Medical Billing and Coding in Indiana

Learn About Our Medical Billing and Coding Process

1. Confirming the Validity of the Patient’s Insurance

• Verification. Gather insurance details from the patient, including pictures of both sides of their insurance card and any other important information.
• Eligibility Check. Validate the current status and coverage of the insurance plan via phone or an online platform.
• Benefits Verification. Understand specifics such as co-pays, co-insurance, deductibles, and any pre-authorizations or referral requirements.
• Document Results. Record all verification details in the patient’s records for future reference.

2. Scheduling an Appointment With the Provider

• Patient Information. Confirm or gather demographic and medical history data.
• Appointment Booking. Schedule an appointment based on provider availability using the practice management system.
• Reminders. Send reminders via phone, email, or text to minimize the chance of no-shows.

3. Delivering Care (First Occurrence)

• Patient Check-In. Update personal and insurance information when the patient arrives.
• Consultation. The provider evaluates the patient to develop a diagnosis and treatment plan.
• Service Documentation. Document all services and procedures performed during the visit.

4. Updating Details in the EMR

• EMR Entry. Input visit details into the Electronic Medical Records system, including medical history, diagnostics, and procedure notes.
• Code Assignment Preparation. Achieve documentation is accurate and comprehensive for proper coding.

5. Practice Support Identifies the Codes

• Medical Coders. Certified coders review EMR data to assign appropriate ICD, CPT, and HCPCS codes.
• Accuracy Check. Verify that the assigned codes accurately represent the services provided and adhere to payer guidelines.

6. Delivering Care (Second Occurrence, if Needed)

• Follow-Up Appointments. Schedule necessary follow-up visits for continued care.
• Continuation of Care. Thoroughly document follow-up visits to record all services provided.

7. Claim Submission

• Claim Preparation. Compile detailed patient and service information for claims submission.
• Claim Validation. Use claim scrubber tools to identify and fix potential errors before submission.
• Electronic Submission. Submit the claim via electronic data interchange (EDI) or a clearinghouse.
• Submission Confirmation. Document confirmation receipt of claim submission.

8. Claim Processing

• Payer Review. The insurance payer reviews the claim for accuracy and eligibility.
• Determination. The payer makes a decision to approve, partially deny, or reject the claim completely.
• Explanation of Benefits (EOB). Receive and log the EOB outlining the payer’s decision concerning the claim.

9. Payment Posting

• Receive Payment. Collect payments from the insurance payer and patient balances.
• Post Payments. Record the payment information in the practice management system and update the patient’s account.
• Adjust Account Balances. Apply necessary adjustments as per agreements and update any outstanding patient balances.

10. Follow-Up

• Denial Management. Investigate reasons for denied or underpaid claims and take steps to resubmit or appeal as necessary.
• Patient Billing. Send statements for outstanding balances and follow up on overdue accounts.
• Customer Service. Address patient or payer queries related to billing or the services provided.

11. Reporting and Analysis

• Operational Reports. Generate reports detailing claim statuses, denials, payments, and accounts receivable to monitor financial health.
• Performance Analysis. Evaluate the efficiency of coding, billing, and collection processes to identify areas for improvement.
• Compliance Audits. Conduct regular internal audits to maintain alignment with billing and coding regulations.