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Billings and Collections ProcessFor medical practices, getting paid for services provided involves several steps. With extensive experience in managing the claim submission process, a reliable medical billing company can help physicians receive proper and timely reimbursement. A professional service provider would have specific strategies in place to coordinate with payers and to improve the billing and collections process.

  • Accurately fill out claim forms: The claim form will be duly filled in with the relevant details including physician or supplier name and address, physician or supplier Tax ID or NPI (National Provider Identifier) Number, policy holder’s (member’s) name, patient’s full name, type of service and procedure code, date of service or purchase, diagnosis and diagnosis code, condition being treated, and charge for each service. The payer that should receive the claim – Medicare or private insurance – will be clearly identified.
  • Submit claims on a daily basis: The biller will ensure that the claims of your medical practice are submitted electronically on a daily basis. All claims will be double checked before submission so that payment is not delayed.
  • Handle rejections and denials by including the patient in calls with the payer: Denials are usually due to missing information, billing errors, and questions about patient coverage, while rejections may be caused by incorrect patient information. By including the payer in the calls with the payer, the medical billing team will present a more convincing front.
  • Adhere to standardized billing procedures: An established medical billing company will adhere to clearly defined, standardized billing, coding and collection procedures that covers:
    • Medical appointment scheduling
    • Patient enrollment
    • Insurance enrollment (for the practice)
    • Insurance verification
    • Insurance authorizations
    • Coding including HCC coding and HEDIS coding
    • Audits
    • Payment posting
    • account analysis and denial management, and
    • AR management

They will also have proper claim follow-up and resubmission practices in place. Questions about denied claims will be discussed with the payer’s representative. Denials will be followed up via letter or the telephone. With these established, efficient billing processes, a reliable provider of physician billing services can help practices maximize revenue.