services
Gastroenterology is the branch of medicine dealing with the digestive system and its disorders. This specialty focuses on diseases affecting the gastrointestinal tract, including the organs from mouth into anus, along the alimentary canal. Physicians practicing in this field are called gastroenterologists.
To maintain a compliant and financially successful practice, gastroenterologists need to stay updated on the various coding guidelines and payer-specific protocols. Medical billing and coding for gastroenterology is challenging and requires an expert range of knowledge to ensure maximum reimbursement. These challenges include billing for colorectal cancer screenings vs. colonoscopies, motility, and GI function studies, documenting proper levels of evaluation and management services, category III codes for treatment of GERD, and applying the use of modifiers -51, -59, and -26.
Additionally, gastroenterology billing and endoscopy billing requires the ability to track underpayments effectively. This requirement often exceeds the competency of most billing software and in-house billing staff. GI practices not effectively targeting underpayments face massive revenue hemorrhage.
Medical Billing Wholesalers is well-versed in both gastroenterology billing and endoscopy billing. Our team of gastroenterology medical billing and coding specialists works hand-in-hand with your practice to ensure you receive maximum reimbursement for services provided. ZONO will identify problem areas such as the correct use of modifiers, evaluate underpayments, and manage all aspects of your practice’s billing.
Zono RCM’ Expertise in Gastroenterology
At Zono, we have a client base that spans across all 50 states, covers a wide range of hospitals, physician practices (including GI practices), and medical billing companies. We employ our experience and knowledge acquired through a decade of working with gastroenterologists in fixing & improving your revenue cycle. Our coders are proficient in ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA, and are certified by the American Academy of Professional Coders (AAPC).
Applying best practices for Gastroenterology Billing & Coding Services
We understand the nuances involved in GI medical billing, such as how to bill a colonoscopy with the advancement beyond the splenic flexure. Otherwise, the documentation would be incomplete and would only support a sigmoidoscopy. Our certified coders work with you 24/7 to prevent problems caused by incorrect use of modifiers, as well as educate your in-house billing specialist on how to avoid them. Our professional billing & coding experts work to prevent claim denials while increasing the number of reimbursements. We do this by focusing on efficient, streamlined processes that decrease the amount of time needed to correctly bill orthopedic services. We have built our delivery model on a strong technology foundation and a team that focuses on providing data-driven solutions to ensure fewer denials and increased revenue.
Why Zono RCM
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We bring excellence, knowledge, and accuracy to GI billing and coding services while building a revenue cycle devoid of defects for your practice.
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With capabilities across the revenue cycle chain- patient demographics entry, insurance verification, insurance authorizations, coding, billing, reconciling of accounts, and denial management, we can add value to your organization through analytics-driven and result oriented processing.
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Our team strives to introduce a friction-free billing, coding, claim submission, and payment posting process.
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We ensure consistent accounts receivable follow-up and prior authorization to avoid claim denials. Our denial management team’s #1 priority is shifting your focus from denial management to denial prevention.
Neonatal Billing & Coding Services
Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty, usually delivered in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn infants who are ill or require special medical care due to:
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Prematurity
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Low birth weight
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Intrauterine growth restriction
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Congenital malformations or disabilities
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Sepsis
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Pulmonary hypoplasia
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Birth asphyxia
A neonatologist is responsible for the life and healthy recovery of the smallest human beings who pose the most extensive & complicated challenges. Partnering or Outsourcing the management of your revenue cycle to an offshore company like ZONO lessens the burden of streamlining the hospital’s financial aspect.
Medical Billing & Coding Services Expertise in Neonatology
At ZONO, we have a client base that spans across all 50 states, covers a wide range of hospitals with NICUs, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA and certified by the American Academy of Professional Coders (AAPC). It would be fair to state that we have a decade of experience in neonatal billing & coding. We also specialize in LEVEL III NICU billing & coding.
Applying best practices for Neonatal Billing & Coding Services
We apply the correct codes for both E/M services offered to a healthy newborn vs. NICU codes for newborns with congenital disabilities. To avoid rejections & re-submissions from the clearinghouse, our team submits clean claims the first time itself and abides by the policies, rules & regulations of all payers. Our coding team employs its extensive knowledge and facilitates the proper use of modifiers to avoid denials.
Best practices for neonatal coding:
Physicians should include Newborn Care Services codes for evaluation and management (E/M) services provided to normal newborns in the first days of life before hospital discharge. Codes for initial care of the normal newborn include:
| 99460 | Initial hospital or birthing center care, per day, for E/M of a normal newborn infant |
| 99461 | Initial care per day, for E/M of normal newborn infant seen in other than hospital or birthing center |
| 99463 | Initial hospital or birthing center care, per day, for E/M of a normal newborn infant, admitted and discharged on the same date |
Codes 99478-99480 describe the intensive care provided to evaluate and manage the recovering low or very low birth weight infant. The code is selected based upon the present bodyweight of the infant as below:
| 99478 | Present bodyweight less than 1500 grams |
| 99479 | Present bodyweight of 1500-2500 grams |
| 99480 | Present bodyweight of 2501-5000 grams |
Inpatient Neonatal Critical Care
The initial day of critical care for evaluating and managing a critically ill neonate, 28-days of age or less is reported with code 99468. We report this code for only one physician. If another physician provides critical care services to the neonate on the same date, we report the services provided using critical care service codes 99291-99292.
Subsequent days of critical care to the critically ill neonate are reported per day with code 99469. As with the initial critical care, code 99469 is used to report only for one physician on a given date.
Exception Service Delivery leading to a Shift from Denial Management to Prevention
We bring excellence, knowledge, and accuracy in neonatal billing and coding services while building a revenue cycle devoid of defects for your hospital. Our team strives to introduce a friction-free billing, coding, claim submission, and payment posting process. We ensure persistent accounts receivable follow-up and prior authorization to avoid claim denials. Zono RCM helps hospitals offer excellent care for their little patients, focusing on improving their administrative & financial excellence.
Neurology Billing & Coding Services
Neurology is a branch of medicine that deals with the disorders, diagnosis, and treatment of the nervous system. It covers all diseases affecting the central and peripheral nervous systems.
Neurologists and Neurosurgeons specialize in treating diseases of the nervous system either through non-surgical or surgical methods, respectively. They reflect an immense sense of knowledge and eye for detail as they cover more than one area of neurology such as pain management, neuromuscular, sleep medicine, stroke and epilepsy. There is also significant overlap with behavioral and mental health as the two disciplines interlink greatly.
Neurology billing and coding is as intricate as the specialty itself. It is almost like a subspecialty of Evaluation & Management. Medical Coders face the daunting tasks of applying the right code from over a hundred codes available for coding neurology and neuromuscular tests. In addition, neurology billing & coding requires a strong knowledge of the place of service rules as neurologists see patients in multiple areas such as hospitals, offices, and care centers. In neurology RCM, failing to audit the smallest error can lead to a large loss of money for the practice.
Entrusting your neurology billing & coding to experts like us enables you to focus your resources on patient care while taking care of your financial stability and growth. At ZONO, we aim to increase revenue, decrease denials while improving and automating your entire revenue cycle.
Medical Billing & Coding Services Expertise in Neurology Billing & Coding
Zono RCM brings over a decade of experience in neurology billing and coding. We have a client base covering various hospitals, practices, clinics, diagnostic partners, and medical billing companies that bill for & offer neurological services. Our service delivery extends to all 50 states. We have built a team of coders proficient in ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA and certified by the American Academy of Professional Coders (AAPC).
Applying best practices for Neurology
Our team of billers and coders is trained exclusively in neurology billing & coding and its nuances. We understand the dire need for precision while billing & coding for neurology. In addition, we perform prior authorizations, eligibility verification and reduce days in AR as per MGMA standards. We are experts in reducing instances of underpayment and denials. Our team ensures that all treatment procedures are coded for from lab reports and physician notes, resulting in maximum reimbursements.
Our expertise in neurology billing and coding includes but is not constrained to:
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Vascular
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Interventional
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Epilepsy; neuromuscular; neuro re-habilitation
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Behavioral
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Sleep medicine; pain management
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Neuro-immunology
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Clinical neurophysiology or movement disorders
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Neurosurgery
OB/GYN Billing & Coding Services
Obstetrics & Gynecology is a branch of medicine specializing in women’s care during pregnancy and childbirth and diagnosing and treating female reproductive organs’ diseases. It also specializes in other women’s health issues, such as menopause, hormone problems, contraception (birth control), and infertility.
An OB/Gyn practice does various procedures ranging from surgeries, pre & postpartum healthcare, and regular health screenings for women.
Complexities in OB/GYN billing
Ob/GYN billing & coding can be challenging to most billers & coders due to the global claims, widely varying coverage terms, and multiple tests performed at numerous facilities. Apart from this, many OB/GYN practitioners lack the billing support provided to large hospitals. Here are a few standard billing & coding errors that occur in OB/GYN billing & coding:
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Overlooking separately billable services rendered during the global period
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Lack of understanding that pregnancy coverage is an amendment to an existing insurance plan
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Pregnancy coverage includes inpatient & outpatient services and is split between them.
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Improper documentation of the policies & services provided
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It requires a clear understanding of the criterion that determines the “medical necessity” to code for the various levels of ground and air ambulance services used.
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Understanding that all laparoscopic OB/GYN surgical procedures involve diagnostic laparoscopy
Our Expertise in Medical Billing & Coding for OB/GYN Clinics
At ZONO, we have a client base that extends across all 50 states, covers a wide range of hospitals, physician practices(including OB/GYN), and medical billing companies. Our team of OB/GYN billers & coders employ their experience and knowledge acquired through a decade of working with obstetricians & gynecologists, improving your revenue & accelerating growth. Our coders are proficient in ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA, and are certified by the American Academy of Professional Coders (AAPC). Our expertise in OB/GYN billing & coding covers specialties including:
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Maternal-Fetal Medicine
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Reproductive Endocrinology and Infertility
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Gynecological Uro-gynecology and Pelvic Reconstructive Surgery
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Advanced Laparoscopic Surgery
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Family Planning
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Pediatric and Adolescent Gynecology
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Menopausal and Geriatric Gynecology
Applying best practices for OB/GYN Billing & Coding Services
At ZONO, we recognize the challenges faced by OB/GYN providers, such as rapidly changing policy rules, ICD updates, and the sensitive nature of your specialty. Our certified coders are capable of choosing appropriate codes from operative reports of real-life surgical cases. We work with you 24/7 to prevent problems caused by incorrect use of modifiers, as well as educate your in-house billing specialist on how to avoid them.
Our professional billing & coding experts work to prevent claim denials while increasing the number of reimbursements. We do this by focusing on efficient, streamlined processes that decrease the amount of time needed to correctly bill for Ob/Gyn services.
We have built our approach by adhering stringently to coding guidelines & bests practices and applying modern technology. The ZONO team focuses on providing data-driven solutions that help reduce denials and increase revenue.
Oncology Billing Services
Oncology is a complex and long-drawn process with comprehensive treatment plans to prevent and cure cancer. As a result, the Oncology Billing process requires detailed medical treatment documentation and timely follow-up with insurance companies to get paid. Accurate medical coding and billing at the end of each treatment phase ensure that the Oncology practice receives adequate reimbursements.
In addition to its procedural complexity, Oncology billing faces frequent changes in codes and compliance policies. Often, payers are unaware of the latest technology leading to a significant reduction in reimbursements received by the practice due to inadequate understanding of the procedure and lack of reimbursement standards. Oncology is also a multidisciplinary field requiring surgeries performed by specialists from other medical disciplines and post-operative trauma and mental health specialists to help patients recover in health and mind. These complexities require coders and billers who need to ensure excellent accuracy while billing & coding.
Our team of coders and billers possess unique expertise and acknowledge that no detail is trivial in Oncology billing. Outsourcing your oncology billing services will help you reap multiple patient care benefits and reduce the administrative backlog.
Zono RCM’ Expertise in Oncology
Our team of medical coders and billers have over ten years of experience in oncology billing. We have a client base that extends over 50 states covering a wide range of hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC).
Applying best practices for Oncology Billing
Our team of medical coders and billers understand that Oncology billing involves expensive treatments, new technology, extensive surgeries, chemotherapy, mental health interventions, and long drawn out treatment plans. They are capable of differentiating between “Bundled” procedures and additional procedures. Their knowledge helps them avoid the misuse of modifiers, thereby preventing claim denials. Since claim denials in oncology lead to huge revenue loss, our team outs in-place an efficient, denial-free revenue management system for your practice.
Our expertise in Oncology includes but is not limited to:
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Medical Oncology.
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Surgical Oncology
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Radiation Oncology
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Gynecologic Oncology
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Pediatric Oncology
Orthopedic Billing & Coding Services
Orthopedic surgery or Orthopedics is the branch of medicine dealing with the conditions of the Musculoskeletal system – the bones, joints, ligaments, tendons, and muscles that are so essential to movement and everyday life.
Complexities in Orthopedic Billing
Orthopedic billing depends on proper documentation before, during, and after a patient visit. The billing team needs to carefully document and charge for all services provided. Errors like incomplete patient demographics entry or not prior- verifying the patient’s eligibility could result in a rejected claim. In addition to authorization errors, not knowing insurer preferences and deadlines can also hamper revenue collection.
Compared to other specialties, orthopedic billing is complex and requires a deeper understanding of providers’ services. Nearly 35% of orthopedic surgery claims are incorrect, out of which 25% of medical claim gets rejected. Such high denial rates can lead to compromised revenue & patient care while bankrupting your orthopedic practice.
Although hiring an in-house billing team and properly training your team can help avoid severe fees and penalties, the orthopedic billing process is too complex to be sustained by an in-house team. One way to reduce stress on your staff and increase reimbursement is to outsource your billing & coding requirements to a technologically empowered billing company like ZONO.
Zono RCM’ orthopedic billing services include regular audit checks, account analysis, and follow-up with payers. While working with us, you will receive regular reports detailing productivity, quality, and new revenue opportunities. ZONO’s expert medical billing professionals use industry best practices and advanced software to meet orthopedic providers’ billing needs.
Medical Billing & Coding Services Expertise in Orthopedics
At ZONO we have a client base that spans across all 50 states, covers a wide range of hospitals, physician practices (including orthopedic practices), and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA, and are certified by the American Academy of Professional Coders (AAPC). It would be fair to state that we have a decade of experience in orthopedic billing & coding.
Applying best practices for Orthopedic Billing & Coding Services
We understand the nuances involved in orthopedic medical billing, such as correctly bill pain pump insertions or plc reconstruction and arthroscopies. Our certified coders work with you 24/7 to prevent problems caused by incorrect use of modifiers, as well as educate your in-house billing specialist on how to avoid them.
Our professional orthopedic billing experts work to prevent claim denials while increasing reimbursements. We do this by focusing on efficient, streamlined processes that decrease the amount of time needed to correctly bill orthopedic services. We have built an approach anchored on modern technology and a team that focuses on providing data-driven solutions to reduce denials and increased revenue. Our expertise in Orthopedics includes but is not limited to:
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Foot and Ankle Surgery
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Hip and Knee Surgery
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Shoulder and Elbow Surgery
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Trauma Surgery
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General Orthopedics
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Orthopedic Oncology
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Spine Surgery
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Bone Health Center
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Hand Surgery
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Pediatric Orthopedic Surgery
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Sports Medicine
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Osseointegration Clinic
Anesthesia Billing & Coding Services
Anesthesiology deals with the total perioperative care of patients before, during, and after surgery. The specialty’s core element is the use of anesthesia and anesthetics to support the vital functions through the perioperative period safely.
An anesthesiologist administers the right dosage of drugs to the patient so that’s he/she does not feel any pain or regain consciousness during surgery. They are also responsible for waking the patient post-surgery. They monitor the patient’s vitals keenly during surgery and alter the dosage administered accordingly.
There are different levels of Anesthesia providers – the Anesthesiologists, Certified Registered Nurse Anesthetists (CRNA), and Anesthesiologist Assistants (AA). They take on a critical role in understanding the patient’s history & conditions. But unfortunately, they are justified that they get billed correctly for their services and get reimbursement to the maximum.
Components of Anesthesia Billing
Anesthesia billing can become complicated as it requires documentation of a high number of records, such as:
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Pre-operative Review. The pre-operative review consists of the patient’s and their family’s medical history, drug, or tobacco habits that have to be taken into account while calculating the required dosage of anesthetics.
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Anesthesia Sheet. The Anesthesia sheet involves the documentation of the following:
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Base Units: The base units reflect the complexity and the skills required for the anesthetic service provided. The CMS publishes the base units once every year.
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Time Units: This is the time spent with the patient administering the anesthetic or monitoring the patient’s condition before, after, or during the surgery. Time units are calculated by dividing the total minutes of service by 15
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Modifiers: Anesthesia “provision/supervision” modifiers (-AA, -QK, -QY, -QZ, and -QX) explain the role of the anesthesiologist and CRNA. These modifiers are essential for clarifying whether an anesthesia procedure was personally performed, medically directed, or medically supervised by an anesthesiologist.
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Formula: (Base Units + Time Units + Modifiers) x Conversion Factor = Anesthesia Reimbursement
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Bundled services: Do not bill the following procedures along with anesthesia procedures.
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Do not bill for the Injection of diagnostic or therapeutic substances along with anesthesia procedures (62320 – 62321 and 62324 – 62325)
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Nerve Blocks (64400 – 64530)
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Transesophageal Echo (TEE) (93312 – 93318)
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Laryngoscopy (31505, 31515, 31527)
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Bronchoscopy (31622, 31645, 31646)
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Post-operative Review: The post-operative review consists of records that state that the patient has not suffered any complications due to the anesthetic administered.
The success of an anesthesiology service largely depends on its ability to generate & collect revenue. The ingredients for successful anesthesia billing include an experienced and trained revenue cycle team, specialty-specific billing software, and compliant billing practices. Outsourcing your billing & coding needs will help shift your focus to offering improved patient care. Zono consists of a team of experts who receive specialized training in billing for anesthesiology services.
Zono RCM’ Expertise in Anesthesia
At ZONO, we have a client base that extends over 50 states covering a wide range of hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS codes based on CMS and AMA guidelines and certified by the American Academy of Professional Coders (AAPC). It would be fair to state that we have a decade of experience in pediatric billing & coding.
Applying best practices for Anesthesia Billing & Coding Services
By obtaining authorization and validating the patient’s eligibility and benefits before the surgery. We are also aware of the services that can or cannot be bundled together with the anesthesiology service offered. In case of the absence of a valid medical reason for the necessity of a drug administered, we follow-up with the physician, clarify the medical necessity for the procedure, and state it clearly to claim rejection. Our expertise in Anesthesiology billing & coding includes but is not limited to:
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Topical infiltration
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Local anesthesia
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Metacarpal/Metatarsal/Digital blocks
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Regional anesthesia o Peripheral Nerve Blocks o Epidural or Spinal Anesthesia
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Monitored Anesthesia Care
Process Rigor
We bring nothing less than excellence, knowledge, and accuracy while building a revenue cycle devoid of defects for your practice. Our team strives to introduce a friction-free billing, coding, claim submission, and payment posting process. To help achieve maximum reimbursements, we ensure that.
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Consistent accounts receivable follow-up is performed.
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Prior authorization is performed regularly.
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The anesthesiologist is credentialed and eligible to be reimbursed in a regular man.
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Our denials team focuses on shifting your focus from denial management to denial prevention.
Physical Therapy Billing Services
Physical Therapy is an intense specialty, and patient care is of utmost importance. In physical therapy, the physicians spend a lot of time drawing treatment plans as per the patient’s needs. Most of the time, physicians do not have enough time to focus on accurate billing and coding. Like any other specialty, on-point billing and coding are essential to keep a financially successful physical therapy service.
Physical therapy billing is intense and challenging as it comes with multiple reasons that lead to claim denials. The most significant reason for claim denials in physical therapy is the “medical necessity” of the service offered. Apart from this, hiring an in-house biller can be very expensive, and it requires a lot of time and effort.
Our team consists of certified, trained coders and billers with a great degree of familiarity with Physical Therapy Billing. They understand the nuances of physical therapy billing and offer strategic solutions to improve the revenue and reduce your practice’s denial rate.
Our Expertise in Medical Billing and Coding for Physical Therapy Clinics
Our team of medical billing and coding professionals are highly skilled and strive to offer an efficient revenue cycle project to our Physical Therapy clients. Our client base extends overall 50 states covering a wide range of hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines, EMR & PMS software, and certified by the American Academy of Professional Coders (AAPC).
Applying best practices for Physical Therapy Billing
Our team of coders and billers understands that your practice’s financial health depends on submitting clean, accurately coded claims. We are well-versed with most of the EMR software. We are can quickly adapt to your existing software or offer custom solutions based on your practice. We also focus on significantly reducing denial rates while improving revenue through accelerated claim submission processes.
Our expertise in Physical Therapy includes but is not limited to:
Orthopedic
Geriatric
Neurological
Cardiopulmonary
Pediatric
Plastic & Reconstructive Surgery Billing & Coding Services
Reconstructive plastic surgery can correct facial defects and body abnormalities caused by congenital disabilities, injury, disease, or aging. Usually, reconstructive plastic surgery aims to improve body function, create a more normal appearance, and improve self-esteem (this may also be called cosmetic surgery). Abnormal structures of the body may result from:
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Injury
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Infection
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Developmental abnormalities
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Congenital disabilities
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Disease
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Tumors
Due to multiple procedure payment reduction rules, co-surgeries, varying levels of wound repair codes (simple/ intermediate/ complex), and the need to use the right surgical and E/M modifier codes, plastic surgery medical coding can be confusing. Medical Coding errors cause delayed or denied reimbursements, leading to revenue loss and loss of time available for patient care. Plastic and reconstructive procedures are costly, and hence, the practices need to work hard and adhere to billing and coding guidelines.
Zono RCM offers comprehensive plastic surgery coding services to reduce claim denials and bring you maximum reimbursement for all services.
Our Expertise in Medical Billing and Codingf or Plastic & Reconstructive Surgery
At ZONO, we have a client base that extends across all 50 states, covers a wide range of hospitals, physician practices, and medical billing companies. Our team of billers & coders employ their experience and knowledge acquired through a decade of working with plastic surgeons in improving your revenue & accelerating growth. Our coders are proficient in CPRC, ICD-9/10, CPT, HCPCS coding guidelines provided by CMS and AMA, and certified by the American Academy of Professional Coders (AAPC). Our coding experts are:
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Experts in reading and understanding physician office notes and procedure note to apply correct ICD-10-CM, CPT®, HCPCS Level II, and modifier coding assignments
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Evaluation and management (both the 1995 and 1997 Documentation Guidelines)
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Possess adequate knowledge of the rules and regulations of Medicare billing, including (but not limited to) incident, teaching situations, shared visits, consultations, and global surgery
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Capable of accurately coding for surgical procedures performed by plastic and reconstructive specialists such as scar revisions, facial repairs, cosmetic surgeries, etc.
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Trained extensively on Medical terminologies & human anatomy and physiology
Applying best practices for Plastic and Reconstructive Surgery Billing and Coding
At ZONO, we understand the challenges faced by Plastic and Reconstructive surgery providers. Rapidly changing policy rules, ICD updates, and your specialty’s sensitive nature can make the billing and coding services complex. Our certified billers and coders are well-versed in the nuances of billing for plastic and reconstructive surgery procedures. We understand the differences between cosmetic and medically necessary plastic surgeries and the respective coding and reimbursement guidelines. We process your claims accurately, improve clean claims rate, and accelerate your cash flow.
We have built our approach by adhering stringently to coding guidelines & bests practices and applying modern technology. The ZONO team focuses on providing data-driven solutions that help reduce denials and increase revenue.
Our best practices in plastic & reconstructive surgery include:
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Choosing appropriate ICD codes for neoplasm, breast-related issues, facial nerve disorders, different types of burns, and other disorders
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Applying correct CPT codes for procedures including but not limited to the following:
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Breast reconstruction—extensive discussion including DIEP flaps
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Skin lesion procedures including injection, biopsy, shave, and excision
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Nasal procedures including rhinoplasty, nasal valve stenosis repair, and turbinates
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Hand surgery
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Reporting Level 4 or Level 5 E/M services with appropriate codes and modifiers and correctly applying consultation code
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Adding appropriate modifiers for multiple procedures in a global period (51 and 59) co-surgeon (62) or assistant surgeon (80, 82) services to optimize your revenue
Our Value
We bring finesse and accuracy to our billing and coding services while building a flawless reimbursement process for your practice. With diligent patient demographics entry, insurance verification, insurance authorizations, coding, billing, and payments reconciliation can add value to your organization. We ensure consistent accounts receivable follow-up and prior authorization to avoid claim denials. Our denial team’s #1 priority is shifting your focus from denial management to denial prevention. Our team strives to introduce a friction-free billing, coding, claim submission, and payment posting process.
Podiatry Billing Services
Podiatry is a medical specialty that deals with diagnosing and treating diseases, injuries, and defects of the human foot. Podiatric medicine involves diagnosing, medical and surgical treatment of disorders of the foot, ankle, and lower extremity. This specialty also includes medical, surgical, mechanical, and physical treatments of the foot. Podiatry billing can be complicated in many ways, beginning with the need to determine and prove the treatment’s medical necessity to the coding nuances.
In addition to this, podiatry practices primarily treat the elderly, necessitating additional billing & coding efforts, as Medicare covers this population. It also demands meticulous use of modifiers and an understanding of coding for inclusive procedures.
Podiatrists usually hire an in house team of coders or billing companies that claim to have experience in podiatry billing. Many of these resources often lack the expertise to track, record & rectify underpaid or unpaid claims consistently. Thereby creating a need for podiatrists to shift to outsourcing their billing & coding needs to reliable & successful billing companies with expertise in the specialty. Zono RCM is among the pioneers in podiatry billing & coding services. With seasoned resources and institutionalized best practices, we can consistently improve collections by over 23% and reduce denials by over 25% by identifying & correcting key issues in Podiatry billing and coding
Applying best practices for Podiatry Billing & Coding
A Significant number of Podiatry claims get denied because of termination of coverage by the payer, the services provided are not being covered, or the maximum benefit for Podiatry services has already been provided. Insurance Details can change at any time, and we check the insurance & coverage details each time. Our team also ensures that the patient is aware of the insurance treatments non-covered by the insurance, thereby preventing further denials. We ensure HIPAA compliance at all stages of the billing & coding process.
Best Practices in Podiatry Billing & Coding
Prior Authorization. Authorization denials are common in Podiatry. It is necessary to obtain prior authorization from the payer and submit the claim and the authorization number to get reimbursements.
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Referring provider. Codes for the provider should be added below the CPT codes while billing for Medicare.
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Accurate coding. Accurate medical coding is an essential requirement for clean claim submission. Based on the payer’s guidelines, the provider can bill for additional procedure codes with other codes separately.
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Medical Necessity. The coding team should be skilled in billing using the right CPTs & diagnosis codes as per the guidelines. The codes must verify NCD (National coverage determinations) & LCD (Local coverage determinations). Coding documentation should also support the medical necessity of the services and treatment billed. Good documentation will subsequently help in appealing unpaid claims.
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Inclusive Services. Most claims get denied as the procedures are counted as inclusive. Please note:
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Providers should not bill CPT codes 11719, 11721 & G0127 together to avoid inclusive denials.
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If the insurance company denies the claim even after using correct modifiers, CCI (Correct Coding Initiative) edits should be checked and appealed with appropriate medical records.
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Frequency of Services. Routine foot care services are considered medically necessary once in 60 days. Payers will deny frequent services within 60 days, as they view it as unreasonable and unnecessary. Providers can appeal such claims for reimbursement with necessary medical documents stating the necessity of the services.
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Use of Q Modifiers. Submitting claims using Q modifiers indicate the findings related to the patient’s condition. Q7, Q8, and Q9 are used to bill podiatry services.
| Modifier | Description |
|---|---|
| Q7 | One Class A Finding |
| Q8 | Two Class B Findings |
| Q9 | One Class B and Two Class C Findings |
Medical Coders may use q modifiers with procedure codes 11055, 11056, 11057, 11719, 11720, 11721, or G012.
Zono RCM’ Expertise in Podiatry Billing Service
Our podiatry billers & coders’ team stay consistently updated while applying Podiatry coding guidelines and ensure maximum first-pass rate. We have a client base that extends over 50 states covering a wide range of hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC).
Radiology Billing Services
Reducing reimbursement rates, increasing infrastructure costs, and shifts in payer mix create challenges for radiology practices. It is more important than ever before to ensure that you can maximize reimbursements and sustain profits.
The unique aspects of billing for radiology services can be challenging for radiologists. It is a service that uses imaging techniques for both diagnosis and treatment of a disease. Radiology has multiple nuances due to its continually evolving advanced technology & treatment methods. Often there are new additions to the CPT codes used for billing radiology services practice, which demands constant attention.
Unlike other medical specialties, Radiology consists of two billing components — the professional component & the technical component. When a radiologist uses a radiology apparatus, dyes & machines, they must bill it under technical elements. When the radiologist interprets the diagnostic results, they must bill the service under the professional part.
Our team consists of certified, trained billers & coders who understand the complexity of Radiology billing. They envisage the impact on the revenue of a radiology practice caused by ignoring the act of differentiating between radiology’s professional & technical components while billing.
Our Expertise in Medical Billing and Coding for Radiology Practices
Zono RCM possesses a team of talented and trained radiology billers and coders who work effectively to reduce denials and increase your practice’s revenue. Our client base extends over 50 states covering a wide range of hospitals, physician practices, imaging centers, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines, EMR & PMS software, and certified by the American Academy of Professional Coders (AAPC).
Applying best practices for Radiology Billing
Our team of billers & coders understand Radiology billing’s unique requirements and strive to build a denial-free claim submission process for your practice. We are aware that Radiology is inseparable from the use of advanced equipment. Therefore we use both CPT and Dx-code while billing for service. We also focus on significantly reducing denial rates while improving collections through clear & accurate claim submission processes.
Our expertise in Radiology Billing includes but is not limited to:
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Diagnostic Radiology
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Computed tomography (CT)
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Fluoroscopy
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Magnetic resonance imaging (MRI)
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Magnetic resonance angiography (MRA)
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Mammography
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X-ray
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Positron emission tomography (PET)
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Ultrasound
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Therapeutic Radiology
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Nuclear Medicine
Maximizing Reimbursements from Radiology Claims
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Shifting focus from denial management to denial prevention. We improve collections by mapping the denials to root causes and working with the practices to eliminate these root causes. Our iterative processes enable the practices to imbibe best practices in clinical documentation, coding and claims submission to shift the focus to denial prevention.
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Identifying underpayments. We compare payments received against contracted rates. We pursue all cases of underpayments aggressively and resolve these by working with third-party payers.
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Business Intelligence. We create custom scheduled/on-demand reports, supporting better decision making, identification, and implementation issues.
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Extensive Experience. We support several interventional and diagnostic radiology clients based at renowned hospitals and academic medical centers.
Urology Billing Services
Urology billing and coding services involve billing and coding for all diagnoses & treatments provided to correct the urinary system’s dysfunctions and the male reproductive system. Billing for urology services can be more convoluted than other specialties due to the nature of its codes & terminologies.
Urology billing and coding requires specialized expertise and knowledge, and only a urology billing specialist can handle its nuances. Urology tends to overlap with other specialties such as oncology, gastroenterology, andrology, pediatrics, endocrinology, and gynecology, making it distinctive & challenging to understand.
As Urologists focus on delivering excellent medical care, often, they lose track of their revenue cycle. Non-payment or underpayment for urology services rendered can substantially impact the practice as urology procedures are typically costly. An in-house billing team can be helpful but may cause many denials on account of the lack of expertise. Outsourcing to a focused urology billing service provider like Zono RCM, who is familiar with urology codes and terminologies, can offer better control over collections & denials to healthcare organizations.
CPT & ICD codes for Urology Surgeries
CPT codes are categorized based on the organs like Kidneys, Ureter, Bladder, Urethra, Male, and Female genital organs.
Code Range: 50010 – 58294
Types of Surgeries in Urology
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Incision/Biopsy
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Excision
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Transplantation
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Catheter introduction
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Laparoscopy
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Endoscopy (Cystoscopy, Urethroscopy, Cystourethroscopy, etc.,
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Repairs
ICD-10 codes
ICD-10 codes should be used based on the LCD guidelines to avoid insurance denials. ICD- 10 codes being used by our coders while coding for urology surgeries are as below
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C00 – D49 – Neoplasm
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E00 – E89 – Endocrine, nutritional and metabolic diseases
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N00-N99 – Diseases of the genitourinary system
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Q50-Q56 – Congenital malformations of genital organs
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R30-R39 – Symptoms and signs involving the genitourinary system
Our Expertise in Urology Billing Services
Our team of urology billers & coders understands the nuances of urology billing and coding. We have developed a set of urology-specific best practices, which help us reduce denials and improve collections. Our client base extends across all 50 states and includes different healthcare entities, including hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are CUC certified (Certified Urology Coder) by the American Academy of Professional Coders (AAPC).
Applying best practices for Urology Billing & Coding
Trained urology coders are challenging to find, expensive to recruit, and their ongoing training can be quite costly. Our team comprises well-trained, CPC certified urology coders that can process 25-30 surgery reports/day. In our Urology specialty coding service, we cover the most complicated portion of the CPT codes and train our coders to handle all procedural, modifier, and diagnostic coding challenges. We ensure HIPAA compliance at all stages of the billing & coding process. Our team performs prior authorization of the eligibility & benefits of the patient to avoid denials.
Best Practices in Urology Billing & Coding
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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.
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Medical Necessity. The urology service provider should be able to justify the medical necessity of the course of treatment to be able to charge accordingly for the highly costly services they provide
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Eligibility & Benefits denials. Verifying a patient’s eligibility & benefits for a particular service at least 48 hrs prior can help reduce the denials.
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Missing/Invalid CLIA number (Clinical Laboratory Improvement Amendments). CLIA number should be updated while billing for the lab test
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Non covered – Medicare will not pay for A Codes like A4357, A4334, A5114, A4340, A4331, etc., and deny as Non-Covered Services. But some secondary insurance will pay for the Medicare non-covered services.
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Coding for Maximum benefits. CPT codes should be coded with the correct units as allowed by the specific payers for specific CPTs. For example, Payers will deny CPT codes 51700, 52300, 52310, 55876, and 77263 if we bill for more than one unit.
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Medical Record Documentation in Billing CPT’s 51701-51703. Codes Providers should not report 51701-51703 in addition to any other procedure that includes catheter insertion as a component
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Modifier 59. Providers must use modifier 59 when billing for two urology services together
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LCD Guidelines. Providers should follow LCD guidelines before billing Urology services