Medical Billing and Coding in Oklahoma

In Oklahoma City, hiring the expertise of medical billing and coding companies has never been greater. With the state’s Medicaid program, SoonerCare, operating under fee-for-service and managed care models, healthcare providers face the complexity of navigating multiple billing structures.

At Practice Support, we offer cutting-edge medical billing and coding services customized to practices of all sizes. We want to achieve accurate and streamlined billing processes, helping healthcare providers to focus on delivering high-quality patient care.

Benefits of Hiring Practice Support for Medical Billing and Coding in Oklahoma

  • Increased Revenue. Our billing and coding specialists can submit accurate and timely claims, reducing denials and maximizing reimbursements. Our precise billing techniques help capture every payable service, positively impacting your bottom line.
  • Improved Efficiency. Streamline your administrative processes, allowing your staff to focus on patient care rather than paperwork. Our dedicated team handles all aspects of billing, freeing your in-house staff from the complex insurance claims process.
  • Expert Compliance. Stay compliant with ever-changing billing regulations, thanks to our experienced specialists. We guarantee that all the coding practices align with the latest healthcare industry standards, which helps avoid legal pitfalls and compliance issues.
  • Improved Claim Tracking. Benefit from our meticulous claim monitoring, achieving quick resolutions and minimal delays. We proactively monitor your claims’ statuses and resolve issues before they become major roadblocks.
  • Veteran Clinicians. Our company is operated by seasoned clinicians who understand healthcare’s medical and administrative aspects. This unique insight enables us to effectively provide a holistic approach to managing your billing and coding needs.

Our Medical Billing and Coding Process

1. Verify the Patient’s Insurance

  • Collect Information: First, we gather the patient’s insurance details, like the front and back of their insurance card, as well as their ID.
  • Check Eligibility: We reach out to the insurance provider by phone or online to ensure the insurance plan is active and covers the services the patient is scheduled for.
  • Confirm Coverage: We find out what the insurance will pay for, including co-pays, co-insurance, deductibles, and whether any pre-authorization or referrals are needed.
  • Record Everything: Finally, we document all this information in the patient’s file for future reference.

2. Book the Appointment

  • Patient Details: We collect or confirm the patient’s demographic and medical history information.
  • Schedule the Visit: We book an appointment using our system at a time that works with the provider’s schedule.
  • Send Reminders: To reduce the chances of no-shows, we send appointment reminders via phone, email, or text.

3. Deliver Care (First Visit)

  • Check-In: When patients arrive, we double-check and update their personal and insurance details at reception.
  • Consultation: The provider meets with the patient, diagnoses their issue, and sets a treatment plan.
  • Document Services: All the services and procedures provided are carefully recorded.

4. Update Electronic Medical Records (EMR)

  • Input Information: We enter the visit details—such as the patient’s history, diagnosis, treatment plan, and procedures—into the EMR system.
  • Prepare for Coding: We ensure everything is well-documented so the coding process can be done accurately.

5. Assign Medical Codes

  • Review the Data: Our certified coders review the details in the EMR and convert the services and diagnoses into the correct medical codes (ICD, CPT, HCPCS).
  • Check for Accuracy: We make sure the codes reflect the care provided and match the payer’s policies.

6. Deliver Care (Follow-Up Visits, if Needed)

  • Book Follow-Up Visits: We schedule follow-up appointments if additional care or monitoring is needed.
  • Document Carefully: We document follow-up visits as thoroughly as the first.

7. Submit the Claim

  • Prepare the Claim: We compile the claim, including the patient’s details, insurance info, medical codes, and charges.
  • Validate the Claim: Our system checks the claim for any errors before submission.
  • Submit Electronically: We send the claim to the insurance company electronically.
  • Confirm Submission: Once the claim is submitted, we receive a confirmation and keep it for our records.

8. Process the Claim

  • Insurance Review: The insurance company reviews the claim to ensure it’s accurate and within their policies.
  • Decision Time: They either approve the claim, partially pay it, or reject it.
  • Explanation of Benefits (EOB): The insurance provider sends an EOB explaining its decision and detailing any payments made.

9. Post the Payment

  • Receive Payment: We collect payments from both the insurance company and the patient.
  • Update the System: Our system records payments, and the patient’s account is updated.
  • Adjust Balances: If any adjustments are needed, such as contractual write-offs, we make them and update the patient’s remaining balance.

10. Follow Up on Claims

  • Handle Denials: If a claim is denied or underpaid, we investigate the reason, gather any additional information needed, and resubmit the claim or file an appeal.
  • Send Patient Bills: If the patient owes any balances, we send them a bill and follow up on any overdue accounts.
  • Answer Questions: We handle any questions or concerns from patients or insurance companies regarding their bills or services.

11. Reporting and Auditing

  • Monitor Financials: We generate reports on claim submissions, denials, payments, and outstanding balances to ensure smooth operation.
  • Assess Efficiency: We regularly review the billing and coding process to spot areas that can be improved.
  • Stay Compliant: Regular audits help us stay compliant with medical billing regulations, and we make adjustments when necessary to avoid any issues.

Learning Oklahoma’s Medicaid Program

Flexible Billing Structures with Fee-for-Service and Managed Care Options

Oklahoma’s Medicaid program, SoonerCare, operates under a fee-for-service model and managed care through SoonerCare Choice. This dual approach allows providers to choose between different billing structures, offering flexibility while ensuring timely reimbursements. Understanding the nuances of each model is crucial for maintaining financial stability and streamlining administrative processes.

Integrating Telehealth into the Reimbursement Framework

Oklahoma Medicaid has integrated telehealth into its reimbursement framework, allowing providers to bill for various services, including virtual consultations, remote monitoring, and telemedicine. This is especially beneficial for reaching patients in Oklahoma’s rural and underserved areas, where access to healthcare facilities may be limited. Telehealth services have become essential for expanding care and maintaining consistent revenue.

Emphasis on Preventive Care

Oklahoma Medicaid strongly emphasizes preventive care, reimbursing providers for services such as immunizations, cancer screenings, well-child visits, and routine check-ups. This focus on prevention helps improve long-term health outcomes and provides a steady stream of Medicaid reimbursements for providers who prioritize preventive care.

Robust Support for Pediatric Care

SoonerCare offers robust support for pediatric care, particularly for children with special healthcare needs, developmental delays, and chronic conditions. Providers can bill for various specialized services, including early intervention programs, therapies, and comprehensive pediatric care plans, ensuring steady funding while addressing the unique needs of Oklahoma’s children.

Billing Codes for Chronic Disease Management Programs

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

Hire Practice Support for Quality Medical Billing and Coding Services

At Practice Support, we believe that our unique combination of medical knowledge and administrative proficiency sets us apart from other medical billing companies. We focus on delivering quality service that maximizes your revenue, enhances your operational efficiency, and keeps you compliant with the latest regulations of medical billing in Oklahoma.

Operating in the dynamic landscape of medical coding in Oklahoma, we understand the specific challenges healthcare providers face in the region. Our localized expertise allows us to tailor our solutions to meet the practices’ needs in Oklahoma, making us the trusted partner for medical billing and coding.

Contact us today if you have additional questions about our Oklahoma medical billing and coding services!

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