Sazs Health RCM, LLC

Billing Consultation
SPECIALTY PHYSICIAN 1 1

Physician

Physician billing, also referred to as professional billing, serves the purpose of invoicing claims to secure payment for medical services or procedures administered by physicians or healthcare providers to patients with healthcare insurance coverage. The primary forms utilized for this billing process are CMS-1500 or 837-P.

This aspect of medical administration encompasses various crucial tasks within medical practices, including appointment scheduling, patient reception, check-in and registration, as well as payment collection.

It’s important to recognize that physician billing encompasses the entirety of the medical billing process, which includes medical coding. This implies that medical billers must undergo training for both billing and coding procedures.

By assembling a team of expert Physician medical billing and revenue cycle management professionals and harnessing cutting-edge technology, Sazs Health possesses a distinctive capability to optimize collections and boost revenue for physician groups of all scales. Whether it’s independent primary care physicians, or any other specialty, we have the expertise to deliver results.

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1 Physician Billing 360x245
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  • Pain Management / Anesthesia

    Our approach to billing Pain Management/Anesthesia services adheres strictly to ASA guidelines, utilizing resources such as the American Society of Anesthesiologists (ASA) Relative Value Guide (RVG®), the ASA CROSSWALK®, and the NCCI Edits policy of CMS. Our Anesthesia Billing policy aligns completely with Time-based Anesthesia Billing standards, incorporating guidelines tailored to the type of Anesthesia providers, services rendered, and Qualifying Circumstances impacting Anesthesia services. In addition to Anesthesia Billing, our Pain Management procedures encompass a range of services, including joint aspirations and injections, as well as injections targeting tendons, trigger points, nerves, and more. We also cover other Pain Management services, such as Chronic Pain Management and Complex Care Management, among others.

  • Podiatry

    Podiatry Billing requires a thorough understanding of reimbursement guidelines, especially considering the discrepancies between Medicare and commercial insurance coverage policies. Medicare coverage policies, often defined by LCD policies, can vary from state to state. Documentation and diagnosis assignment criteria, particularly for Orthotics coverage, are crucial aspects that providers and coders must focus on.

  • Orthopedics

    Orthopedics, or orthopedic services, focus on treating conditions related to the musculoskeletal system, encompassing bones, joints, ligaments, tendons, and muscles. Imaging procedures play a crucial role in diagnosing and sometimes treating orthopedic conditions. Your healthcare provider may order X-rays, bone scans, CT scans, MRI scans, arthrograms (joint x-rays), and discographies. Treatment may involve injections of medication into the affected area, such as corticosteroids or other types of injections into joints, tendons, ligaments, or around the spine. Surgical procedures used in orthopedics include amputation, arthroscopic surgeries, bunionectomy and hammer toe repair, cartilage repair or resurfacing procedures, knee cartilage surgery, fracture care, joint fusion, joint replacements, ligament reconstructions, repair of torn ligaments and tendons, and various spine surgeries including diskectomy, foraminotomy, laminectomy, and spinal fusion. Newer orthopedic procedures include minimally invasive surgery, advanced external fixation, and the use of bone graft substitutes and bone-fusing proteins.

  • Cardiology

    Cardiology services primarily encompass Diagnostic Cardiology and Interventional Cardiology. Diagnostic procedures include EKG, Stress Echo, and Doppler Echo, while Interventional Cardiology focuses on Cardiac Catheterization, used for identifying heart blocks, embolisms, and performing angioplasties. Billing and coding in Cardiology are complex due to procedural guidelines, contractual changes, and evolving codes.

  • Gastroenterology

    Gastroenterology coding and billing services involve assigning services related to visits and surgeries pertaining to conditions of the stomach and intestines, liver function, and related issues such as irritable bowel syndrome (IBS) and pancreatitis. This includes hepatology, focusing on liver, gallbladder, biliary tree, and pancreas conditions such as liver disease, jaundice, enzyme defects, and liver issues indicated by blood tests. Surgical procedures may include EGD, colonoscopy, liver transplants, gallbladder removal, and treatment for conditions such as anal fissures, gallstones, constipation, hemorrhoids, hernias, and Crohn's disease.

  • Nephrology

    Nephrology coding involves evaluation and management services, dialysis procedures, chronic kidney disease management, acute kidney injury, transplantation, and billing considerations. Code selection for E/M services in nephrology is based on factors including the complexity of the patient’s condition and medical decision-making. Dialysis procedures are common for patients with end-stage renal disease (ESRD), requiring documentation of the type and duration of dialysis, any complications, and patient response. Kidney transplantation, a life-saving procedure for ESRD patients, necessitates thorough pre-transplant evaluation and post-transplant care, adhering to specific Medicare guidelines for billing nephrology services, including dialysis, transplantation, and related services.

  • Neurology

    Neurology coding involves the systematic assignment of standardized codes to medical procedures and diagnoses concerning the nervous system, encompassing the brain, spinal cord, and nerves. It accurately describes the spectrum of medical services offered by neurologists, spanning from diagnostic tests to treatments for neurological conditions. These services include evaluation and management (E/M) services, diagnostic tests, and therapeutic procedures. E/M services entail a comprehensive history and physical examination, alongside any necessary diagnostic tests or consultations. Diagnostic tests aid in diagnosing neurological conditions and may comprise imaging studies such as CT scans or MRI scans, as well as electroencephalography (EEG) and other assessments. Therapeutic procedures are geared towards treating neurological conditions and may entail interventions such as injections or electroconvulsive therapy (ECT).

  • Rheumatology

    Rheumatology coding and billing revolve around the diagnosis and treatment of arthritis and other musculoskeletal disorders, including inflammatory and autoimmune conditions. Rheumatology billing requires precise documentation of specific diagnoses, including causation, anatomical location, and laterality, to support practice growth. Accurate coding in terms of anatomic location, laterality, and adherence to complex insurance guidelines significantly impacts reimbursement in rheumatology billing.

  • Surgery

    Surgery coding entails adhering to specialty-specific guidelines and considering the Place of Service, whether it's in an Ambulatory Surgical Center (ASC), Inpatient, or Outpatient setting. Coding guidelines vary depending on factors such as anatomical site, surgical approach (open/endoscopic/laparoscopic), patient position (e.g., supine/prone/decubitus), site of insertion, placement/replacement, revision, and the use of modifiers for related or unrelated complications to optimize reimbursement.

  • Obstetrics & Gynecology

    Coding and Billing in Obstetrics and Gynecology involve understanding the distinctions between Global Delivery and Non-Global Delivery coding guidelines, proper documentation of prenatal flow sheets, adherence to antepartum and postpartum billing guidelines, and nuances between Medicaid and non-Medicaid delivery guidelines. Additionally, familiarity with abortion billing and non-obstetric surgeries such as hysterectomy and myomectomy procedures, as well as IUD insertion/removal/replacement, are crucial. Coders should also possess knowledge of diagnostic procedures like Doppler and Spectral color flow Duplex Ultrasound.

  • Pediatrics

    Pediatric services are centered around providing Evaluation and Management (E&M) care for both Sick visits and preventive services. Key areas of focus in Pediatric coding and billing include screening services such as developmental screening and pediatric immunizations. One common scenario in this realm is the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Screening.

  • Internal Medicine

    Billing for Internal Medicine services necessitates a comprehensive grasp of Evaluation & Management (E&M) coding. This includes understanding the differentiation between New Patient and Established Patient encounters, conducting MDM analysis to determine E&M level, adhering to guidelines for various types of E&M services such as Telephone and Audio-visual consultations, and navigating postoperative E&M coding. Other E&M services like Observation Care and Consultations are also part of this domain.

  • Family Practitioners

    Family physicians collaborate with patients as partners in healthcare, assisting them in maintaining wellness, managing chronic conditions like diabetes and high blood pressure, and treating acute ailments such as neck pain and shingles. They provide comprehensive care across all life stages, from birth through adolescence to childbirth, midlife, and eldercare. Emphasizing wellness, they work with patients to prevent disease and coordinate with specialists when specialized care is necessary.

  • Urology

    Urology, a surgical specialty, focuses on addressing issues within the urinary tract and reproductive system for both men and women. While urinary tract infections and enlarged prostates are typically managed through medical interventions, conditions such as bladder cancer, prostate cancer, kidney stones, and stress incontinence often require surgical treatment. Urology Billing primarily encompasses three main categories: Evaluation and Management (E&M) codes, Diagnostic procedures, and Therapeutic procedures. Common Diagnostic procedures include PSA testing, Cystoscopy, Cystourethroscopy, and Uretero-pyelography. Meanwhile, typical Therapeutic services include catheterization and lithotripsy.

  • Optometry

    Optometry Billing involves the utilization of specific E&M CPT codes tailored for office visits within the optometry field. Effective Optometry Billing requires a comprehensive grasp of procedures that can be inherently bilateral or unilateral. Typical billing scenarios encompass procedures like Fundus Photos, Threshold Visual Fields Exams, and Corneal Foreign Body Removal. Understanding the distinction between routine and medical plans, as well as the potential application of copays and the impact of deductibles on fees, is essential for accurate billing.

  • Dermatology

    Dermatology Coding and Billing encompass a range of procedures including biopsies, incision and drainage, excisions, and repair of benign and malignant neoplasms. Complex procedures such as ATT and grafting are also part of this spectrum. Successfully coding and billing these procedures requires a thorough understanding of LCD policies, NCCI Edits, and insurance guidelines. Accurate code assignment and reimbursement hinge on distinguishing between medically necessary dermatology procedures and non-covered cosmetic procedures.

  • Physiotherapy

    Billing for Physiotherapy Services necessitates familiarity with evaluation and re-evaluation guidelines, therapy modalities, individual versus group therapy distinctions, and the impact of modifiers like 59, KX, and GP on reimbursement. Additionally, understanding signing requirements for Advance Beneficiary Notices (ABN) and dealing with bundled services are essential considerations.

  • Ophthalmology

    Ophthalmology involves managing various medical conditions and disorders related to the eyes. Ophthalmologists, highly trained medical professionals, play a vital role in preserving and restoring visual health. When providing services, ophthalmologists must accurately translate them into standard codes for claim submission and reimbursement. Ophthalmology medical billing utilizes two main categories of codes: eye codes for evaluation and management (E&M) codes. Understanding the distinctions between these categories ensures the accuracy of claims, leading to cleaner claims and reduced denials.

  • Chiropractic

    Chiropractors commonly serve as attending or concurrent care providers for musculoskeletal complaints, typically related to spine and/or extremity occupational conditions. Services may include evaluation, diagnosis, spinal and/or extremity manipulation, and rehabilitative exercises. Chiropractic adjustment, also known as spinal manipulation, aims to improve spinal motion and enhance physical function using controlled, sudden force applied to spinal joints.