Medical Billing and Coding in South Dakota
South Dakota has different healthcare practices, some of which require assistance from other companies to improve their efficiency. One area where they need help is medical billing and coding, which is a lengthy and complex process that requires extensive experience and knowledge.
If your healthcare practice needs expert medical billing and coding solutions, Practice Support is here to help. We have worked with multiple healthcare providers across the state and always focus on delivering accurate and timely billing services.
Why Hire Practice Support in south Dakota
Increased Revenue
By minimizing errors and optimizing claims, Practice Support ensures you capture every dollar you’re entitled to. Our medical billing in South Dakota helps reduce claim denials and increases reimbursement rates.
Improved Efficiency
Our services free up your staff to focus on patient care by automating and streamlining the billing process, which other medical billing companies might not offer. We utilize advanced software systems to reduce manual processes, ensuring your practice runs smoothly.
Complying With Billing Regulations
Improved Claim Tracking
Founded by Veteran Clinicians
Our Medical Billing and Coding Process
1. Confirming the Validity of the Patient’s Insurance
- Verification. Collect the patient’s insurance details, including front and back copies of their card and other necessary information.
- Eligibility Check. Verify the active status and coverage of the insurance plan via phone or online portal.
- Benefits Verification. Ascertain the extent of the plan’s coverage, co-pays, co-insurance, deductibles, and any pre-authorization or referral requirements.
- Document Results. Record all verification details in the patient records for future use.
2. Scheduling an Appointment With the Provider
- Patient Information. Confirm or gather the patient’s demographic and medical history.
- Appointment Booking. Schedule an appointment using the practice management system based on provider availability.
- Reminders. Send appointment reminders via phone, email, or text to reduce no-show rates.
3. Delivering Care (First Occurrence)
- Patient Check-In. Update the patient’s personal and insurance details at reception.
- Consultation. The provider assesses the patient and develops a diagnosis and treatment plan.
- Service Documentation. Record all services and procedures performed during the visit.
4. Updating Details in the EMR
- EMR Entry. Input details from the visit, including history, diagnostics, and procedure notes, into the Electronic Medical Records system.
- Code Assignment Preparation. Ensure documentation is thorough and accurate for coding purposes.
5. Practice Support Identifies the Codes
- Medical Coders. Certified coders review EMR data to assign appropriate ICD, CPT, and HCPCS codes.
- Accuracy Check. Ensure codes accurately reflect the provided services and comply with payer policies.
6. Delivering Care (Second Occurrence, if Needed)
- Follow-Up Appointments. Schedule any required follow-up visits for further care.
- Continuation of Care. Document follow-up visits thoroughly to ensure all services are recorded.
7. Claim Submission
- Claim Preparation. Compile comprehensive patient and service details for the claim.
- Claim Validation. Use a claim scrubber tool to identify potential errors before submission.
- Electronic Submission. Submit the claim via electronic data interchange (EDI) or clearinghouse.
- Submission Confirmation. Document the confirmation receipt for the claim submission.
8. Claim Processing
- Payer Review. The insurance payer reviews the claim for accuracy and eligibility.
- Determination. The payer decides on full approval, partial denial, or rejection of the claim.
- Explanation of Benefits (EOB). Receive and document the EOB outlining the payment decision.
9. Payment Posting
- Receive Payment. Collect payments from the insurance payer and any patient payments due.
- Post Payments. Record these payments in the practice management system and update the patient account.
- Adjust Account Balances. Apply necessary adjustments based on agreements and post remaining balances due from patients.
10. Follow-Up
- Denial Management. Review and address reasons for denied or underpaid claims and resubmit or appeal as needed.
- Patient Billing. Send statements for balances owed and follow up on overdue accounts.
- Customer Service. Address questions or concerns from patients or payers regarding the bill or services.
11. Reporting and Analysis
- Operational Reports. Generate reports on claim statuses, denials, payment postings, and accounts receivable to monitor financial health.
- Performance Analysis. Assess efficiency in coding, billing, and collections, identifying improvement areas.
- Compliance Audits. Conduct internal audits regularly to ensure adherence to billing and coding regulations.
Get to Know South Dakota’s Medicaid Program
Fee-for-Service Model
South Dakota’s Medicaid program primarily operates under a fee-for-service model, providing flexibility but requiring providers to carefully manage billing processes to ensure timely and accurate reimbursements.
Telehealth Integration
South Dakota Medicaid has integrated telehealth into its reimbursement policies, allowing providers to bill for various virtual services. This is crucial for reaching patients in rural areas and maintaining consistent revenue streams.
Emphasis on Preventive Care
South Dakota Medicaid emphasizes preventive care, reimbursing for services like immunizations and screenings, ensuring better patient outcomes and steady Medicaid reimbursements for providers prioritizing these services.
Support for Pediatric Care
South Dakota Medicaid offers strong support for pediatric care, allowing providers to bill for specialized therapies and comprehensive care plans, ensuring funding while addressing the unique needs of children.
Chronic Disease Management
Medicaid includes billing codes for chronic disease management, enabling providers to bill for ongoing patient care and education. This ensures continuous care and a consistent revenue stream for managing chronic conditions.
Hire Practice Support for Expert Medical Coding and Billing Solutions in South Dakota
You can breathe easy knowing that you have a reliable billing and coding company to help your South Dakota practice improve its operations. With our experienced medical billers and coders, you’ll be hitting your goals and providing excellent patient care without a problem.
Give us a call to learn how we do medical coding in South Dakota or if you have other questions we have not been able to answer.
Schedule a consultation