Healthcare practices in Arizona are increasingly reliant on the expertise of medical billing and coding companies to smooth out operations and ensure financial viability. As the healthcare landscape evolves, with a growing emphasis on regulatory compliance and reimbursement processes, efficient billing and coding become vital.
Practice Support is one company that provides this type of service, standing ready whenever healthcare organizations need excellent and reliable services. Our expertise reduces billing errors and ensures patients receive the correct charges for their medical services.
Our team streamlines the billing process, reducing the time from patient care to payment, which leads to improved cash flow for your practice.
By outsourcing your billing and coding needs, your staff can focus more on patient care than administrative tasks.
Before scheduling the appointment, we verify the patient’s insurance details to check if they have active coverage and understand their benefits. We contact the insurance company through an electronic verification system to confirm eligibility, plan details, and pre-authorization requirements.
Once insurance coverage is confirmed, the patient’s appointment with the healthcare provider can be scheduled. This involves coordinating with the patient to find a suitable time and completing all necessary pre-appointment paperwork.
On the appointment day, the healthcare provider delivers the necessary medical care or service during the patient’s visit. This care is thoroughly documented for coding and billing purposes.
We enter the specifics of the patient’s visit, including diagnoses, treatments, and services provided, into the Electronic Medical Record (EMR) system. The accuracy of this data is crucial for coding and billing.
Using the information documented in the EMR, our medical coders assign appropriate codes for diagnoses (using ICD codes), procedures (using CPT codes), and supplies or medications (using HCPCS codes). These codes are essential for the billing process.
If follow-up care is needed, another appointment is scheduled, and the process from service delivery to updating the EMR is repeated.
Once we complete the coding, a medical bill or claim is prepared and submitted to the patient’s insurance company electronically through a medical billing software system. The claim includes all relevant codes and patient information.
The insurance company reviews the submitted claim to determine the accuracy of the codes, verifies patient coverage, and applies any applicable co-pays, deductibles, or co-insurance. They may request additional information or corrections if needed.
After the claim is processed, the insurance company sends back an Explanation of Benefits (EOB) detailing what was covered and the payment amount. The payment is posted in the practice’s billing system, and any remaining balance is billed to the patient.
If discrepancies, denials, or unpaid claims exist, our billing staff follows up with the insurance company to resolve issues. This may involve appealing denied claims, correcting errors, or providing additional documentation.
The final step involves generating reports and analyzing the billing and coding process to identify trends, ensure compliance, and improve efficiency. This could include reviewing accounts receivable, tracking claim denials, and evaluating the practice’s overall financial health.
Arizona’s Medicaid program, called the Arizona Health Care Cost Containment System (AHCCCS), functions via managed care organizations (MCOs) to simplify billing processes. This approach reduces administrative tasks for providers and guarantees prompt reimbursements, supporting the financial stability of healthcare businesses.
AHCCCS has seamlessly incorporated telehealth into its reimbursement system, enabling providers to deliver virtual consultations, remote monitoring, and telemedicine services. This integration is particularly beneficial for Arizona’s rural and underserved areas, allowing healthcare providers to extend their reach and improve access to care without needing more infrastructure.
Arizona Medicaid offers extensive billing codes for various behavioral health services, including therapy, crisis intervention, substance abuse treatment, and community-based mental health care. This lets providers tackle the growing demand for mental health services while generating consistent revenue through Medicaid reimbursements.
Arizona Medicaid supports a vast range of HCBS, which allows businesses to offer in-home care, personal assistance, and community support services. These services will help individuals with disabilities and the elderly, ensuring consistent Medicaid funding and enabling providers to offer the community excellent, quality care.
Arizona Health Care Cost Containment System (AHCCCS) focuses on preventive care, offering reimbursement for services like immunizations, well-child visits, and routine health screenings. This approach improves patient outcomes by catching health issues early and allows providers to build long-term relationships with patients, ensuring regular Medicaid reimbursements.
Hospital coding is specifically tailored for inpatient and outpatient services that hospitals or health systems provide. It requires various coding systems, the primary one being the ICD (International Classification of Diseases) coding system, which reports diagnoses and the severity of the patient’s condition.
Additionally, hospitals employ CPT (Current Procedural Terminology) codes to denote the specific procedures and services rendered, alongside HCPCS (Healthcare Common Procedure Coding System) codes, which cover non-physician services, such as durable medical equipment.
A crucial aspect of hospital coding is assigning DRG (Diagnosis-Related Group) codes for payment purposes. These codes group patients based on clinical similarity and resource use, allowing hospitals to manage billing and reimbursements from Medicare and Medicaid effectively.
Professional coding relates to services rendered by individual healthcare providers, such as physicians and specialists. Professional coders primarily use CPT codes to detail the evaluation, management, and treatment services provided during a patient visit. An essential component of professional coding is the proper application of modifiers, which provide additional details about the service performed, such as whether it was a bilateral procedure or the provider managed multiple procedures during a single encounter.
You can always trust Practice Support when providing services like medical billing in Arizona. We have catered to numerous healthcare practices, ensuring we never miscalculate even the tiniest number. Our medical coders and billers are ready to assist your healthcare business.
Contact us now if you need more details about our medical coding in Arizona or what practices we have serviced in the past.
Schedule a consultation