Patient Registration and Verification:

The billing process starts when a patient schedules an appointment. During the registration phase, we ensure accurate demographic information is captured and verify the patient’s insurance coverage. This includes confirming eligibility, checking the benefits, and reviewing the patient’s copay, deductible, or coinsurance.

Pre-Authorization and Eligibility Check Prior to the patient’s visit:

We handle the process of obtaining pre-authorization or approval from the insurance company for specific procedures or services that may require prior authorization. This ensures that services are covered by the insurance plan, helping to avoid claim denials later.

Charge Capture After the patient receives services:

Our team records all the procedures and treatments performed during the visit. Accurate charge capture is crucial to ensure that every service provided is billed correctly. This information is gathered from the physician's notes, medical codes, and service records.

Medical Coding:

Accurate medical coding is essential for proper billing. Using ICD-10, CPT, and HCPCS codes, our certified medical coders translate the patient's diagnosis, procedures, and services into standardized codes. These codes determine how much reimbursement the provider will receive from the insurance companies.

Claim Submission:

Once the coding is completed, we prepare and submit claims electronically to the payer (insurance company). This is done in compliance with industry standards such as HIPAA to ensure secure, accurate claim submissions.

Claims Follow-up and Payment Posting After submission:

Our team monitors the status of the claims to track approvals and rejections. If a claim is denied or underpaid, we work to resolve any issues, correcting errors or providing additional information to the payer. Once the payment is received, we post it to the appropriate patient account, ensuring that every payment is recorded correctly.

Denial Management and Appeals:

Denied claims can delay payments and cause revenue loss. We employ a rigorous denial management process to identify the reasons behind each denial, appeal the decision when necessary, and re-submit claims with any required corrections or documentation. Our goal is to minimize denials and maximize reimbursement.

Patient Billing and Collections:

Once insurance payments are processed, we handle patient billing for any remaining balances, such as copays, coinsurance, or deductibles. We provide clear, understandable patient statements, and manage collections efforts, ensuring that patients are aware of their financial responsibility while adhering to the practice’s policies.

Reporting and Analytics:

We provide detailed reports on your practice’s financial performance, including collections, outstanding claims, and denials. Our team uses advanced analytics to identify trends, optimize workflows, and offer actionable insights to improve revenue cycle efficiency.

Compliance and Regulatory Updates:

Our team stays up to date with the latest industry regulations and compliance requirements, including HIPAA, ICD-10 updates, and payer-specific policies. We ensure that your billing practices are always in line with the latest rules to avoid penalties and ensure proper reimbursement.