Our Medical Billing and Coding Process in Wyoming
1. Confirm Patient’s Insurance is Valid
- Verification Process. Before the patient receives care, the medical office staff confirms insurance coverage. This involves checking the patient’s insurance card and contacting the insurance provider to verify the policy number, coverage type, co-payments, deductibles, benefits, and other limitations.
- Pre-authorization. The insurance company may need pre-authorization for certain procedures or specialist consultations. This step guarantees that the insurance provider approves the coverage of the service.
2. Schedule an Appointment With the Provider
- Appointment Booking. The patient is scheduled for an appointment through scheduling software or via phone. During booking, staff confirms demographics, contact information, and insurance policy details.
- Reminders. Automatic reminders via phone or email are often sent to ensure the patient remembers the appointment.
3. Delivery of Care
- Consultation & Treatment. On the day of the appointment, the patient receives the care or treatment from the healthcare provider. This may include consultations, diagnostic tests, procedures, and follow-up recommendations.
- Documentation. Providers document all aspects of patient care, including diagnosis, treatment plans, prescriptions, and any advice given.
4. Details are Updated on the EMR (Electronic Medical Records)
- Data Entry. Post-treatment, details from the appointment are entered into the EMR system. This record includes patient history, diagnostic results, treatment given, and any recommendations.
- Accuracy Check. Ensuring the data entered is accurate and complete is critical, as this information is used for subsequent billing and coding processes.
5. Practice Support Identifies the Codes
- Coding Process. Our practice support staff or medical coders review patient records and identify the correct ICD-10 (International Classification of Diseases) codes for diagnoses and CPT (Current Procedural Terminology) codes for medical procedures performed.
- Compliance. Accurate coding is needed to comply with insurance company requirements and to ensure the practice receives appropriate reimbursement.
6. Delivery of Care (Second Occurrence)
- Additional Services. If patient care involves multiple visits or continued treatment, delivering care and updating the EMR is repeated as necessary.
- Ongoing Documentation. Continuous documentation is maintained to ensure that every additional service is recorded.
7. Claim Submission
- Claim Creation. Based on the coded procedures and diagnoses, we create a claim. This includes service details, patient information, and insurance information.
- Electronic Submission. Claims are typically sent electronically to the insurance company using standardized formats (e.g., HIPAA 837 format). Some practices may also submit paper claims.
- Timely Filing. Ensuring claims are submitted within the time frame to avoid denials due to late submissions.
8. Claim Processing
- Insurance Review. The insurance company reviews the submitted claim to determine if the services provided are covered under the patient’s policy.
- Adjudication. This includes checking eligibility, verifying coverage, and assessing co-payments, deductibles, or co-insurance amounts. The insurer may approve, deny, or request more information.
9. Payment Posting
- EOB/EOP. Explanation of Benefits (EOB) or Explanation of Payments (EOP) is received from the insurance company outlining what has been covered and any payment adjustments.
- Posting Payments. Payments received from insurance companies and patients (for co-pays or out-of-pocket expenses) are posted to the patient’s account in the billing system.
- Balance Billing. If any amount is not covered by insurance, the balance is billed to the patient.
10. Follow-Up
- Denial Management. If a claim is denied or underpaid, billing staff reviews the reason for denial. They may need to correct and resubmit claims or appeal the decision.
- Patient Follow-Up. Contacting patients for any outstanding payments or clarifying billing concerns.
11. Report and Analysis
- Reporting. Regular reports are generated to monitor the practice’s financial performance. This includes accounts receivable aging reports, denial rates, payment turn-around times, and revenue cycle metrics.
- Data Analysis. Analyzing data identifies trends, billing errors, and areas for improvement. It assists in enhancing operational efficiency and ensuring compliance with healthcare regulations.
The Importance of Medicaid in Wyoming
Prompt and Precise Reimbursements
Wyoming Medicaid operates primarily under a fee-for-service model, rather than through managed care organizations (MCOs). This type of structure offers flexibility but requires providers to carefully manage billing processes for timely and accurate reimbursements. Understanding this system is needed for maintaining financial stability and optimizing billing practices in Wyoming’s Medicaid environment.
Integration Into Telehealth
Wyoming Medicaid has integrated telehealth into its reimbursement policies, allowing providers to bill for virtual consultations, remote patient monitoring, and other telemedicine services. This is particularly vital in a state like Wyoming, where large rural areas and low population density can limit healthcare access. Telehealth services ensure patients receive timely care, and providers can expand without needing extensive physical infrastructure.
Billing Options for Behavioral Health Services
Wyoming Medicaid offers extensive billing options for behavioral health services, including mental health counseling, substance abuse treatment, and crisis intervention. The state emphasizes the integration of behavioral health services within primary care settings, providing consistent billing opportunities for providers and ensuring that mental health care is accessible across the state.
Extensive Support for Home and Community-Based Services
Wyoming supports a variety 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 important in a state with a significant rural population, helping vulnerable individuals receive care within their communities, backed by reliable Medicaid funding.
Pediatric Care Support
Wyoming Medicaid offers 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 Wyoming’s children.
Looking for Reliable Medical Billing and Coding Companies in Wyoming? Choose Practice Support!
When you need to hire expert medical billing in Wyoming, make sure you remember Practice Support. We have provided our services to multiple practices and satisfied their needs. Our company understands that billing errors can greatly impact your practice. We do our best never to let that happen and to ensure you get a streamlined cash flow.
Hire us today if you have questions about our medical coding in Wyoming.