Cesar M Limjoco MD’s Post

Our Objectives: To provide comprehensive medical coding services, including but not limited to HCC coding, surgical coding, ED coding, and other specialty coding, ensuring compliance with healthcare standards, guidelines, and regulatory requirements. To offer complete medical billing services to healthcare providers, hospitals, and clinics, facilitating the accurate and timely submission of claims, payment posting, and resolution of claim denials. To manage the full revenue cycle process, from patient registration to the final payment collection, including charge capture, claims processing, coding audits, and financial reporting, aimed at maximizing reimbursements and improving operational efficiency for healthcare organizations. To provide consulting and advisory services in medical billing, coding, and revenue cycle management, offering strategic solutions to improve healthcare financial performance and ensure compliance with industry regulations. To develop and implement technology-based solutions to automate and streamline the processes of medical coding, billing, and revenue cycle management, ensuring accuracy, efficiency, and data security in healthcare transactions. To engage in any lawful act or activity relating to the aforementioned services, including hiring and training personnel, entering into agreements, and collaborating with partners and clients to ensure the effective delivery of healthcare administrative services.

Looking to increase your bottom line? Need guidance on navigating healthcare revenue, coding, billing, and coverage? Come learn how to become a strong advocate for the IR profession in the areas of economics and reimbursement. This is the stuff you did not learn in medical school. "Navigating the IR revenue cycle to increase your bottom line" January 24-25, 2025 Emory Conference Center Hotel 1615 Clifton Rd, Atlanta Secure Your Spot Today: https://lnkd.in/ehfMyCV7 Why attend? Many physicians have limited knowledge of the revenue cycle because they do not oversee this process and typically receive no formal training in healthcare reimbursement, coding, billing, or coverage. This lack of understanding and available resources can hinder their willingness to develop these skills to improve revenue, discover opportunities for revenue recovery, or have informed conversations with administrators overseeing these processes. The course will provide two in-person pathways for both physicians and business leaders to address these gaps. Importantly, the course will educate on all aspects of financial literacy across various practice settings, including academic practice, hospital-based private practice, or hybrid hospital/OBL. The skills gained in this course will help you (more effectively) ask for additional resources, recognize when to trust the physician and technical revenue from your practice, and teach you the revenue language and give you the skills to put systems in place to get paid for the work that you do. 

Navigating the complexities of medical billing in Canada can feel daunting for specialist physicians—especially if you’re new to billing. Rest assured—the rules, codes and processes might appear overwhelming initially, but with the right knowledge and tools in place, you can breeze through billing and feel more confident you’re claiming fully for your work. Here, we’ve assembled 8 of our top medical billing tips and best practices for new and seasoned specialist physicians alike:

Navigating the complexities of medical billing in Canada can feel daunting for specialist physicians—especially if you’re new to billing. Rest assured—the rules, codes and processes might appear overwhelming initially, but with the right knowledge and tools in place, you can breeze through billing and feel more confident you’re claiming fully for your work.Here, we’ve assembled 8 of our top medical billing tips and best practices for new and seasoned specialist physicians alike: https://lnkd.in/gG2_gf_6

I hope everyone has a great weekend, here is a guide for accurately coding surgical procedures. --------- Coding for surgical procedures is a complex yet essential aspect of medical billing and healthcare management. Accurate coding ensures that healthcare providers receive appropriate reimbursement for their services and maintain compliance with healthcare regulations. This article will provide comprehensive tips for coding surgical procedures, highlighting best practices, common pitfalls, and strategies to improve accuracy and efficiency. Medical coding is a crucial process in healthcare, involving the translation of medical procedures, diagnoses, and services into standardized codes. These codes are used for billing purposes, insurance claims, and maintaining patient records. Surgical procedures, given their complexity, require meticulous attention to detail in coding to avoid errors that can lead to denied claims or reduced reimbursements... Full article below.

Healthcare management and healthcare administration are terms often used interchangeably, but they can refer to slightly different aspects of managing healthcare operations. Healthcare Management: This term is generally broader and encompasses the oversight and administration of healthcare systems and hospitals. It involves strategic decision-making, planning, and policy implementation across an entire healthcare organization. Healthcare managers focus on the business and operational aspects of running healthcare services, ensuring that the organization meets its goals, is financially sound, and complies with regulations. They often work at higher strategic levels, making decisions that affect the entire organization's future. Healthcare Administration: This is more specific and often refers to the day-to-day management of healthcare facilities and staff. Healthcare administrators might work more closely with individual departments within a healthcare facility, such as nursing, surgery, or information technology. Their roles are typically more focused on managing staff, budgets, and communications within particular areas of an organization. They ensure that the departments operate efficiently and are properly resourced. In practice, the roles and responsibilities of healthcare managers and administrators can overlap significantly, and the distinction between the two can vary by institution. Both roles aim to enhance the quality of healthcare delivery and patient outcomes, but their focus might differ in scope and operational specifics. Comment on this post if you want to discuss how you can learn biomedical informatics techniques applicable to both healthcare management and administration.

Demystifying Medical Coding: Understanding the Different Types In the complex landscape of healthcare, medical coding plays a crucial role in ensuring accurate billing, patient care documentation, and data analysis. It translates diagnoses, procedures, and medical services into universally recognized alphanumeric codes, which are essential for reimbursement and healthcare analytics. Here, we delve into the various types of medical coding and their significance in the healthcare ecosystem. https://lnkd.in/g7nN-BsE

Navigating Level 3 vs. Level 4 E/M Coding: Key Insights for Physicians The difference between a Level 3 and Level 4 office visit might not seem significant, but to payers, these visit types tell completely different stories about the work required to treat a patient. 🔍 Understanding the Distinction: When physicians report a Level 4 evaluation and management (E/M) code, they're signaling to payers that more effort is needed to manage the patient's condition. This often involves medical management for an exacerbation of an existing chronic condition, a complication, or a new problem. As Raemarie Jimenez, CPC, from AAPC explains, payers might deny Level 4 E/M codes for patients who respond well to treatment and are generally well-managed. However, the convenience of Electronic Health Records (EHRs) can sometimes lead to unjustified Level 4 coding. EHRs might pull forward irrelevant information or pre-populate data, falsely inflating the actual work performed by the physician. This can lead to over-documentation and potential scrutiny from payers. 💡 To avoid these pitfalls, physicians should ask themselves three key questions before assigning a Level 4 E/M code: Is this patient sicker than most of the patients I see? What specifically elevates the level of effort required to treat this patient? Have I documented this information in the record? Have I reported the most specific ICD-10-CM diagnosis code to justify patient severity? Additionally, physicians should be aware of how their EHR might contribute to upcoding. Consider these questions: Does the EHR auto-populate information, requiring physicians to deselect what's not pertinent to the visit? Auto-population can lead to oversight and unintentional upcoding. Best practice is for physicians to manually select what they want to bring forward. Do diagnosis-specific templates require physicians to perform certain tasks every time they see a patient? All work must be clinically relevant. Physicians shouldn't be forced to follow EHR prompts that don't align with their clinical judgment. Does the EHR require physicians to bill a certain code? The system-calculated code might not always be accurate. Physicians need the ability to override it when necessary to avoid inflated E/M levels. By staying vigilant and ensuring that documentation truly reflects the complexity of each patient's visit, physicians can avoid payer scrutiny and ensure fair reimbursement. Stay informed, stay compliant, and continue providing top-notch care! 🚀 For more information: https://lnkd.in/gSWftyve #HealthcareCompliance #EMCoding #MedicalBilling #HealthcareManagement

Choosing the right medical coding audit is essential for ensuring compliance, accuracy, and optimizing revenue. Our latest article delves into the various types of medical audits - from compliance and reimbursement to specialized reviews - and offers insights on how to select the right one based on your organization’s needs. Whether you’re focused on maintaining DRG validation or enhancing provider documentation, this guide provides actionable recommendations: https://ow.ly/6z5V50TnjLm #YESHIMConsulting #MedicalCodingAudits #MedicalReviews #CodingAccuracy #RevenueCycle #HealthcareManagement