Physician practices are increasingly relying on professional medical billing firms to manage their billing, coding and reimbursement issues. These companies have structured and well-organized processes in place to ensure speedy settlement of claims.

1. How can Medical Billing Companies be more Efficient?

2. While timely provision of medical service and patient care is the main concern of
healthcare providers, many of these entities struggle to strike a balance between this
and their administrative work. Busy healthcare facilities find it difficult to handle
claim submission and settlement. Submitting medical claims to an insurance carrier
and managing the overall claim process has to done with great attention to
detail, failing which practice revenues would be adversely affected. Professional
medical billing companies have experts on the job. They implement structured and
well-organized processes to prevent denials and delays, and settle outstanding
claims quickly.
Well Organized Processes for Accurate and Timely Claim Processing
Medical billing specialists implement the following processes to submit claims and
ensure proper and timely payment:
Insurance Verification and Authorization: Incorrect patient information,
even errors in spelling, can lead to the need for claim rework and resubmission.
In a professional medical billing company, all insurance benefits and coverage
details are verified prior to the appointment to ensure patient eligibility.
Information such as payable benefits, demographic details, pre-authorization
number, details on co-pay, co-insurance and deductibles, patient policy status,
effective date and plan details are verified online or by calling the insurance
provider. Patient information is entered into billing system with utmost care.

3. Accurate Coding: Accuracy in coding is necessary for the smooth processing of
medical claims. Inaccurate or outdated codes lead to claim rejection. Reliable
firms have a team of experienced, AAPC-certified medical coders who stay
updated with the latest developments and can assign the right CPT, ICD or
HCPCS codes for all treatments and procedures.
Charge Capture: Charges are reviewed for completeness and accuracy. The
charge team enters the codes and charges as they appear on the bill. The charge
entries are audited for typographical or keying errors.
Claim Scrubbing: System-based claim scrubbing is performed before
submission to validate all patient information, CPT, ICD, and HCPCS code
combinations. The codes are checked against National Correct Coding Initiatives
(CCI) edits, Medically Unlikely Edits (MUEs), frequency allowances, and more.

4. Patient Collection: Patients are personally contacted to enquire about and
collect the payments that are due from them. In fact, many physician practices
lose out on payments from patients because they do not follow-up on these and
even write them off.
AR Management: All unpaid insurance claims and EOBs are assessed,
prioritized and followed up on immediately by the AR analysts. Follow-up is
handled via electronic clearinghouses, insurance websites and via telephone and
email.
Payment Posting: ERA and EOB payments are posted daily into the billing
software against the appropriate patient account. Low payments and denials are
identified and necessary refund requests or appeals are generated.

5. A physician’s office needs to be focused on delivering proper treatment and care,
and undertaking medical coding and billing tasks in-house would prove too
burdensome. Medical billing companies have the expertise to provide
professional medical billing and coding solutions and that’s why they can help
physicians settle claims efficiently and quickly.
Claims Appeal Process: A dependable medical billing company will allow
any claim to be written off without appealing it first. Based on the conditions of
claim rejection, the medical billing specialist takes all the steps necessary to
resubmit the claims and ensure reimbursement.
Contact Us
8596 E. 101st Street, Suite H
Tulsa, OK 74133
Main: (800) 670 2809
Fax: (877) 835-5442
E-mail: info@managedoutsource.com
URL: www.outsourcestrategies.com