To ensure healthcare practices are in-network with insurance companies, proper credentialing and/or payer enrollment is crucial. Servicing the medical community for over 30 years, we’ve provided the highest level of credentialing services.
Medwave boasts a highly experienced team of medical billing professionals dedicated to serving your healthcare provider specialty. Including, HL7 integration for exchange of patient data and billing and RPA for billing automation process purposes.
Effective denial management is essential for healthcare providers to ensure proper reimbursement for their services, maintain financial stability, and to provide high-quality patient care. Denied claims result in lost revenue and burden.
Medwave is located in Cranberry Township, Pennsylvania, serving the Pittsburgh metropolitan area and the rest of the USA. We are dedicated to providing exceptional billing and credentialing services. Our team of experienced professionals do the job right and provide healthcare providers the peace of mind they deserve.
Behavioral health refers to the study, diagnosis, and treatment of mental and emotional disorders, as well as substance abuse and addiction. It encompasses a wide range of conditions, including depression, anxiety, bipolar disorder, addiction, and schizophrenia, among others.
Behavioral health professionals, such as psychiatrists, psychologists, and counselors, work to help individuals overcome these conditions and improve their overall well-being. This can involve a combination of therapy, medication, and lifestyle changes, depending on the individual’s needs.
Behavioral health is essential for overall health and wellness and is becoming increasingly recognized as an integral part of primary care.
We serve the following types of Behavioral Health Providers
Inpatient
Outpatient
Residential
Inpatient Hospital
Small and Large Private Practices
Common Mental / Behavioral Health CPT Codes
90791: Psychiatric or psychological intake interview without medical services
90792: Psychiatric intake interview with medical services
90832: 30 minutes of individual psychotherapy
90833: 30 minutes of individual psychotherapy performed with an E/M service
90834: 45 minutes of individual psychotherapy
90836: 45 minutes of individual psychotherapy performed with an E/M service
90837: 60 minutes of individual psychotherapy
90838: 60 minutes of individual psychotherapy performed with an E/M service
90847: 50 minutes of family psychotherapy with the patient present
90846: 50 minutes of family psychotherapy without the patient present
90853: Group psychotherapy
96101: Psychological testing, interpretation, and reporting per hour by a psychologist
96102: Psychological testing per hour by a technician
96111: Developmental testing
New CPT Codes for Mental Health Services
Code 96156 has replaced codes 96150 and 96151
Code 96152 has been updated to 96158 plus 96159
Code 96153 has been updated to 96164 plus 96165
Code 96154 has been updated to 96167 plus 96168
Code 96155 has been updated to 96170 plus 96171
Summary
Outsourcing your behavioral health billing can offer several advantages to mental health providers and facilities. Billing for mental health services can be complex, time-consuming, and requires specialized expertise. By outsourcing this process to a third-party billing company, mental health providers can save time and reduce administrative burden, while ensuring billing accuracy and compliance with regulations.
Additionally, outsourcing can provide access to advanced billing technology and expertise in mental health billing, which can help maximize revenue and improve the financial health of the practice or facility.
Medwave is a leader in providing comprehensive medical billing services to behavioral (mental) health providers. Whether you are a psychiatrist, psychologist or clinical social worker, we work with you to provide an excellent performance-driven experience that will make a difference in your office’s reimbursement.
With over 20 years plus of behavioral health billing and credentialing experience, we have assisted new and established practices accurately process many hundreds of thousands of claims. We are able to utilize your current cloud-based software or we can help you discover new products tailored to your behavioral health practice volume.
Let our team of professionals guide your practice to a successful and productive new year. Contact us today to speak to a member of our team on how we can help your behavioral health practice.
Toxicology Lab Billing
Outsourced Billing for Toxicology Labs
Outsourcing your toxicology lab billing can offer several benefits to healthcare providers and laboratories. Billing for toxicology lab services can be complicated, and it requires specialized expertise and knowledge of coding and billing regulations. By outsourcing this process to a specialized billing company, you can benefit from their experience and expertise in toxicology billing, reducing the risk of errors and denials.
One of the significant benefits of outsourcing your toxicology lab billing is the reduction in administrative burden. Toxicology billing can be time-consuming and complex, and by outsourcing this process, you can free up your staff’s time and resources to focus on providing quality patient care. This can help increase operational efficiency and productivity, leading to a better patient experience and increased revenue.
Outsourcing your billing can also improve your billing accuracy and reduce the risk of denials. Specialized billing companies use advanced billing technology and software that can help streamline the billing process, resulting in faster payments and improved cash flow. Additionally, these companies have extensive knowledge of coding and billing regulations, which can help ensure that your billing is accurate and compliant with all necessary guidelines.
Another significant benefit of outsourcing your billing is the access to expertise. Medical billing professionals who specialize in toxicology billing have extensive knowledge and experience in this area, which can be invaluable for healthcare providers and laboratories. These professionals can help you navigate complex billing regulations and ensure that you are maximizing your revenue.
Outsourced billing can also help improve your financial performance. By reducing billing errors and denials, you can increase your revenue and improve cash flow. This can help you invest in your practice or laboratory, such as purchasing new equipment, hiring additional staff, or expanding your services.
Outsourcing can ensure compliance with all necessary regulations and guidelines. Toxicology lab billing requires adherence to various regulations, and failing to comply can result in significant financial penalties and harm against your reputation. By outsourcing to a specialized billing company, you can ensure that your billing is compliant with all necessary guidelines, reducing the risk of penalties and fines.
What Exact Benefits Do We Offer Toxicology Labs?
Benefits offered to Toxicology Labs include:
Services offered Does the billing company have practical experience in the toxicology lab environment? This is likely the most significant issue in choosing the appropriate resource for lab billing and coding. If the services you need aren’t offered, then why are you paying for such services? At a minimum, your toxicology billing service should give assured turnaround times to complete coding, submitting claims and following up claims that have been postponed or denied. Medwave has helped our toxicology lab clients increase their monthly income through enhanced billing performance through our team of dedicated professionals. Our end-to-end laboratory billing services provides maximum reimbursement for our clients while reducing overall costs and time to payment.
Total service billing Rejection and denial processing is what sets great billing services apart from the run-of-the-mill company. Medwave never misses an opportunity to appeal an insurance denial to ensure your lab gets paid correctly and rapidly for your services. Medwave processes denials and initiates the appeals procedure as soon as a denial is received. We view this as an essential role of a billing company, every bit as significant as getting claims submitted and payments posted. It’s critical for us to fight for every single dollar of a lab’s revenue and we don’t write off anything lacking prior approval from the lab.
Correct coding Does the billing company know what codes are dictated by what tests and which payors want which code for toxicology billing? Medical billing for toxicology lab work is highly complex and endures numerous, and often arbitrary, changes. Moreover, to ensure labs obtain proper reimbursement, billers must keep abreast of frequent changes to guidelines, both from Medicare and commercial payers, and be accustomed with how to apply existing rules, such as those prescribing use of medically unlikely edits and modifiers. Labs turn to Medwave for their toxicology billing. We’re well-informed in the subtleties of toxicology billing and work hand-in-hand with your lab to pinpoint the correct billing procedures your payers adhere to and help overcome problem areas.
Transparency Even when you outsource to experts, you still need to know what’s going on with your medical claims. A well-thought-of and reliable lab billing company such as Medwave will provide you regular reports that reveal what they’ve been doing for your lab and where you stand with claims. There’s no need for you to micro-manage, however, you do want to at least keep an eye on the billing to ensure it’s being taken care of efficiently.
Security Patient privacy is indispensable to your lab’s success, not only because you’re maintaining a business and your clients are entrusting you with their confidential information. But you also must obey federal and state privacy laws, such as HIPAA rules and regulations. Medwave is a trustworthy provider of lab billing services, one that takes security as seriously as you do.
Reduction of in-house staff Engage Medwave and allow us to be your billing staff. You’ll no longer have to be concerned with taxes, vacation/sick leave, payroll or personnel management. If you choose to maintain some (or all) of your existing billing staff, but reallocate their responsibilities, you can always be confident that your billing is being processed skillfully and with a minimum of fuss.
Summary
Outsourcing your toxicology lab billing can provide several benefits, including a reduction in administrative burden, improved billing accuracy, access to expertise, improved financial performance, and compliance with regulations. These benefits can help you run your practice or laboratory more efficiently and effectively, ultimately providing the best possible patient care.
In today’s healthcare landscape, independent toxicology labs are exploring for ways to stay financially solid. Our task is to maximize toxicology billing revenue, make sound business decisions, and pilot a course through the challenges of the healthcare environment.
At Medwave, we’ve put together a determined team of laboratory billing specialists who manage the entire toxicology billing cycle. From claim submission and payment posting to denial follow-up and appeals, Medwave manages every aspect of the billing process. Our know-how, dedication and practices outdo our competitors and we’ve demonstrated to be front and center in the lab billing industry.
The Medwave team is always working to stay on top of ever-changing requirements in the laboratory billing industry. Your claims filing, patient billing and accounts receivable management are in the hands of dependable, knowledgeable medical billing professionals.
Contact us today to see how we can be the best asset to your toxicology laboratory, by helping you get paid fast and efficiently. Our staff is here to help you and your office succeed in preparing claims and getting reimbursed.
Genetic testing is a medical test that analyzes a person’s DNA to identify changes or variations in their genes that may cause or increase the risk of developing a certain medical condition or disease. This type of testing can be used to diagnose genetic disorders or to determine an individual’s risk for inherited diseases such as cancer, Alzheimer’s disease, or heart disease.
Genetic testing can be performed on various types of samples, including blood, saliva, or tissue, and can involve different techniques, such as DNA sequencing, PCR, or chromosomal analysis. The results of genetic testing can provide important information for individuals and their families to make informed decisions about their health, such as choosing appropriate medical treatment, monitoring for disease progression, or making lifestyle changes to reduce the risk of developing certain conditions.
Genetic Testing has greatly evolved over the past few years with labs becoming an industry staple for everyday health and wellness. It has become an increasingly important and effective tool in identifying and treating disease.
Genetic testing confirms or rules out genetic conditions as well as determine whether a person can pass those conditions onto their offspring. This helps clinicians focus on the correct treatment as quickly as possible which leads to better health outcomes for patients.
Over the past several years, innovation around genetic testing has helped drive tremendous growth in this testing field. This growth in genetic testing is impressive – approximately 14 new tests enter the market each day. Currently, there are approximately 75,000 genetic tests, creating dizzying complexity for patients, providers and health plans.
Most insurers now require that the appropriate ICD-10 codes and authorization be on file prior to a claim being submitted. Without such prior documentation and DX codes, those claims will be denied.
That’s why we offer medical billing services to help you through this ever-changing maze of billing codes (especially, understanding which CPT codes are used in genetic testing billing) and procedures. We are also pleased to offer credentialing services to let you focus more on your core business than the mounds of paperwork to complete the process.
Genetic Testing Billing & Credentialing
Billing
Let the specialists at Medwave help organize for all the requirements essential to getting your claims paid sooner, every time. Our team is quite proficient and has the know-how in the medical billing and coding needs of genetic testing lab specialists and has firsthand experience working with both commercial and government insurance firms to get your claims paid fast and efficiently. You can be assured our end-to-end medical laboratory billing services provides maximum reimbursement while reducing overall costs and time to payment.
Here’s what we offer:
Complete solution We totally take care of your billing. Your staff will no longer have to perform data entry, amend claims or contact patients to collect money. Moreover, we believe rejection and denial processing is what sets great billing companies apart from the run-of-the-mill, ordinary billing company. That’s why Medwave never overlooks an opportunity to appeal an insurance rejection to make sure your lab gets paid properly and quickly.
Increasing client revenue Medwave has assisted our medical laboratory clients in boosting their monthly income via superior billing performance by our team of highly trained experts. We also proactively notify your lab on fee schedule developments and can help with contracting if required.
Reduce in-house staff Employ Medwave and allow us to be your billing staff. You’ll no longer have to be concerned with taxes, vacation/sick leave, payroll or personnel supervision when you work with us. Even should you choose to maintain some of your current billing staff, but shuffle their responsibilities, you can be confident in knowing that your billing is being managed expertly and attended to each day.
Transparency Even when you outsource to experts, you still need to know what’s going on with your medical lab claims.A well-thought-of and reliable lab billing company such as Medwave will provide you regular reports that make known what they’ve been doing for your lab and where you stand with claims. There’s no need for you to micro-manage, however, you do want to at least keep an eye on the billing to ensure it’s being taken care of efficiently.
Security Patient privacy is essential to your lab’s success, not only because you’re maintaining a business and your clients are entrusting you with their confidential information. But you also must obey federal and state privacy laws, such as HIPAA rules and regulations. Medwave is a trustworthy provider of lab billing services, one that takes security as seriously as you do.
Credentialing
Credentialing refers to medical or insurance credentialing, as both are used interchangeably. Healthcare providers, including medical laboratories, who wish to bill an insurance company as an in-network provider must undergo a process of credentialing.
Put simply, medical provider credentialing is a process by which medical organizations verify the credentials of healthcare providers to ensure they have the required licenses, certification and skills to properly care for patients. It’s an essential function for medical labs and others which precedes hiring or obtaining coverage by an insurance carrier.
About twenty years ago, healthcare providers still believed credentialing to be optional for building a practice. In contrast, today it’s become more essential than ever for providers to be networked with insurance companies. This is largely due in part to more and more people in the U.S. having health insurance than ever before. And in many ways, those health insurance plans cover more than previously. This is especially true when it comes to medical lab procedures.
At Medwave, we offer a team of medical laboratory credentialing professionals committed to serving all your credentialing needs. From gathering relevant information to filing claims and following up with insurance companies, our specialists hand the entire credentialing process, allowing you to focus on your medical lab as a healthcare provider.
We recognize that credentialing is a time-consuming process. That’s why our credentialing team possesses the experience and know-how to get medical laboratory credentialing done quickly and efficiently. Our credentialing service includes such essentials as provider enrollment and primary source verification. The following post, Credentialing (On-Board Process for Providers, Facilities) elaborates our overall process in greater detail. In other words, we do everything from A to Z to get you approved.
Medwave credentialing benefits include:
We keep all your credentialing information in one place.
We possess years of experience to navigate through the processes of Medicare and Medicaid provider enrollment, commercial insurance provider enrollment and other healthcare provider credentialing needs.
Our status reports on progress of credentialing keep you up to date.
Our application collection resources are among the best in the industry.
Our application completion includes ongoing monitoring.
Finally, our medical credentialing is perhaps most important because it’s the one method that permits patients to place their trust with utmost confidence in their chosen healthcare providers.
We could go on, but we’d rather you give us a call to make an appointment so we can properly demonstrate what Medwave can do to streamline your billing and credentialing processes, save you time and money, and put to bed those internal billing and credentialing headaches.
Our staff is here to help you and your office succeed in preparing claims and getting reimbursed. Contact us today to see how we can be the best asset to your genetic testing coverage and reimbursement endeavor.
COVID-19 testing is the process of detecting the presence of the SARS-CoV-2 virus, which causes COVID-19, in a person’s body.
There are several types of COVID-19 tests available, including PCR tests, antigen tests, and antibody tests. PCR tests are considered the gold standard and involve collecting a sample from the back of the throat or nose, which is then analyzed in a laboratory to detect the virus’s genetic material. Antigen tests are rapid tests that can provide results within minutes and work by detecting specific proteins on the virus’s surface. Antibody tests, on the other hand, detect antibodies that the body produces in response to the virus.
COVID-19 testing is an essential tool for controlling the spread of the virus, as it allows individuals to know whether they are infected and take appropriate measures to prevent transmission.
COVID-19 Testing Billing
Why Outsource Your COVID-19 Testing Billing?
Outsourcing your COVID-19 testing billing can be a smart move for healthcare providers and laboratories looking to maximize their revenue and streamline their operations.
Testing has become a critical aspect of patient care, and billing for these services can be complex and time-consuming.
By outsourcing this process to a specialized billing company, you can benefit from their expertise and advanced technology to improve your revenue cycle management.
One of the most significant benefits of outsourcing your billing is the access to specialized expertise. Medical billing professionals have extensive knowledge of medical coding and billing regulations, which can be challenging for healthcare providers to navigate.
By partnering with a specialized billing company, you can access their expertise and experience, allowing you to ensure that your billing is accurate and compliant with all regulations.
Outsourcing your billing can also reduce the administrative burden on your staff, allowing them to focus on other critical tasks. Billing can be time-consuming and complex, and outsourcing this process can free up your staff’s time, enabling them to concentrate on patient care and other important tasks. This can help improve your operational efficiency and productivity, resulting in a better patient experience.
Outsourced billing can also help increase your revenue. Billing errors and denials can result in lost revenue, and by outsourcing to a specialized billing company, you can improve your accuracy and reduce denials. This can result in higher revenue and fewer lost claims, providing a significant financial benefit to your organization.
In addition to expertise and revenue benefits, outsourcing also provide access to advanced billing technology and software. Medical billing companies often use advanced technology to streamline the billing process, reducing the time it takes to process claims and improving accuracy. This can result in faster payments and improved cash flow, allowing you to reinvest in your organization and continue providing the highest quality patient care.
Outsourcing your billing can ensure compliance with all regulations and guidelines. It requires adherence to various regulations, and failing to comply can result in penalties and fines. By outsourcing to a specialized billing company, you can ensure that your billing is compliant with all regulations, reducing your risk of financial penalties and harm to your reputation.
At Medwave, we’ve assembled a determined team of laboratory billing specialists (including COVID-19 / Coronavirus testing) who administer the complete billing process, from initial submission of a claim to denial follow-ups and appeals. Our experience, dedication and practices outperform our competition and we’ve consistently shown to be at the front of the laboratory billing industry.
What Precise Benefits Do We Offer COVID-19 Testing Labs?
Services Offered Does the billing company have real-world know-how in the test lab environment? This is perhaps the most important prerequisite in contracting with a lab billing partner. Plus, at a minimum, your laboratory billing service should provide guaranteed turnaround times to complete coding, submit claims and follow up those claims postponed or denied. Medwave has witnessed our laboratory clients boost their revenues through superior billing performance by our team of dedicated professionals. Our end-to-end laboratory billing services deliver maximum reimbursement for our clients while at the same time slashing overall costs and time to payment.
Full-Service Billing
The processing of rejections and denials is what sets great billing services apart from mediocre companies. Medwave never overlooks an opportunity to appeal an insurance denial to make certain your lab gets paid accurately for your services in as little time as possible. We’ve determined that this is an essential role of a medical billing company, every bit as important as submitting claims. We fight for every dollar and will not write off anything without the client’s prior approval.
Proper Coding Does the billing company know the correct codes for which tests and which payers want which code? Billing for laboratory testing is highly complex and undergoes frequent changes. Moreover, to ensure labs obtain proper reimbursement, billers must keep current of changes to guidelines from both Medicare and commercial payers and know how to apply existing rules and regulations. Labs consistently turn to Medwave for their COVID-19 test billing. That’s because we’re well-informed in the subtleties of lab test billing and work with your lab to pinpoint the correct billing procedures your payers adhere to, which includes understanding which CPT codes are used in COVID-19 billing.
Transparency Getting an accurate picture of your lab’s financial performance is demanding. With data hidden in spreadsheets and out-of-date systems, collecting information essential to optimizing operations and to plan for the future is often strenuous and time consuming. To help meet these challenges, Medwave offers cutting-edge financial and practice assessment tools, explicitly designed to give greater visibility of your operation and acquire key data and metrics for regulatory reporting.
Security Patient privacy is essential to your lab’s success and not only because you’re supporting a business and your clients are trusting you with their confidential information. But you must also adhere to federal and state laws, especially HIPAA rules and regulations. Medwave is a trustworthy provider of lab billing services, one that takes security as seriously as you do.
Reduction of Billing Employees Partner with Medwave and allow us to be your billing staff. You’ll no longer have to be concerned with taxes, vacation/sick leave, payroll or personnel management for an in-house billing department. If you do choose to maintain part (or all) of your existing billing staff, but redistribute their responsibilities, you can always be confident that your billing is being processed skillfully and with minimal fuss.
In today’s healthcare landscape, independent laboratories and COVID test kit manufacturers are constantly searching for ways to stay financially solvent. At Medwave, our task is to maximize your billing revenue, help you make sound business decisions and pilot a course through the maze of this healthcare environment.
Our team is always working to stay atop of ever-changing requirements in the medical billing industry. You can rest assured that your claims filing, patient billing and accounts receivable management are in the hands of dependable, knowledgeable medical billing professionals.
We invite you to contact us today to see how we can be the finest asset in your test laboratory by helping you get paid quickly and efficiently. Our staff is here to help you succeed in preparing claims and getting fully reimbursed.
Summary
Outsourcing your COVID-19 testing billing can provide a range of benefits, including access to expertise, reduced administrative burden, increased revenue, access to advanced technology, and compliance with regulations. Medwave is well-versed in COVID-19 testing billing for new variants, as well. These benefits can help you run your practice or laboratory more efficiently and effectively, ultimately improving the quality of care you provide to your patients.
Allergies are the fifth leading chronic disease in the United States and third-most common chronic disease among youth. Allergies impact in excess of 50 million people living in the USA, according to the allergy testing diagnosis page at American College of Allergy, Asthma, and Immunology website. Inhaled allergens are by far the most widespread type.
Allergy symptoms are the outcome of an overreaction of a person’s immune system to an irritant or allergen, such as dust, mold or cat dander. The immune system releases immunoglobulin (IgE) antibodies in an attempt to fight off the irritant, or allergy. Allergy tests attempt to detect these IgE antibodies in different ways. Since allergies can cause symptoms ranging from mild to life-threatening, if a person has an allergic reaction, they’ll want to know what’s causing it.
Blood testing and skin prick testing are the usual tests to help determine the likelihood of having an allergy. This assists the doctor in identifying the allergies That way, the patient and doctor can work together to find ways to stop or lessen the symptoms.
Obviously, testing is critical to treating allergies. The specific allergy must be identified (by an allergist or immunologist) before it can be treated accordingly.
Allergy Testing Billing and Credentialing
If you’ve had to do allergy testing billing before, you know how muddled it can get. Not all insurance companies view allergy tests identically and the way they deal with them is often differently from the Medicare / Medicaid billing system, as well.
This places those in charge of allergy testing billing management in tough circumstances. If you take the time to assure that each and every claim is submitted accurately, it can leave you little if any time for to be more patient-oriented. If you don’t, you can see a cascade of fines, deferred payments or outright rejected claims.
Moreover, some allergy testing services have acknowledged that they have been on the radar of third-party payer investigation units because they have learned that many practices bill these services incorrectly.
How Cumbersome is Allergy Testing Billing?
For starters, as skin testing is used as the principal tool to establish treatment for the allergic condition, billing for this component demands wide-ranging experience.
Knowing when to use modifiers, in concert with the appropriate number of skin tests to be billed, and how the specific insurance company responds all need to be determined at the beginning of treatment. As the number of testing “pricks” increase in terms of quantity, the amounts billed must be plainly defined and documented.
Many insurance firms have “ceilings” or quantity limits for a specific day of treatment thus leading to the necessity for return visits. Failure by the biller to identify the proper amount of testing can lead to a denial of claims.
Food sensitivity testing, poles apart from prick testing, requires the grasp of billing protocols for lengthy services and for reporting the monitoring of the patient’s vitals (blood pressure, pulse rate and respiration) throughout the documented test.
Another potential logjam — In standard medical practice, allergy testing is not to be performed on the same day as allergy immunotherapy and this means that the two different billing codes should not be reported together. Instead, allergy testing must be executed before immunotherapy, so as to identify the offending allergens.
For this reason, the number of tests administered must always show on any billing claim.
Common Allergy Testing CPT Codes
95004: Percut allergy skin tests
95012: Exhaled nitric oxide meas
95017: Venom testing; percutaneous and intradermal
95018: Drug/biological testing; percutaneous and intradermal
95024: Allergy test, intradermal
95027: Allergy titrate-airborne
95070: Bronchial allergy tests
95071: Bronchial allergy tests
95076: Ingestion challenge test; first 120 minutes
95079: Ingestion Challenge test; each additional hour
Benefits of Partnering with Medwave
Our experienced personnel are aware of the nuances of allergy testing billing and coding. We will work hand-in-hand with your practice to identify and potential problem areas or processes that need to be adjusted. You can be assured that our team of certified medical billers will manage all aspects of your allergy testing claims to help ensure you receive proper compensation with no unwarranted delays. To assist you in your decision, we developed an article on “5 Reasons to Outsource Your Allergy Billing.”
With years of experience managing allergy testing billing, we reduce costs and risks while bringing you best-in-class service that will deliver the following benefits:
Streamline claims and collection processing Our professional medical billers make sure your claims are submitted in an accurate and timely manner to ensure you receive timely reimbursement for the work you have performed. We have actually seen some of our clients increase their revenue without seeing any additional patients.
Decreased rejections and denials We thoroughly review claims to ensure they are complete before submitting them to insurance companies or government programs such as Medicare. We address each and every claim as you would, not just high-value claims.
Leads to an increase in cash flow
Whenever your staff is away, on vacation or for other reasons, the claim submission gets delayed leading to a lot of backlogs and issues with cash flow. Irrespective of your current staffing situation, our billing service maintains a continuous flow of claims going out and cash coming in. With this, you will typically get paid faster by investing almost nothing in staff training.
Free up your staff to focus more on patient care Because we manage the billing process, you and your staff members are relieved of billing duties and can give your complete attention to solving patient’s needs. it just makes good business sense to invest time and effort in your core competencies like patient care as it sets you apart from the competition.
Ensures billing compliance There’s no denying that healthcare is an ever-changing industry. Among all these changes, keeping up with medical billing comes as a challenge the practice owner has to make sure that the office is following all the rules and protocols. With Medwave, there are no such concerns as we stay atop the latest changes to ensure proper submission of claims and complete compliance.
Improved security of patients’ data When it comes to medical records, data protection is critical. As information stored in health records is more valuable than ever before, it becomes expensive to maintain a system to guard that data. By assigning all your allergy testing billing to Medwave, we make a patient repository and protect all data records. We also ensure there is no or minimal possibility of a data breach.
Peace of mind Outsourcing medical billing services gives you peace-of-mind that your claims are clean, your patients understand their billing responsibility and that your practice is in the hands of billing experts who will not let you down.
Bottom Line: What’s in it for you?
Outsourcing healthcare billing work can be a tough decision, but (ultimately) it will save your allergist practice time and money.
The result of engaging Medwave will lead you and your team to considerably less stress. You can concentrate on providing the best possible services while we make sure you get efficiently paid for it. Additionally, you’ll see significantly more return on claims (annually), meaning you’ll have more access to funds and your business will thrive, allowing you to offer effective patient care.
At Medwave, we’ve built our business model around a commitment to creating trustworthy partnerships. We believe in setting clear expectations for performance and striving to always meet these expectations.Contact us today to see how we can be the best asset to your allergy testing practice, by helping you get paid fast and efficiently.
Speech therapy is a type of therapy that helps individuals who have difficulty with communication, language, or speech-related disorders. Speech therapists, also known as speech-language pathologists, work with individuals of all ages to improve their communication skills.
The therapy sessions may involve exercises to improve pronunciation, vocabulary, and grammar, as well as techniques to help with speaking fluency, such as breathing exercises and relaxation techniques. Speech therapy may also involve working with individuals who have difficulty with swallowing or eating. The goal of speech therapy is to help individuals develop effective communication skills and improve their quality of life.
Speech / Language Pathology Therapy Billing & Credentialing
Billing and Coding for Speech / Language pathology therapy practices are evolving every year. Even with the new 4-level evaluation codes put into place, CMS or U.S. Centers for Medicare Medicaid Services is still collecting data throughout 2017 to see if there need to be more changes made to how SLP Therapists are reimbursed. There are multiple rules and regulations for SLP therapy billing and coding.
Every insurance company is different, which is why checking eligibility, submitting authorizations and documentation and adhering the correct modifiers to your patient’s claims can be a daily task that many offices struggle to learn and understand. Medwave and its professionally trained staff are here to help you and your office succeed in submitting your claims correctly.
Keeping Compliant
The first step to ensuring that you and your speech therapy practice are on the right track is to make sure that you are documenting your patient’s visits correctly. Correctly documenting your patient’s notes can be the difference between getting paid and acquiring authorizations and losing thousands of dollars in income a year.
What should you be including in your documentation?
Most current ICD-10 codes
Updated CPT Evaluation codes
Patient Specific Functional Scale (PSFS)
G- Codes upon Evaluation and Re-evaluation and at least every 10th
New SLP Evaluation Codes
As of January 1st, 2014, the CPT code 92506 for a Speech, Language, voice, communication, auditory therapy evaluation was replaced by 4 new CPT codes. The new codes will allow therapists to make a more specific evaluation based on the complexity of the patient’s diagnosis and performance.
New CPT Codes for Speech Therapy
92521 – Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 – Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)
92523 – Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 – Behavioral and qualitative analysis of voice and resonance
Patient Specific Functional Scale
The patient-specific functional scale score is being used by multiple insurance companies as a way to properly measure a patient’s functional condition. Before being evaluated, the patient is asked to list as many as three activities they are having trouble performing based upon their diagnosis. Once identified, they will point to a number scale from 0-10, 10 being fully functional, and score how they deem themselves able to perform that activity. This will be completed before the initial evaluation and upon every re-evaluation after.
Patient-specific activity scoring scheme (Point to one number):
As of January 1st, 2013, it is required to append “G” codes to the initial visit, at least every 10th and upon the discharge of treating a patient under Part B Medicare. Highmark BCBS has now initiated the same policies for tracking the functional limitations of a patient. As of July 2017, all claims will be denied if G-codes and their modifiers are not used.
How do I know which G-code to use?
Based on the patients DX codes, you would choose the corresponding G-codes that best explain the patient’s functional limitations. You will always need to include 2 of the 3 codes in a set. You will either use the current status code with the goal status code or the current status code and discharge code. These codes will also need to be included in the patient’s documentation for every date of service:
Motor Speech G-code set:
G8999 Current Motor Speech Status
G9186 Motor Speech goal status
G9158 Motor Speech D/C status
Spoken Language Comprehension G-code set:
G9159 Lang Comp current status
G9160 Lang Comp goal status
G9161 Lang Comp D/C status
Spoken Language Comprehension G-code set:
G9162 Lang express current status
G9163 Lang express goal status
G9164 Lang express D/C status
Swallowing G-code set:
G8996 Swallow current status
G8997 Swallow goal status
G8998 Swallow D/C status
Voice G-code set:
G9171 Voice current status
G9172 Voice goal status
G9173 Voice D/C status
Severity Modifiers
Modifiers are needed to more accurately show the level of functional status the patient currently has and the goal being reached. There are a total of seven modifiers to choose from:
Modifier Impairment Limitation Restriction
CH – 0 percent impaired, limited or restricted
CI – At least 1 percent but less than 20 percent impaired, limited or restricted
CJ – At least 20 percent but less than 40 percent impaired, limited or restricted
CK – At least 40 percent but less than 60 percent impaired, limited or restricted
CL – At least 60 percent but less than 80 percent impaired, limited or restricted
CM – At least 80 percent but less than 100 percent impaired, limited or restricted
CN – 100 percent impaired, limited or restricted
When submitting claims for Medicare it is still necessary to append the GN modifier to show the service is being performed as outpatient speech-language pathology.
Medwave Billing & Credentialing has a dedicated team of medical billing and credentialing experts to help you maximize your office’s reimbursement and keep you up-to-date with today’s ever-changing medical billing and credentialing regulations. Our team is experienced and well educated in the medical billing and coding guidelines of Speech Therapy and has firsthand experience working with commercial, government, auto and workman’s compensation companies to get your claims paid fast and efficiently.
Our sole objective is to move your office to a more efficient and effective work process so that your claims reimbursement is at its maximum. Utilizing the most current ICD-10 and CPT coding ensures that your office’s claims are clean and paid the first time. Our staff is here to help you and your office succeed in preparing claims and getting reimbursed.
Contact us today to see how we can be the best asset to your office by helping you get paid fast and efficiently.