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. Certified medical coders review 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. 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 coding and medical audits to adhere to regulations, making necessary adjustments to maintain compliance.
Learn More About Montana’s Medicaid Program
Fee-for-Service Model with Managed Care Options
Montana’s Medicaid program operates primarily under a fee-for-service model, with managed care options for specific populations such as children under the Healthy Montana Kids (HMK) plan. This system requires providers to navigate traditional billing processes, but it also offers flexibility in service delivery. Timely reimbursements are crucial for maintaining financial stability in this setup.
Wide Range of HCBS Through Medicaid Waivers
Montana supports a wide range of HCBS through various Medicaid waivers, enabling providers to offer in-home care, personal assistance, and community-based services for individuals with disabilities, the elderly, and those with chronic conditions. These services are crucial in a state with a significant rural population, ensuring consistent Medicaid funding and helping providers meet the diverse care needs of Montana’s residents.
Integrated Care Models
Montana’s Medicaid program encourages integrated care models that combine physical health, behavioral health, and social services. Providers implementing these holistic care models can maximize billing opportunities by offering comprehensive services that address multiple aspects of patient health, improving outcomes and enhancing revenue streams.
Supporting Rural Health Providers
Montana Medicaid strongly emphasizes supporting rural health providers, recognizing the unique challenges of delivering care in underserved and remote areas. This support includes higher reimbursement rates and incentives for providers serving rural communities, allowing businesses to expand their reach and improve access to care for rural populations.
Comprehensive Medicaid Billing Codes for Emergency Services
Providers offering emergency services in Montana can rely on comprehensive Medicaid billing codes that cover a wide range of urgent care needs. This ensures that businesses providing critical emergency care maintain financial stability through consistent and prompt Medicaid reimbursements.
Choose Practice Support to Experience Efficient Medical Billing and Coding Solutions in Montana
Practice Support stands out among medical billing and coding companies for its dedication to improving the financial health of Montana healthcare providers. Our end-to-end medical billing and coding solutions are backed by a team of experienced professionals, including veteran clinicians who bring invaluable insights to the table. We understand the unique challenges faced by providers in Montana and are committed to helping you overcome them.
We employ the latest billing and coding software and best practices to process your claims accurately and efficiently. From initial patient verification to complex claim follow-ups, our comprehensive approach guarantees that all billing aspects are handled meticulously.
Contact Practice Support today if you have questions about how we conduct medical coding in Montana.