Medical Billing and Coding in Texas

Medical billing and coding are essential components of the healthcare industry in Texas. These processes involve translating patient care into billing claims that are submitted to insurance companies for reimbursement. That’s what Practice Support offers to all types of practices, using advanced billing and coding programs to achieve precise and efficient billing.

  •  

Why You Need Our Medical Billing and Coding Services in Texas

Expert Knowledge

Our team is well-versed in medical coding in Texas. Our services ensure accuracy and compliance with each client we serve.

Cost Efficiency

Outsourcing your billing and coding to us can reduce overhead costs, allowing your practice to allocate resources more effectively.

Advanced Technology

We use the latest billing software, which improves our entire process, greatly reducing errors and expediting claims.

Regulatory Compliance

Stay ahead of ever-shifting healthcare regulations with our proactive approach to compliance and updates.

Enhanced Revenue Cycle Management

Our systematic method optimizes your revenue cycle, leading to faster reimbursements and improved cash flow.

Focus on Patient Care

By offloading administrative burdens, your practice can concentrate more on patient care and satisfaction.

Trusted Clinicians

  •  Expert clinicians founded our company, so we deeply understand the medical industry and its challenges.

Our Medical Billing Process

 

1. Confirm Patient’s Insurance Is Valid

Before providing any services, we verify the patient’s insurance is current and active. This step involves:

  • Insurance Verification. We check the patient’s insurance card for policy details and contact the insurance company either through their online portal or customer service to confirm coverage.
  • Eligibility Verification. We ensure the specific services required by the patient are covered under their policy.
  • Financial Responsibility. We determine the patient’s out-of-pocket expenses, co-payments, and deductibles.

 

2. Schedule an Appointment With the Provider

After verifying the insurance, our medical billing and coding specialist proceeds with the following:

  • Appointment Booking. The patient’s appointment is scheduled with the appropriate healthcare provider based on their medical needs and urgency.
  • Notification. To reduce no-shows and cancellations, we send reminders to patients about their upcoming appointments via phone, email, or text message.

 

3. Delivery of Care (First Occurrence)

At the appointment:

  • Patient Check-In. We verify the patient’s identity, collect any required co-payments, and ensure that relevant documentation is complete.
  • Providing Care. The healthcare provider conducts the examination, administers treatment, or performs necessary procedures.

 

4. Details are Updated on the Electronic Medical Record (EMR)

Post-care:

  • Documentation. The provider documents the visit details, including the diagnosis, treatment provided, procedures performed, and follow-up instructions.
  • EMR Update. Accurate and detailed entry of this information into the Electronic Medical Record (EMR) system.

 

5. Practice Support Identifies the Codes

After the details are recorded:

  • Coding. Our certified medical coders review the documentation to assign appropriate Diagnosis (ICD-10-CM) and Procedure (CPT/HCPCS) codes, ensuring they accurately reflect the care provided.
  • Compliance. We ensure the codes meet relevant regulatory requirements and payer policies to avoid claim denials.

 

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

If additional care or follow-up appointments are required:

  • Re-scheduling. We arrange subsequent visits and repeat the steps above as necessary.

 

7. Claim Submission

After coding is completed:

  • Claim Preparation. We create a claim with important codes, patient information, provider details, and other supporting documentation.
  • Claim Submission. If required, we submit the claim to the insurance payer either electronically (via Electronic Data Interchange – EDI) or through paper submission.

 

8. Claim Processing

The insurance company:

  • Adjudication. Reviews the claim to determine its validity, accuracy of codes, and whether the services provided are covered under the patient’s insurance policy.
  • Response. Issues an Explanation of Benefits (EOB) to the provider and the patient detailing the covered amount and any adjustments, denials, or additional information required.

 

9. Payment Posting

Once the claim is processed:

  • Payment Posting. Recording the payment from the insurance company into the patient’s account, noting any adjustments, deductibles, or co-insurance amounts.
  • Patient Billing. Generating any remaining patient bills for amounts not covered by insurance.

 

10. Follow-up

If there are issues or denials:

  • Denial Management. Reviewing and addressing denials, submitting necessary corrections or additional documentation, and resubmitting claims.
  • Accounts Receivable Management. Tracking unpaid claims and conducting follow-ups with patients and payers as necessary.

 

11. Reporting and Analysis

Finally:

  • Reporting. Generating reports to analyze the efficiency of the process of medical billing in Texas, identify trends, and ensure financial health.
  • Continuous Improvement. Implementing improvements based on analysis to streamline future billing processes and minimize errors

Why Healthcare Practices Can Benefit from Texas Medicaid

 

Learning Texas Medicaid’s Managed Care System

Texas Medicaid operates primarily through a managed care system under programs like STAR, STAR+PLUS, and STAR Kids. These programs are designed to streamline billing processes, reduce administrative burdens, and ensure timely reimbursements. For providers, Texas Medicaid’s managed care model offers a structured environment that supports consistent revenue flow while enabling a focus on patient care.

 

Enhancing Patient Access to Services

Texas Medicaid has made huge strides in incorporating telehealth services into its reimbursement structure. Providers can bill for a variety of virtual services, including consultations, follow-ups, and remote patient monitoring. This is especially beneficial in Texas, given the vast rural areas where there is limited access to healthcare. Telehealth bridges this gap, allowing providers to extend care to underserved populations while maintaining a reliable revenue stream.

 

Integrating Behavioral Health Services in Texas Medicaid

Behavioral health is a crucial component of Texas Medicaid, with integrated billing options for mental health counseling, substance abuse treatment, and crisis intervention. The state’s focus on holistic care enables providers to offer comprehensive behavioral health services, addressing physical and mental health needs. This integration supports consistent billing opportunities across multiple care areas, promoting better patient outcomes.

 

Texas Medicaid’s Support for Home and Community-Based Services

Texas Medicaid supports a wide range of HCBS through various waivers, enabling providers to deliver in-home care, personal assistance, and community-based services for individuals with disabilities, the elderly, and those with chronic conditions. These services are important in a state with a large and diverse population, guaranteeing that vulnerable individuals receive care within their communities supported by reliable Medicaid funding.

 

Supporting Rural Healthcare Providers

Texas Medicaid recognizes the unique challenges faced by rural healthcare providers and offers higher reimbursement rates and specific incentives for services provided in these areas. These initiatives help rural populations gain access to vital healthcare services and offer financial motivation for providers to extend their reach into underserved communities.

Texas Medical Billing and Coding: Choose Practice Support Today!

Crunching numbers are tough for most people to handle, and that’s why Practice Support is available to provide quality medical billing and coding services. We are one of the very few medical billing and coding companies in Texas that is always ready to lend a helping hand. Don’t waste time and save your company from medical billing errors by working with us.

Hire Practice Support to experience quality services from experienced medical billers and coders.

Schedule a consultation