Our Medical Billing and Coding Process
1. Confirm the Validity of the Patient’s Insurance
- Verification. Gather the patient’s insurance information, including the front and back of their insurance card and other required details like identification.
- Eligibility Check. Contact the insurance provider via phone or online portal to verify that the insurance plan is active and covers the scheduled services.
- Benefits Verification. Determine what the patient’s medical insurance will cover, including co-pays, co-insurance, deductibles, and whether pre-authorization or a referral is needed.
- Document Results. Record all verified insurance details in the patient records for future reference.
2. Schedule an Appointment With the Provider
- Patient Information. Gather or confirm the patient’s demographic and medical history.
- Appointment Booking. Use the practice management system to schedule an appointment based on provider availability.
- Reminders. Send appointment reminders via phone, email, or text to minimize no-show rates.
3. Deliver Care (First Occurrence)
- Patient Check-In. Confirm and update the patient’s personal and insurance details at reception.
- Consultation. The provider examines the patient and formulates a diagnosis and treatment plan.
- Service Documentation. Document all services and procedures performed during the visit.
4. Update Details in the EMR
- EMR Entry. Input the visit details, including history, diagnostics, treatment plans, and procedure notes, into the Electronic Medical Records (EMR) system.
- Code Assignment Preparation. Ensure documentation is thorough and accurate to form the basis for subsequent coding.
5. Practice Support Identifies the Codes
- Medical Coders. Our medical coding in Alaska reviews EMR data to translate documented services and diagnoses into appropriate ICD, CPT, and HCPCS codes.
- Accuracy Check. Verify that medical codes accurately reflect the services provided and comply with payer policies.
6. Deliver Care (Second Occurrence, if Needed)
- Follow-Up Appointments. Schedule additional visits if further examination, treatment, or monitoring is necessary.
- Continuation of Care. Document these follow-up visits as precisely as the initial ones to ensure all delivered services are recorded.
7. Claim Submission
- Claim Preparation. Compile the claim with comprehensive patient information, insurance details, diagnosis and procedure codes, and charges.
- Claim Validation. Use a claim scrubber tool to identify potential errors.
- Electronic Submission. Submit the claim to the insurance payer via electronic data interchange (EDI) or clearinghouse.
- Submission Confirmation. Receive and document a confirmation receipt verifying claim submission.
8. Claim Processing
- Payer Review. The insurance payer reviews the claim for accuracy, eligibility, and policy compliance.
- Determination. The payer decides whether to approve the claim fully, partially deny it, or reject it.
- Explanation of Benefits (EOB). The payer sends an EOB or remittance advice outlining the decision and payments made.
9. Payment Posting
- Receive Payment. Collect payments from the insurance payer and corresponding patient payments.
- Post Payments. Record payments in the practice management system, updating the patient account and EOB.
- Adjust Account Balances. Apply any necessary adjustments based on contractual agreements and post the remaining balances due from the patient.
10. Follow-Up
- Denial Management. Review reasons for denied or underpaid claims, gather additional documentation if needed, and resubmit or appeal.
- Patient Billing. Medical billing professionals send statements to patients for balances they owe and follow up on overdue accounts.
- Customer Service. Address questions or concerns from patients or payers about the bill or services received.
11. Reporting and Analysis
- Operational Reports. Generate reports on claim submission statuses, denials, payment postings, and accounts receivables to monitor financial health.
- Performance Analysis. Assess coding, billing, and collection efficiency, identifying areas for improvement.
- Compliance Audits. Conduct regular internal audits to ensure adherence to medical billing and coding regulations, making necessary adjustments to maintain compliance.
Get to Know Alaska’s Medicaid Program
Coordinated Care Model for Billing
Alaska’s Medicaid program, though not operating through traditional managed care organizations (MCOs), employs a coordinated care model that streamlines billing processes. This approach helps providers reduce administrative burdens and ensures timely reimbursements, crucial for maintaining financial stability in a state with many remote healthcare facilities.
Comprehensive Behavioral Health Billing
Alaska Medicaid offers comprehensive billing options for various behavioral health services, including substance abuse treatment, mental health counseling, and crisis intervention. These services are critical in a state with high rates of mental health issues and substance abuse, providing providers with opportunities to address these needs while generating consistent revenue.
Extensive HCBS Support in Alaska
Alaska Medicaid supports an extensive array of HCBS, allowing providers to offer in-home care, personal assistance, and community-based services to individuals with disabilities and the elderly. This is particularly important in a state where long-term care facilities are scarce, ensuring consistent Medicaid funding for providers offering these essential services.
Emphasis on Preventive Care
Emphasizing preventive care, Alaska Medicaid reimburses providers for essential services such as immunizations, well-child visits, and routine health screenings. This focus on early detection and prevention helps improve patient outcomes and allows providers to establish long-term care relationships, ensuring ongoing Medicaid reimbursements.
Strong Support for Pediatric Care
Alaska Medicaid offers strong support for pediatric care, especially for children with developmental delays, chronic conditions, and special healthcare needs. Providers can bill for specialized therapies, early intervention services, and comprehensive care plans, ensuring steady funding while addressing the unique needs of Alaskan children.
Improve Your Healthcare Practice in Alaska by Hiring Practice Support’s Medical Billing and Coding Services!
Your practice must function seamlessly, as it can greatly affect your patient’s outcome. If you’re struggling to improve your medical billing and coding process, you should turn to Practice Support at once because we can help you improve them.
Call us immediately to understand why many clients choose us over other medical billing and coding companies around Alaska.