Medical billing is the process of submitting and following up on claims with health insurance payer's in order to receive payment for services rendered by a healthcare physician. A medical billing specialist focuses on insurance collections, payment posting, and payer rejections. An effective claims tracking process can optimize revenue performance for the physician practice or facility.
Medical auditing covers a variety of areas including medical record standards and documentation guidelines, coding compliance, reimbursement concepts, audit scope and statistical sampling methods, and more. Audits can be performed on clinical documents, billing records, coding resources, and administrative data. Accurate auditing can help reduce errors and improve processes and procedures in the physician practice or facility.
Medical coding involves the review of clinical documentation (physician notes, laboratory tests, radiology results) and assigns standard codes using CPT, ICD-10-CM, and HCPCS. Coding guidelines are constantly updating and changing - a knowledgeable medical coder can maximize reimbursement for the physician practice or facility.
Deep diving into your data can give a physician everything he/she needs to know in order to have a fully functioning and profitable practice or facility. Data analyzing methods can include an array of focus topics, such as: denials, collections, accounts receivable, profit/loss, and more. Clean data can provide trends, improvements, and insights of the past, present, and future of the physician practice or facility.
Consulting & Training
Consulting and training involves the explanation of fundamental skills that are needed for managing a practice or facility. Continuing education on the development, implementation, and monitoring of compliance, regulatory guidelines, risk assessments, and staff education is a valuable service to have available. Extensive practice management knowledge contributes to the success of the physician practice or facility.
Physician practices and facilities need a little help with all the "extra" responsibilities when it comes to health insurance. For example, some tedious and time consuming tasks include: insurance verifications, prior authorizations, patient collections, and personal injury claims. All administrative processes and procedures, if done effectively, will ultimately enhance revenue for the physician practice or facility.