Medical coding services

The unique aspects of billing for radiology services can be challenging for RCM companies and their billers and coders. Since the service uses imaging techniques for both diagnosis and treatment of a disease, it has multiple nuances and is continually evolving advanced technology & treatment methods. Hence, there are continually new additions to the CPT codes used for billing radiology services.

Unlike other medical specialties, Radiology consists of two billing components -- the technical, applied when a radiologist uses a radiology apparatus, dyes & machines, and the professional, applied when the radioligist interprets these results and makes a diagnosis.

Our certified billers & coders are trained to acknowledge Radiology billing's unique nature which includes the use of advanced equipment. Therefore, we use both CPT and Dx-code while billing for services and our focus is to significantly reduce denial rates while improving collections through clear & accurate claim submission processes.

Our expertise in Radiology Billing includes but is not limited to:
  • Diagnostic Radiology
    • Computed tomography (CT)
    • Fluoroscopy
    • Magnetic resonance imaging (MRI)
    • Magnetic resonance angiography (MRA)
    • X-ray
    • Positron emission tomography (PET)
    • Ultrasound
  • Therapeutic Radiology
  • Nuclear Medicine
    Interventional Radiology
  1. Angiography/Angioplasty
  2. Embolization procedures
  3. Tumor Ablation procedure)
  4. Biopsy procedures
  5. Vertebroplasty
  6. Venous Access procedures

Anesthesia codes may have multiple segments, depending on the number of pre- and post-process visits the extent of monitoring needed, the number of units of anesthesia administered, and more. There are different levels of Anesthesia providers - the Anesthesiologists, Certified Registered Nurse Anesthetists (CRNA), and Anesthesiologist Assistants (AA) and they all play a critical role in the patients care and each must be properly recognized and billed. The success of an anaesthesiology service largely depends on its ability to generate & collect revenue. Shai consists of a team of experts who receive specialized training in billing for anesthesiology services.

    Our expertise in Anesthesiology Billing includes but is not limited to:-
  1. Pain management
  2. Critical/intensive care anesthesia services
  3. Pediatric anesthesia
  4. Palliative anesthesia
  5. Cardiac anesthesia
  6. Neuro-anesthesia
  7. Acute-pain anesthesia

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.

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).

Orthopedic coding depends on proper documentation before, during, and after a patient visit. The billing team needs to carefully document and charge for all services provided.

Compared to other specialties, orthopedic billing is complex and requires a deeper understanding of providers' services.

Shai orthopedic billing services include regular audit checks, account analysis, and follow-up with payers. 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. We have extensive knowledge of ICD, CPT, and HCPCS codes, and they use modifiers strategically to ensure claims have no problems in getting reimbursed at the right time.

    Our expertise in Anesthesiology Billing includes but is not limited to:-
  • Foot and Ankle Surgery/
  • Hip and Knee Surgery
  • Shoulder and Elbow Surgery
  • Trauma Surgery
  • General Orthopedics
  • Orthopedic Oncology
  • Spine Surgery/
  • Bone Health Center
  • Hand Surgery
  • Pediatric Orthopedic Surgery
  • Sports Medicine
  • Osseointegration Clinic

With rapidly evolving technologies and complex diagnostic protocols, cardiology coding 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.

Physicians treating a patient for cardiac issues end up opting for different diagnostic routines, performing multiple procedures, and using varied tools and techniques. This means that the billing process can be quite exhaustive. Up-coding cardiology billing services may end up leading to claim denials at the payer’s end. Similarly, down-coding may lead to the physicians not being compensated enough for their work. The right medical billing and coding team can prevent these from happening.

Shai’s cardiology billing services has experts with hands-on experience in the industry and are well-aware of the latest ICD codes and changes. Our team is up-to-date with the latest MACRA laws and knows the industry requirements like the back of their hands.

    Our cardiology billing service expertise includes:-
  1. Cardiac surgery
  2. Pediatric cardiology
  3. Cardio-oncology
  4. Interventional cardiology
  5. Vascular surgery
  6. Cardio-obstetrics
  7. Preventive cardiology
  8. Cardiac diagnostics

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.

Shai 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. We will identify problem areas such as the correct use of modifiers, evaluate underpayments, and manage all aspects of your practice's billing.

We employ our experience and knowledge acquired through a decade of working with gastroenterologists in fixing & improving your revenue cycle.

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:

  • Overlooking separately billable services rendered during the global period
  • Lack of understanding that pregnancy coverage is an amendment to an existing insurance plan
  • Pregnancy coverage includes inpatient & outpatient services and is split between them.
  • Improper documentation of the policies & services provided
  • 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.
  • Understanding that all laparoscopic OB/GYN surgical procedures involve diagnostic laparoscopy

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 expertise in OB/GYN billing & coding covers specialties including:-
  • Angiography
  • Reproductive Endocrinology and Infertility
  • Gynecological Uro-gynecology and Pelvic Reconstructive Surgery
  • Advanced Laparoscopic Surgery
  • Family Planning
  • Pediatric and Adolescent Gynecology
  • Menopausal and Geriatric Gynecology

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.

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.

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.

Shai 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.

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.

Behavioral Health is an integrated interdisciplinary that addresses issues arising out of behaviors affecting the well-being of the mental and physical health of a person. Behavioral health experts are a part of most healthcare practices these days. Independent behavioral health practices are springing up everywhere too. Behavioral health includes both drug-based treatments and non-invasive therapies and sessions.

Since there could be multiple kinds of diagnostic procedures and treatments involved with every patient, recording them right and using the right codes and modifiers for each are intensive procedures that can be handled effectively only by the right experts.

Unclear understanding of the procedures or simple documentation errors can lead to the billers or coders sending out imperfect claims that may quickly get rejected or denied. Policy violations are another challenge for behavioral health medical billing service providers. The segment needs accordant knowledge and an unwavering focus on details.

Our team of behavior & mental health billers & coders have trained specialty specifically and can offer data-driven solutions for improving your revenue cycle.

At Shai, behavioral health billing services can handle all the below sub-segments of behavioral health. We understand the industry precisely and can add immense value to your existing practice.

  1. Outpatient counselling
  2. In-patient treatments
  3. Home-based treatment services
  4. Intensive and emergency management solutions
  5. Medical supervision solutions
  6. Rehabilitation and support group programs
  7. Alternative treatments
  8. Dual diagnosis

Managing hierarchical condition category (HCC) coding reviews is a complex process. At SHAI we can take care of the entire process for both providers and payers. Hierarchical Condition Category (HCC) coding can help healthcare organizations ensure appropriate payment for services among populations experiencing serious or chronic illness. We leverage retrospective, concurrent and prospective reviews for a more thorough analysis and enhanced insight. Our highly trained staff can assist with the coding of complex cases for risk adusted and provide a more complete picture of the patient. We will also work with you to ensure documentation complies with HCC reporting requirements for maximum reimbursement.

  • Conduct high-accuracy diagnostic coding.
  • Ensure medical records are complete and accurate based on Hierarchical Condition Categories (HCCs) guidelines.
  • Verify risk-adjusted codes and documentation based on industry standards.
  • Provide assessment of documentation based on M.E.A.T. criteria.

“Inpatient” means that the patient is formally admitted to the hospital on the physician’s order. The facility where the patient is admitted for an extended stay may be a hospital, nursing home, rehab facility, or long-term care facility. Staying in the hospital overnight does not necessarily make the patient an inpatient.

Inpatient coding refers to the codes used for reporting the patient’s diagnosis and procedures performed on inpatients. Both ICD-10-CM and ICD-10-PCS coding manuals are used for inpatient coding. ICD-10-PCS is exclusively used for inpatient, hospital settings in the U.S. ICD-10 PCS excludes common procedures, lab tests, and educational sessions that are not unique to the inpatient, hospital setting.

Inpatient coding is more complex than outpatient coding. Inpatient codes report the full range of services provided to the patient over an extended period of time or the period of hospitalization. Inpatient coding also comes with a present on admission (POA) reporting requirement. Present on admission is defined as the conditions present at the time the order for inpatient admission occurs. The aim of the POA indicator is to distinguish conditions present at the time of admission from the complications or conditions that develop during the patient’s stay at the hospital.

Inpatient services are typically coded according to Medicare Severity-Diagnosis Related Groups (MS-DRGs). DRGs group patients according to diagnosis, treatment and length of hospital stay. The assignment of a DRG depends variables such as: principal diagnosis, secondary diagnosis or diagnoses, surgical procedures performed, comorbidities and complications, patient’s age and sex, and discharge status. Complications and comorbidities (CC) add to the severity and reimbursement of the episodes of care. Proper assignment of MS-DRG requires the right tools based on ICD-10-CM and PCS codes and guidelines.

Our team of inpatient coders understands the nuances of billing and coding Inpatient services, which help us reduce denials and improve collections.

Pathology is a small yet invincible segment of healthcare that requires effective and timely billing and coding. Since pathology provides diagnostic information to other healthcare departments, pathology services may be required every time a new patient walks in, or an old patient requires a follow-up.

As a result, a pathology billing service teams may be extremely swamped with work, handling hundreds of bills a day.

Pathology is often referred to as the precursor of any medical procedure. It broadly involves blood tests, drug tests, hematology, urinalysis, and other invasive and non-invasive diagnostic tests.

Though a small segment of healthcare services, since there could be hundreds of procedures and tests performed, pathology and laboratory services include a wide range of codes and modifiers that your team needs to be familiar with.

There are usually two kinds of tests pathology departments handle – qualitative and quantitative. Billers will need to know what each test exactly entails to bill the payers right. Usually, Pathology billing service providers will need to bill based on the number of tests performed and not based on the results offered. By combining tests, you could be losing precious money that the lab is eligible for.

    Our expertise in Pathology billing & coding covers services including:
  • Disease-oriented panels
  • Drug assays
  • Clinical pathology
  • Molecular pathology
  • Surgical pathology
  • Cytopathology
  • Urinalysis
  • Hematology
  • Anatomic pathology
  • In vivo lab procedures
  • Reproductive Medicine Procedures

The work of a general surgeon is intensive. General surgeons may be required to operate on any of the nine basic surgery areas and need to be prepared and on their feet all the time. The backend team of a practice needs to be prepared to handle General surgery billing and coding service challenges equally. Since a general surgeon performs a wide range of surgeries, the billers and coders need to be vigilant and ensure the practice neither over-bills nor under-bills the payer.
Just like how technology has affected most of the healthcare segment, it has made its mark in general surgery too. Surgeons can use various tools and techniques to diagnose and treat patients; all these need to be captured right when billing the payer.
A general surgeon usually works with a large team, and each expert’s effort must be documented and claimed for. The billers and coders need to understand the procedures right and know global packages, the right modifiers for same-day and multiple-day procedures, and the role of different surgeons and technicians performing tests, examinations, and treatments.

Handling medical billing and coding for such a busy and comprehensive field is not easy. If you are a general surgeon, then you need to start analyzing if your practice is making the money that it deserves. Shai comes with hands-on experience in handling general surgery medical billing and coding services for your practice.

    General Surgery Billing and coding Services for the below sub-segments
  1. Trauma surgeries
  2. Laparoscopic surgeries
  3. Breast surgeries
  4. Vascular surgeries
  5. Endocrinal surgeries
  6. Colorectal surgeries
  7. Dermatological surgeries