Medical Billing Services include:
- Eligibility and Verification: Checking patient health benefits from the insurance carrier’s website and through phone calls.
- Appointment Scheduling: Creating appointments in the scheduler while receiving patient calls.
- Patient Demographics and Charge Entry: Full entry of patient demographics and associated charges.
- Insurance Claims Submission: Submitting insurance claims for primary, secondary, or tertiary coverage.
- Accounts Receivable Analysis: Conducting analysis with corrective and preventive actions, making decisions for collections.
- Claims Follow-Up: Strong follow-up on claim denials from various insurances, including Workers Comp, Medicare, Medicaid, BCBS Semi Government, Managed Care, and Commercial Insurances (Aetna, BCBS, Cigna, UHC, Oxford, etc.).
- Patient Billing Inquiries: Addressing patient billing inquiries based on information received from the provider's office.
- Claim Status Checking: Verifying claim status through insurance websites, auto response units, and live calls.
- On-Call Appeals: Making on-call appeals for the reprocessing of incorrectly processed claims based on billing knowledge.
- Medical Coding: Using ICD-9, CPT, and HCPCS codes and/or review with guidance from Encoder Pro Expert licensed version for accurate coding.
- Financial Reporting: Preparing daily, monthly, and annual Accounts Receivable (AR) financial reports, including custom reports where required.
- Patient Billing: Handling patient billing as per instructions.
- Credentialing: Providing credentialing guidelines.
- Consulting/Training: Offering consulting and training services.
- Superbill Review and Appeals: Reviewing superbills and managing appeals.
Medical Coding includes:
- Researching Codes: Identifying the correct diagnosis (DX) and CPT codes according to medical records.
- Providing Accurate DX Pointers: Ensuring correct DX pointers are provided the first time to avoid payment delays.
- Suggesting Modifiers: Recommending appropriate modifiers to maximize revenue, utilizing the Encoder Pro Expert licensed version.
