Medical Billing and Coding in Wisconsin
Navigating the complexities of medical billing and coding in Wisconsin is important for healthcare providers seeking to optimize their operational efficiency and financial outcomes. With the state’s diverse healthcare landscape and continuously evolving regulations, having a proficient billing and coding service is more critical than ever.
That’s where Practice Support steps in and provides the necessary solutions. We have worked with various healthcare practices across the state, so you should know that your company is in good hands.
Why Wisconsin Healthcare Practices Hire Us
Led by Experienced Clinicians
Increase Efficiency
Our solutions enable your staff to focus on patient care by automating and streamlining the billing process, a feature not always provided by other medical billing companies. Using advanced software systems, we minimize manual tasks to guarantee your practice operates seamlessly.
Boost Earnings
Practice Support maximizes your revenue potential by minimizing errors and optimizing the claims process. Our medical billing in Wisconsin is devoted to reducing claim denials and enhancing reimbursement rates, helping you capture every dollar you’re entitled to.
Adhere to Billing Regulations
Streamline Claim Tracking
Learn Our 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 statuses, 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 Wisconsin’s Medicaid Program
Managed Care Efficiency and Integration
Wisconsin’s Medicaid program, BadgerCare Plus, operates primarily through managed care organizations (MCOs). This system integrates physical health, behavioral health, and dental services into a streamlined billing process. The managed care model helps reduce administrative burdens for providers while ensuring predictable and timely reimbursements, allowing for a focus on comprehensive patient care.
Telehealth Expansion for Rural Access
Wisconsin Medicaid has embraced telehealth, providing comprehensive reimbursement options for virtual consultations, remote monitoring, and other telemedicine services. This is particularly beneficial in Wisconsin’s rural areas, where access to healthcare can be limited. Telehealth services allow providers to maintain consistent care delivery and revenue streams while improving patient access to necessary services across the state.
Behavioral Health Billing Opportunities
Wisconsin Medicaid offers extensive billing options for behavioral health services, including mental health counseling, substance abuse treatment, and crisis intervention. The state has integrated behavioral health into its managed care plans, promoting a holistic approach to patient care. This integration supports consistent billing opportunities for providers specializing in behavioral health, ensuring that mental health services are accessible and adequately funded.
Supporting Home and Community-Based Services (HCBS)
Wisconsin supports a wide array 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 a diverse population, ensuring that vulnerable individuals receive care in their communities backed by reliable Medicaid funding.
Emphasis on Preventive Care
Wisconsin Medicaid emphasizes preventive care, providing reimbursements for services such as immunizations, well-child visits, cancer screenings, and routine health check-ups. This focus on prevention helps improve long-term health outcomes and reduces overall healthcare costs, providing a steady revenue stream for providers who prioritize preventive care services.
Hire Practice Support for Expert Medical Coding and Billing Services in Wisconsin
Choosing Practice Support for your medical coding and billing needs in Wisconsin means working alongside experts who can enhance your healthcare practice’s efficiency and financial health. Our comprehensive services ensure accurate claims processing, reduced denials, and seamless compliance with state regulations.
Call us if you have questions about our work, like how we do medical coding in Wisconsin. Experience the peace of mind of having a trusted ally with Practice Support’s expert solutions.
Schedule a consultation