Medical Billing and Coding in Oregon

Working with expert medical billing and coding companies is needed in the rapidly evolving healthcare field to guarantee your practice’s financial health. In Oregon, where regulations can be particularly stringent, having a dependable partner like Practice Support can make all the difference.

At Practice Support, we address the unique challenges of medical billing and coding in Oregon. We provide personalized solutions to optimize your revenue cycle and improve your practice’s efficiency.

Why You Should Hire Practice Support

Increased Revenue

By giving your billing and coding responsibilities to Practice Support, you can reduce errors that lead to claim denials and rejections. Our expertise and sharp eyes can help maximize your revenue potential. You can focus on growing your patient base while we handle the complexities of the billing process.

Improved Efficiency

Our team uses updated software and technology to streamline your billing processes, allowing you to concentrate on providing exceptional patient care. By improving operational efficiency, we can reduce your operation’s downtime and increase productivity.

Complying With Billing Regulations

Stay compliant with Oregon’s stringent billing regulations through our up-to-date knowledge and thorough documentation practices. We’ll make sure that all procedures of medical billing in Oregon align with current rules and guidelines, protecting your practice from costly penalties and audits.

Improved Claim Tracking

Our tracking systems give you full visibility and control over your claims process. Our tools can ensure timely submission and quick resolution of any issues that arise. By offering improved claim tracking, we help you stay on top of your revenue cycle, decrease your accounts receivable, and increase your practice’s cash flow.

Owned and Operated by Veteran Clinicians

With a team led by experienced healthcare practitioners, Practice Support understands the complexities of clinical workflows. Our veteran clinicians bring a unique perspective to medical coding in Oregon, handling every aspect of your practice’s billing process with the utmost care.

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 insurance companies 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. Based on contractual agreements, apply any necessary adjustments 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 accurate coding, billing, and collection efficiency, identifying areas for improvement.
  • Compliance Audits. Conduct regular internal audits to ensure adherence to medical billing and coding regulations, making necessary adjustments to maintain compliance.

Get to Know Oregon’s Medicaid Program

 

Operating Through Coordinated Care Organizations

Oregon’s Medicaid program, known as the Oregon Health Plan (OHP), operates primarily through Coordinated Care Organizations (CCOs). These CCOs integrate physical, behavioral, and dental health services, streamlining medical biller processes and reducing administrative burdens. This system ensures timely reimbursements, helping healthcare providers maintain financial stability while focusing on delivering comprehensive care.

 

Telehealth Integration

Oregon Medicaid has fully integrated telehealth into its reimbursement framework, allowing providers to bill for virtual consultations, remote monitoring, and telemedicine services. This expansion has been particularly beneficial in reaching patients in Oregon’s rural and underserved areas, where access to healthcare facilities may be limited. Telehealth enables providers to extend their services and improve patient care without requiring significant physical infrastructure.

 

Behavioral Health Services

Behavioral health services are a key component of the Oregon Health Plan. Providers can bill for a wide range of mental health and substance abuse treatments, including crisis intervention and integrated behavioral health within primary care settings. Oregon’s focus on holistic care encourages providers to offer comprehensive behavioral health services, ensuring consistent billing opportunities and better patient outcomes.

 

Home and Community-Based Services

Oregon supports a wide array of HCBS through 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 vital in a state with a significant rural population, ensuring that vulnerable populations receive care within their communities supported by consistent Medicaid funding.

 

Preventive Care

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

Call Practice Support for Expert Medical Billing and Coding in Oregon

Ensuring your Oregon healthcare practice’s financial health and regulatory compliance is no small feat. By partnering with expert medical billing companies like Practice Support, you can easily navigate the complexities of Oregon’s unique healthcare landscape.

Our billing and coding specialists, led by veteran clinicians, understand the complexities of the healthcare industry and are devoted to providing solutions that enhance your practice’s efficiency and profitability. We manage each step meticulously, from the initial insurance verification to the final insurance claim follow-up.

Reach out to us today to learn more about our medical billing and coding solutions for Oregon.

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