Medical Billing
Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider. Medical billing translates a healthcare service into a billing claim. The responsibility of the medical biller in a healthcare facility is to follow the claim to ensure the practice receives reimbursement for the work the providers perform. A knowledgeable biller can optimize revenue performance for the practice. Aver Healthcare is providing medical billing services to our clients at an affordable price.
At Aver Healthcare, we believe we can be a true medical billing partner and that having a culture of urgency, transparency, and accountability lead to a better client experience. We are skilled professionals and problem solvers that take pride in being responsive and reliable for our clients.
Insurance Eligibility & Benefits verification is one of the top most integral part in the Medical Billing process. As per the industry research, most of the insurance denials or delays in processing the claims occur due to missed or improper coverage information.
Insurance companies frequently make policy changes and updates in their health plans. If the provider or the billing office is not aware of these changes, this may directly impact the practice cash flow. Therefore, verifying patient’s Eligibility & Benefits becomes inevitable part in the Medical billing cycle.
Our insurance verification team follow a standard questionnaire while verifying the patient’s eligibility & benefits. This questionnaire has been built in a way to zero out any rejections from the payers and ensure all the claims sent out reaches the payer as a Clean Claim resulting in maximizing the cash flow of the practice.
Post to the service rendered to the patient, Aver Healthcare verifies all the Patient insurance and demographic details completely before updating the information in the Billing Software. On existing patients the team verifies the eligibility on cases when the patient returns for additional service. Our experienced billing professionals ensure a seamless solution by minimizing the data entry through creative combination of advanced technology in the billing software.
The Process can be enumerated as:
- Receipt of patient information from the client thru secured network
- Validation of Patient Information
- Registering / uploading patient demographic and insurance details in the billing software.
CPT Coding:
Current Procedural Terminology (CPT) is a medical code set that is used to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies and accreditation organizations. CPT codes are used in conjunction with ICD-9-CM or ICD-10-CM numerical diagnostic coding during the electronic medical billing process.
ICD 10 CM:
ICD-10-CM is a seven-character, alphanumeric code. Each code begins with a letter, and that letter is followed by two numbers. The first three characters of ICD-10-CM are the “category.” The category describes the general type of the injury or disease. The category is followed by a decimal point and the subcategory. This is followed by up to two sub classifications, which further explain the cause, manifestation, location, severity, and type of injury or disease. The last character is the extension.
Each diagnostic note needs to be coded with CPT and ICD-10 codes to enter into the medical billing system. Our experienced coders take care of the coding process with high levels of accuracy and diligence. In case your bills are pre-coded, we will validate them to prevent up-coding/down-coding and integrate into the billing process.
Medical billing charge entry services by our team can help healthcare organizations improve and maintain an uninterrupted cash flow, avoid any delays in payments, and minimize the instances of denied and rejected claims. Our team of data entry specialists takes care of even the smallest of the details, which could have a great impact on the claims later and ensure that all the charge entry we do is completely error free.
Quality Check:
The completed claims are once again checked for valid and complete information, correct procedures and diagnoses codes. The single most common cause for rejection of claims is the submission of incomplete/incorrect information. The efficient medical billing process by our staff eliminates such chances
The final audited and recorded medical claims are printed and sent to the respective insurance agencies and government departments along with relevant information and the necessary supporting documentation required for the final settlement.
Clearing House:
A Medical claims Clearing House acts as a middleman between the provider (doctor, dentist, chiropractor, etc.) and the payer (insurance company). The practice management software on a billing professional’s computer creates an electronic file (the claim). This file is then uploaded to your medical billing clearinghouse account. Our staff will follow up on acknowledgement reports sent by clearing house for any rejection and other internal errors and send the claims with correct information.
One of the final steps of the medical billing process - payment posting, is imperative for an optimized revenue cycle. Once payments are posted to patient accounts, any denials can be addressed following accurate payment posting methods. At the same time, quick turnaround time and attention to detail are important aspects of the payment posting.
Our analytics team accurately identifies the source and reason for claims denial, reduces the denial rate, and helps businesses improve their revenue cycle. We have a well-experienced team of denial analysts trained to identify the root cause of expensive denials and detect the trends and patterns of such denials. This helps healthcare organizations or the physicians to rectify the problems in their process and ensure that such instances do not occur in the future.
We provide Medical Billing and Coding services with utmost security, following all HIPAA regulations to protect your sensitive data. We can provide you with the information required to fully understand the state of your practice. We provide reporting on payment and charges, accounts receivables, reimbursement, procedure code analysis, insurance analysis, payment analysis, bulk pending issues and denials.