How YES HIM Consulting Can Help International Healthcare Companies Navigate U.S. Medical Billing and Coding Services
How YES HIM Consulting Can Help International Healthcare Companies Navigate U.S. Medical Billing and Coding Services
International companies entering the U.S. healthcare market face unique challenges, from overcoming regulatory hurdles to understanding U.S. payment and reimbursement systems and breaking into a highly competitive environment. The complexity of the U.S. medical billing and coding services underscores the importance of seeking expert guidance and support when entering this competitive landscape.
Our team of consultants at YES HIM Consulting is committed to guiding these companies through the complexities of the American healthcare system. Garnering insights and strategies from years of experience, our experts can ensure that international medical companies will remain compliant with our healthcare regulations while earning the most accurate reimbursements for their services and technologies. Recently, we had the privilege of assisting an international health-based patient education company with its expansion into the U.S. market.
First Step: Understanding the Client’s Needs
As the first step in any consulting project, our consultants take the time to understand the client’s needs, challenges, and goals. In this case, our client sought our expertise to streamline their reimbursement practices and ensure their coding and billing processes followed U.S. regulations.
Additionally, they requested we review and optimize their existing “how-to” billing guide. We took it a step further by examining their payer contracts for potential errors and offered advice on how they could negotiate better pricing.
Second Step: Initiating Our Comprehensive Review Process
After our initial kick-off call with the client, during which we outlined their goals and developed an action plan, we conducted a detailed analysis of their existing billing guide, processes, and payer contracts. Here’s a step-by-step overview of our approach:
- Initial Assessment: We evaluated their current coding and billing procedures. Our consultants compared them against U.S. standards to identify any non-compliant practices.
- Optimizing Billing Practices: We provided recommendations to refine their billing guide, ensuring it was foolproof and aligned with the latest CPT codes. This involved identifying discrepancies and suggesting corrections to avoid billing errors.
- Payer Contract Review: Our team meticulously reviewed their current payer contracts, pinpointing errors and areas for improvement. We provided strategies to optimize their billing guidelines per payer, both government and commercial.
- Service and CPT Code Alignment: We assessed whether their services matched the selected CPT code descriptions. Where discrepancies were found, we advised modifying services or selecting more appropriate codes.
Third Step: Negotiating Custom Contracts
Given the client’s aim to rapidly expand in the U.S., we emphasized the importance of negotiating custom contracts with each payer. By leveraging our expertise, we helped the client negotiate better rates with payers, ensuring their services were adequately valued.
Without official guidance on their area of patient education, we advised the client to obtain written agreements from payers specifying coverage details and rates. This proactive approach minimizes future disputes and financial uncertainties.
Fourth Step: Addressing Unique Challenges
One of the significant challenges our client experienced was the lack of official guidance on their area of patient education. This gray area required us to delve into payer-specific policies and provide tailored advice.
For services without clear guidelines, we recommended that our client directly communicate with payers to include coverage specifics in the contracts. Additionally, we advised our client to contact authoritative resources like the American Hospital Association (AHA) through Coding Clinic for ICD-10 queries and the American Medical Association (AMA) for CPT queries. These resources serve as valuable backups for ensuring coding accuracy.
For Medicare-related cases, we instructed our client to consult the Medicare Administrative Contractor (MAC) by state to obtain precise instructions.
Bridge the Gap in the U.S.: Best Practices Checklist for International Companies
To assist other international healthcare companies entering the U.S. market, we outlined the following best practices based on our experience helping clients bridge the gap between their services and coding:
- Engage Early: Start communication with payers well before launching services in the U.S. market to ensure all coding and billing practices are compliant.
- Regular Audits: Conduct regular internal audits to maintain coding accuracy and compliance. This proactive approach helps identify and rectify issues promptly.
- Stay Informed: Keep up with changes in coding guidelines and payer policies to avoid non-compliance, governmental audits, and penalties.
- Custom Contracts: Negotiate custom contracts with payers, specifying coverage and reimbursement details to protect against future recoupments.
Secure Your Trusted Team for Medical Billing and Coding Services
Understanding the U.S. coding and billing landscape can be daunting for international healthcare companies. However, with the right guidance and support, it is possible to successfully serve patients, build your business, and grow your revenue.
At YES, we are dedicated to helping our clients succeed by providing expert consulting services tailored to their unique needs. Our recent project with the international health-focused patient education company is a testament to our commitment to excellence and client satisfaction.
If your organization is looking to expand into the U.S. market and needs assistance with medical coding and billing, reach out to our team of consultants at the form below to schedule a consultation today. Our experts are ready to help you navigate the complexities of the U.S. healthcare system and achieve your business goals.
