Medical Billing and Coding in Minnesota

Know More About Our Medical Billing and Coding Process

1. Confirming the Validity of the Patient’s Insurance

• Verification. Gather detailed insurance information from the patient, including copies of both sides of the insurance card and any other required data.
• Eligibility Check. Confirm the insurance plan’s current status and coverage through a phone call or online system.
• Benefits Verification. Determine the plan’s coverage details, such as co-pays, co-insurance, deductibles, and any necessary pre-authorizations or referrals.
• Document Results. Log the verification details into the patient’s records for future reference.

2. Scheduling an Appointment With the Provider

• Patient Information. Verify or collect the patient’s demographic details and medical history.
• Appointment Booking. Arrange the appointment using the practice management system, considering the provider’s availability.
• Reminders. Dispatch reminders via phone, email, or text to minimize no-show occurrences.

3. Delivering Care (First Occurrence)

• Patient Check-In. Update the patient’s personal details and insurance information at reception.
• Consultation. The provider examines the patient and formulates a diagnosis and treatment plan.
• Service Documentation. Document all services and procedures conducted during the visit.

4. Updating Details in the EMR

• EMR Entry. Enter visit information into the Electronic Medical Records system, including medical history, diagnostics, and procedure notes.
• Code Assignment Preparation. Verify that documentation is complete and precise for coding purposes.

5. Practice Support Identifies the Codes

• Medical Coders. Certified coders evaluate EMR data to assign proper ICD, CPT, and HCPCS codes.
• Accuracy Check. Ensure codes accurately represent the services provided and conform to payer policies.

6. Delivering Care (Second Occurrence, if Needed)

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

7. Claim Submission

• Claim Preparation. Assemble detailed patient and service information for the claim.
• Claim Validation. Utilize claim scrubber tools to detect and correct potential errors before submission.
• Electronic Submission. File the claim via electronic data interchange (EDI) or through a clearinghouse.
• Submission Confirmation. Record the receipt of confirmation for the claim submission.

8. Claim Processing

• Payer Review. The insurance payer examines the claim for correctness and eligibility.
• Determination. The payer determines whether to approve, partially deny, or reject the claim fully.
• Explanation of Benefits (EOB). Receive and record the EOB that outlines the payer’s decision on the claim.

9. Payment Posting

• Receive Payment. Obtain payments from both the insurance payer and any due amounts from patients.
• Post Payments. Log these payments within the practice management system and update the patient account accordingly.
• Adjust Account Balances. Implement necessary adjustments per agreements and post any remaining balances owed by patients.

10. Follow-Up

• Denial Management. Investigate and rectify reasons for denied or underpaid claims, then proceed to resubmit or appeal when necessary.
• Patient Billing. Issue statements for balances due and pursue overdue accounts.
• Customer Service. Respond to inquiries or concerns from patients or payers about the bill or provided services.

11. Reporting and Analysis

• Operational Reports. Create reports detailing claim statuses, denials, payments, and accounts receivable to assess financial health.
• Performance Analysis. Evaluate the effectiveness of coding, billing, and collections, identifying areas for improvement.
• Compliance Audits. Conduct regular internal audits to ensure compliance with billing and coding regulations.