Medical Billing : How does it work?

Medical Billing Process

We believe that the whole process revolves around having efficient staff who understands that the most important thing about billing and collections is information. Proper information gathering is the most important step. This process requires not only a lot of accurate collection of information as well as proper data entry and follow up. The process starts at the front desk. We have given a brief explanation below on how our process works. Please contact us if you have any further questions.

Front Desk

A new patient or an existing patient contacts the office. The front desk then collects all insurance information (by phone, fax or in person, if the patient is a walk in) for medical billing and verification purpose. This information is then sent to MOS. This is then verified and authorized relative to the type of care the patient is seeking. If it is a referral, a special pre-authorization may need to be obtained from the respective Primary care physician.

Insurance Verification and authorization

On an initial visit; after the front desk collects all the information, insurance information is then transferred to MOS. (By fax, scan, e-mail or by accessing the database at the client site). The insurance is immediately verified and sent back to you. This would also be entered in the system for billing purposes. Any information pertaining to the client that is needed, including prior verification for procedures or treatment will be verified. The front desk then proceeds to inform the patient on his/her deductibles, Co-payments, eligibility and so on.

Consultation

The patient then proceeds to see the physician or the respective provider. After the patient is advised on the care that is necessary for them, it is determined if any special preauthorization is needed, and that information is transferred to the team with the right amount of documentation and the special authorization taken care of immediately.

Coding

Coding is the next step toward billing; by putting the proper code on a proper document for the visit. This can be done by the physician or the transcription department. MOS does pre coding and coding for medical offices and have AAPC certified.

QA process

The insurance coders or medical coders after their coding will have the document send for audit and review before they are sent to the billing department. Only after these processes are done the work is handed over to the billing department for processing.

Billing

Charge Entry and Charge Posting. We provide support for all software and are very well versed with most billing systems and can provide support for UB 92, HCFA and so on. We can do electronic medical billing and paper claims processing as required by insurances.

Charge Team

In this department we have competent individuals who first enter the patient personal information from the Demographic sheets. They then check for the relationship of the diagnosis code and CPT. They then creates a charge, according to the billing rules pertaining to the specific carriers and locations. All charges are accomplished within the agreed turnaround time, which is generally 24 hours can be faster if necessary.

Audit

The daily charge entry then needs to be audited to double check the accuracy of this entry, in other words, this is the check and balance to make certain the billing rule is being followed accurately. Also this department verifies the accuracy of the claims based on carrier requirements to be sure we have a clean claim.

Claims Transmission

Claims are then filed and information sent to the transmission department. The transmission department prepares a list of claims that go out on paper or through electronic media. Once claims are transmitted electronically, confirmation reports are obtained and filed after verification. Paper claims are printed and attachments done, and if necessary, put into envelopes and sent to the US for postage and mailing either from the client site or from MOS office. Transmission rejections are analyzed and appropriate corrective action is taken.

Carrier Adjudication

The carrier Utilization Review department would then review the claim and after their review, the claim would then be adjudicated and processed for payment. Then the check and explanation of Benefits (EOB) is sent to the provider.

Cash Application

The Cash Applications team receives the cash files (Check copy & EOB) and applies the payments in the billing software against the appropriate patient account. During cash application, overpayments are immediately identified and necessary refund requests are generated for obtaining approvals. Also underpayments/denials are informed to the analysts.

Patient Billing

When our analyst team requests that the patient has to be billed for a deductible or for the balance the charge team would proceed to do so.

Collections

We also provide comprehensive collections to ensure high reimbursements. Please read more about this at our collections page.

Please Contact us if you have more questions.