Medical billing is a complex process that involves submitting claims to insurance companies, managing claim denials, posting payments, and reviewing credits. Skilled oversight of the claim’s life cycle is critical for providers as it directly impacts revenue. This process requires multiple skills including Medical Coding, knowledge of EHR and practice management systems, and a very well-defined revenue cycle management workflow.

Billing Care Solutions understands the importance of medical billing and coding for the financial health of a practice. We have a team of highly passionate medical billing and coding professionals. We help our clients increase their efficiency by handling complex billing issues effectively. Our billers and coders are proficient in CPT, ICD-10, HCPCS, HEDIS, and OIG guidelines. Furthermore, we utilize a platform that integrates the needs of Physicians, Patients, and Payers dynamically to create efficiencies in patient care.

1. Patient registration:

The very first stage of a patient’s appointment should include the notation of the patient’s demographic information as well as information about his/her insurance, such as the insurance payer and policy number. Any information that will be useful and/or necessary in a claim situation should be detailed at patient check-in.

2. Insurance Verification/Authorization

Even regular patients need to verify their insurance information and eligibility before every appointment. A change in insurance information can also impact benefit and authorization information, so it is always worth the trouble of double-checking. . Insurance information can change at any time, which is why you need to ask patients before every visit if their insurance information has changed.

3. Charge Entry

The charge entry includes the appropriate linking of medical codes to services and procedures rendered during the patient’s visit. It also includes entering the charges for services that the patient received.

4. Claim Submission

Each insurance provider may have different requirements for information provided on claim forms. It is beneficial to check with the insurance provider regarding the specific process required.

5. Payment Posting

This last step involves posting and deposit functions. At this point, the amount billed to the patient will be zero if it has been paid in full or it will reflect the amount owed by the patient. The insurance payer’s responsibility should have been met by this step in the process.

How to prevent Errors in Medical Billing?

In the health care industry, fraud and abuse are used to describe different types of reimbursement problems. Here are some ways to prevent errors in medical billing:

1. Confirm the accuracy of all bills and claims before sending them out.
2. Thoroughly validate the information of all coming clients before serving them.
3. Develop a compliance program and keep your employees informed about how it works.
4. Appoint a chief compliance officer and team to oversee billing compliance and claim validity.
5. Outsource your billing to a responsible third-party billing company that will audit your claim process.

How Effective Ways to Manage Medical Billing?

Billing Care Solutions should know that our organization has many options available to improve the coding and billing process, leading to faster submission times and a boost to your first-pass approval statistics.

Here are some ways to improve the medical claim billing process for organization starting today.

1. Clarify the collection process upfront.
2. Maintain and update patient files.
3. Automate basic billing functions.
4. Track denials.
5. Outsource your most problematic collections.
6. Enhance quality control.
7. Follow-up on delinquent claims.