Medical Billing and Coding Georgia

Our Medical Billing and Coding Process

1. Confirm the Validity of the Patient’s Insurance

• Verification. Collect all vital insurance details from the patient, including their insurance card and identification. This initial step ensures that all necessary information is gathered upfront to avoid delays later.
• Eligibility Check. Verify with the insurance provider that the plan is active and covers the scheduled services. This confirmation prevents denied claims due to inactive coverage.
• Benefits Verification. Determine the specifics of what the patient’s insurance will cover, including co-pays, deductibles, and necessary pre-authorizations.
• Document Results. Record all verified insurance information in the patient’s records for future reference. Having a documented record ensures that all stakeholders have access to the necessary information.

2. Schedule an Appointment With the Provider

• Patient Information. Collect or confirm the patient’s demographics and medical history. Accurate information is vital for personalized care and effective billing.
• Appointment Booking. Schedule an appointment using the practice management system based on provider availability. Efficient scheduling optimizes the provider’s time and minimizes patient wait times.
• Reminders. Send appointment reminders via phone, email, or text to reduce no-show rates. Reminders help maintain a steady patient flow and prevent revenue loss due to missed appointments.

3. Deliver Care (First Occurrence)

• Patient Check-In. Confirm and update the patient’s personal and insurance information upon arrival. This step ensures all records are current and accurate.
• Consultation. The provider examines the patient, diagnosing and developing a treatment plan. Effective communication and documentation set the foundation for accurate medical billing and coding.
• Service Documentation. Document all services and procedures performed during the visit. Thorough documentation is crucial for proper coding and timely reimbursements.

4. Update Details in the EMR

• EMR Entry. Input all details from the visit, including history, diagnostics, and treatment plans, into the EMR system. Having complete and accurate EMR entries supports all subsequent billing activities.
• Code Assignment Preparation. Ensure documentation is accurate to facilitate correct coding. Proper preparation reduces the risk of rejected or denied claims.

5. Identify the Codes

• Medical Coders. Our certified medical coders review EMR data and apply the appropriate ICD, CPT, and HCPCS codes. Expert coding translates clinical services into billable data accurately.
• Accuracy Check. Verify that the codes accurately reflect the services provided and comply with payer policies. Correct coding is essential for ensuring claims are processed without delays.

6. Deliver Care (Second Occurrence, if Needed)

• Follow-Up Appointments. Schedule any additional visits necessary for continued treatment or monitoring.
• Continuation of Care. Document follow-up visits accurately, just like initial visits, ensuring all provided services are recorded.

7. Claim Submission

• Claim Preparation. Assemble the claim with all necessary patient information, insurance details, diagnosis, procedure codes, and charges. Comprehensive claim preparation is key to successful billing.
• Claim Validation. Use a claim scrubber tool to identify any potential errors before submission. Validation tools help catch mistakes that could lead to claim denials.
• Electronic Submission. Submit the claim via electronic data interchange (EDI) or clearinghouse. Electronic submissions are faster and more reliable, facilitating quicker reimbursements.
• Submission Confirmation. Document and confirm the successful submission of the claim. Tracking submissions ensures that all claims are accounted for and follow-up actions can be timely.

8. Claim Processing

• Payer Review. The insurance payer reviews the claim for accuracy, eligibility, and policy compliance. The payer’s review is a critical step where accurate coding and documentation prove beneficial.
• Determination. The payer decides on approval, partial denial, or rejection of the claim. We manage this step to ensure you are promptly informed of any decisions and ready to address issues.
• Explanation of Benefits (EOB). The payer sends an EOB or remittance advice detailing their decisions and payments. This document provides transparency into the payer’s decisions affecting your reimbursements.

9. Payment Posting

• Receive Payment. Accept payments from the insurance payer and any corresponding patient payments.
• Post Payments. Record payments in the practice management system, updating patient accounts and EOBs. Timely posting aids in financial management and patient account accuracy.
• Adjust Account Balances. Apply necessary adjustments based on agreements and post any remaining balances due from the patient. This final step ensures your accounts reflect accurate balances, supporting your financial health.

10. Follow-Up

• Denial Management. Review denied or underpaid claims, gather additional documentation as needed, and resubmit or appeal. Efficient denial management recovers revenues that might otherwise be lost.
• Patient Billing. Send statements to patients for balances owed and follow up on overdue accounts. Clear patient communication about billing builds trust and encourages timely payments.
• Customer Service. Address any questions or concerns from patients or payers regarding billing or services. Providing exceptional customer service ensures that any issues are resolved promptly and satisfactorily.

11. Reporting and Analysis

• Operational Reports. Generate reports on claims status, denials, payment postings, and accounts receivable to monitor financial health. Regular reporting provides insights into your practice’s performance and financial status.
• Performance Analysis. Assess the efficiency of coding, billing, and collections to identify areas for improvement. Continual performance analysis maintains high standards of operation.
• Compliance Audits. Conduct regular internal audits to ensure adherence to billing and coding regulations. Regular audits help identify compliance gaps and opportunities for process enhancements.