Medical Billing and Coding Nebraska

Nebraska is home to various healthcare practices that cater to its diverse population, including primary care clinics, specialized medical facilities, and hospitals. These practices often encompass family medicine, pediatrics, geriatrics, mental health services, and urgent care. The rural nature of communities in Nebraska can face unique challenges, such as limited access to healthcare providers and resources.

Without the expertise of medical billing and coding companies, many Nebraska healthcare providers may struggle with insurance claims, reimbursement processes, and regulatory compliance. Practice Support is always around to provide the needed services to keep your healthcare practice afloat.

Benefits of Hiring Practice Support’s Medical Billing and Coding in Nebraska

Increased Revenue

Practice Support can help healthcare providers maximize their revenue and reduce claim denials by ensuring accurate coding and timely medical billing in Nebraska.

Enhanced Efficiency

Our services streamline the billing process, allowing healthcare professionals to focus more on patient care than administrative tasks.

Expert Compliance

With ever-changing healthcare regulations, our team ensures adherence to compliance standards, reducing the risk of audits and penalties.

Improved Claim Tracking

We provide detailed tracking of submitted claims, allowing quicker follow-ups and ensuring that payments are received promptly.

Managed by Veteran Clinicians

Our company is run by veteran clinicians with extensive knowledge and experience in the healthcare industry. Their helpful insight lets us achieve precise billing and coding results for any practice we work with.

The Standard Process of Medical Billing and Coding

 

1. Confirm the Validity of the Patient’s Insurance

  • Verification. The healthcare practice collects the patient’s insurance details, including the insurance card (front and back) and other required information, such as identification.
  • Eligibility Check. Contact the insurance provider via phone or use their online portal to confirm that the insurance plan is active and covers the services scheduled.
  • Benefits Verification. Determine what the patient’s insurance will cover, including co-pays, co-insurance, deductibles, and whether pre-authorization or a referral is needed for certain services.
  • Document Results. Note all verified insurance details in the patient’s records for reference during subsequent steps.

 

2. Schedule an Appointment With the Provider

  • Patient Information. Collect or confirm the patient’s demographic and medical history information.
  • Appointment Booking. Utilize the practice management system to schedule an appointment based on provider availability.
  • Reminders. Send appointment reminders to the patient via phone, email, or text to reduce no-show rates.

 

3. Delivery of Care (First Occurrence)

  • Patient Check-In. Confirm and update personal and insurance details at the reception.
  • Consultation. The provider examines the patient and determines a diagnosis and treatment plan.
  • Service Documentation. Accurately document all services rendered and procedures performed during the visit.

 

4. Details are Updated on the EMR

  • EMR Entry. The healthcare provider or support staff inputs the visit’s details, including history, diagnostics, treatment plans, and procedure notes, into the Electronic Medical Records (EMR) system.
  • Code Assignment Preparation. The documented details must be thorough and accurate, forming the basis for subsequent coding.

 

5. Practice Support Identifies the Codes

  • Medical Coders. Our certified medical coders review the EMR data to translate the documented services and diagnosis into appropriate ICD (International Classification of Diseases), CPT (Current Procedural Terminology), and HCPCS (Healthcare Common Procedure Coding System) codes.
  • Accuracy Check. We verify that the codes accurately reflect the services provided and comply with payer policies.

 

6. Delivery of Care (Second Occurrence, if Needed)

  • Follow-Up Appointments. Sometimes, additional visits are necessary for further examination, treatment, or monitoring.
  • Continuation of Care. Document these additional visits as precisely as the first, ensuring all delivered services are recorded.

 

7. Claim Submission

  • Claim Preparation. Compile the claim with complete patient information, insurance details, diagnosis and procedure codes, and charges.
  • Claim Validation. Use a claim scrubber tool to identify potential errors before submission.
  • Electronic Submission. Submit the claim to the insurance payer through an electronic data interchange (EDI) or clearinghouse.
  • Submission Confirmation. Receive and document a confirmation receipt verifying the claim submission.

 

8. Claim Processing

  • Payer Review. The insurance payer reviews the submitted claim for accuracy, eligibility, and compliance with their policies.
  • Determination. The payer decides whether to approve the claim fully, partially deny it, or reject it completely based on documentation and coverage specifics.
  • Explanation of Benefits (EOB). The payer sends an EOB or remittance advice outlining the decision and any payments made.

 

9. Payment Posting

  • Receive Payment. Payments from the insurance payer and any corresponding patient payments are received.
  • Post Payments. The payments are recorded in the practice management system and compiled with the patient account and the EOB.
  • Adjust Account Balances. Apply any adjustments based on contractual agreements and post any remaining balances due from the patient.

 

10. Follow-Up

  • Denial Management. If any claims are denied or underpaid, review the reasons for the denial, gather any necessary additional documentation, and resubmit the claim or appeal the decision.
  • Patient Billing. Send statements to patients for any balances they are responsible for. Follow up on overdue accounts using a structured collection process.
  • Customer Service. Address questions or concerns patients or payers may have 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 the practice’s financial health.
  • Performance Analysis. Assess the practice’s efficiency in coding, billing, and collections. Identify areas for improvement to minimize errors and optimize revenue cycle management.
  • Compliance Audits. Regularly conduct internal audits to ensure adherence to medical billing and coding regulations and make adjustments as needed to maintain compliance.

 

Learn More About Nebraska’s Medicaid Program

 

Better Billing Processes

Nebraska’s Medicaid program, known as Heritage Health, operates through three managed care organizations (MCOs). This model integrates physical health, behavioral health, and pharmacy services into a single system, which streamlines billing processes, reduces administrative burdens, and achieves timely reimbursements. This integration is particularly beneficial for providers aiming for a consistent and predictable revenue cycle.

 

Telehealth Integration

Nebraska Medicaid has embraced telehealth, offering comprehensive reimbursement for telemedicine services. Providers can bill for virtual consultations, remote monitoring, and other telehealth services, which is particularly advantageous in Nebraska’s rural areas where access to healthcare can be challenging. This expansion of services helps providers reach more patients without requiring significant physical infrastructure.

 

Support for Behavioral Health

Nebraska Medicaid strongly emphasizes behavioral health, with integrated billing for mental health services, substance abuse treatment, and crisis intervention. The state’s focus on holistic care allows providers to offer comprehensive behavioral health services within the Medicaid framework, ensuring that mental health care is accessible and adequately funded.

 

Placing Importance on Chronic Disease Management

Nebraska Medicaid includes billing options for chronic disease management, focusing on conditions such as diabetes, asthma, and heart disease. Providers can bill for ongoing management services, patient education, and regular monitoring, ensuring continuous patient care and a consistent revenue stream for healthcare providers.

 

Integrated Care Models

Nebraska promotes integrated care models through its Heritage Health program, combining physical health, behavioral health, and pharmacy services. Providers adopting these models can maximize billing opportunities by offering a comprehensive range of services, improving patient outcomes, and enhancing revenue streams.

Leave the Medical Billing and Coding Job to Practice Support!

You can trust Practice Support for providing excellent medical billing and coding services in Nebraska. This is thanks to our years of experience working with different healthcare practices and backed by seasoned clinicians who know the healthcare industry inside and out. We always study our client’s practice and provide specific billing and coding services to achieve the desired results.

Call us today for expert billing and medical coding in Nebraska!

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