Medical Billing and Coding Virginia
In Virginia’s dynamic healthcare environment, hiring professional medical billing and coding services is important for any healthcare provider looking to optimize operations and sustain profitability. With complex regulatory requirements and evolving insurance policies, managing billing processes in-house can be time-consuming and prone to error.
With Practice Support, Virginia healthcare providers can ensure precise claims processing, minimize denials, and maintain compliance. We have worked with various healthcare practices across the state, which has given us the knowledge needed to provide quality results.
Benefits of Working With Practice Support
Increase Efficiency
Our solutions enable your staff to dedicate more time to patient care by automating and streamlining the billing process—something other medical billing companies do not always offer. By using advanced software systems, we reduce manual tasks, ensuring your practice operates smoothly and efficiently.
Boost Earnings
At Practice Support, we improve your revenue potential by reducing errors and optimizing the claims process. Our medical billing in Virginia focuses on reducing claim denials and improving reimbursement rates, capturing every dollar you deserve.
Streamline Claim Tracking
Led by Experienced CliniciansLed by Seasonesd Clinician
Adhere to Billing Regulations
Practice Support’s Medical Billing and Coding Process
1. Confirming the Validity of the Patient’s Insurance
- Verification. Gather detailed insurance information from the patient, including copies of both sides of the insurance card and any other required data.
- Eligibility Check. Confirm the insurance plan’s current status and coverage through a phone call or online system.
- Benefits Verification. Determine the plan’s coverage details, such as co-pays, co-insurance, deductibles, and any necessary pre-authorizations or referrals.
- Document Results. Log the verification details into the patient’s records for future reference.
2. Scheduling an Appointment With the Provider
- Patient Information. Verify or collect the patient’s demographic details and medical history.
- Appointment Booking. Arrange the appointment using the practice management system, considering the provider’s availability.
- Reminders. Dispatch reminders via phone, email, or text to minimize no-show occurrences.
3. Delivering Care (First Occurrence)
- Patient Check-In. Update the patient’s personal details and insurance information at reception.
- Consultation. The provider examines the patient and formulates a diagnosis and treatment plan.
- Service Documentation. Document all services and procedures conducted during the visit.
4. Updating Details in the EMR
- EMR Entry. Enter visit information into the Electronic Medical Records system, including medical history, diagnostics, and procedure notes.
- Code Assignment Preparation. Verify that documentation is complete and precise for coding purposes.
5. Practice Support Identifies the Codes
- Medical Coders. Certified coders evaluate EMR data to assign proper ICD, CPT, and HCPCS codes.
- Accuracy Check. Ensure codes accurately represent the services provided and conform to payer policies.
6. Delivering Care (Second Occurrence, if Needed)
- Follow-Up Appointments. Schedule any essential follow-up visits for continued care.
- Continuation of Care. Thoroughly document follow-up visits to record all provided services.
7. Claim Submission
- Claim Preparation. Assemble detailed patient and service information for the claim.
- Claim Validation. Utilize claim scrubber tools to detect and correct potential errors before submission.
- Electronic Submission. File the claim via electronic data interchange (EDI) or through a clearinghouse.
- Submission Confirmation. Record the receipt of confirmation for the claim submission
8. Claim Processing
- Payer Review. The insurance payer examines the claim for correctness and eligibility.
- Determination. The payer determines whether to approve, partially deny, or reject the claim fully.
- Explanation of Benefits (EOB). Receive and record the EOB that outlines the payer’s decision on the claim.
9. Payment Posting
- Receive Payment. Obtain payments from both the insurance payer and any due amounts from patients.
- Post Payments. Log these payments within the practice management system and update the patient account accordingly.
- Adjust Account Balances. Implement necessary adjustments per agreements and post any remaining balances owed by patients.
10. Follow-Up
- Denial Management. Investigate and rectify reasons for denied or underpaid claims, then proceed to resubmit or appeal when necessary.
- Patient Billing. Issue statements for balances due and pursue overdue accounts.
- Customer Service. Respond to inquiries or concerns from patients or payers about the bill or provided services.
11. Reporting and Analysis
- Operational Reports. Create reports detailing claim Virginia, denials, payments, and accounts receivable to assess financial health.
- Performance Analysis. Evaluate the effectiveness of coding, billing, and collections, identifying areas for improvement.
- Compliance Audits. Conduct regular internal audits to ensure compliance with billing and coding regulations.
Get to Know Virginia’s Medicaid Program
Managed Care Efficiency and Integration
Virginia’s Medicaid program, the Commonwealth Coordinated Care Plus (CCC Plus) program, operates primarily through managed care organizations (MCOs). This system integrates various healthcare services into a streamlined billing process, including physical health, behavioral health, and long-term care. Providers benefit from predictable reimbursements and reduced administrative burdens, which support a focus on comprehensive patient care.
Telehealth Integration and Accessibility
Virginia Medicaid has integrated telehealth into its reimbursement framework, allowing providers to bill for virtual consultations, remote monitoring, and other telemedicine services. This is especially important for reaching patients in rural and underserved areas of Virginia, where access to healthcare can be limited. Telehealth services ensure patients receive timely care while allowing providers to maintain a consistent revenue stream.
Behavioral Health Billing Opportunities
Behavioral health is a key component of Virginia Medicaid, with integrated billing options for mental health counseling, substance abuse treatment, and crisis intervention. The state’s focus on integrating behavioral health with physical health care supports holistic patient care and provides consistent billing opportunities for providers specializing in mental health services.
Home and Community-Based Service (HCBS) Support
Virginia supports a wide range of HCBS through Medicaid 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 crucial in a state with diverse urban and rural populations, ensuring that vulnerable individuals receive care within their communities backed by reliable Medicaid funding
Pediatric Care and Developmental Support
Virginia Medicaid offers strong support for pediatric care, particularly for children with special healthcare needs, developmental delays, and chronic conditions. Providers can bill for specialized therapies, early intervention programs, and comprehensive care plans, ensuring steady funding while addressing the unique needs of Virginia’s children.
Let Practice Support Help Your Healthcare Practice's Medical Coding and Billing Operations
Let your practice’s medical billing and coding operations experience increased efficiency by hiring Practice Support. You can trust our professional team of medical billers and coders to provide quality results. Combining our expertise and streamlined process, we achieve precise claims processing, minimize denials, and maintain smooth compliance with state regulations.
Call us now to learn more about our work, like how we do medical coding in Virginia.
Schedule a consultation