100% Payment From Insurance On All Claims
A large percentage of claim rejections are due to lack of prior insurance verification or having incorrect benefit information. Getting proper health coverage information is a prerequisite to successful claim processing and patient care. Biller’s target should be getting all claims paid with first submission. In order to do that, office and biller must have patient’s correct demographics and insurance information. A form of picture ID is a must as well. At MBS, we make medical coverage verification a priority. We verify medical coverage for patients ahead of the appointment date by confirming active coverage and referral requirements. We also work with the office staff to ensure proper information is collected at the time of the appointment and help develop effective patient processing steps.
We do not submit claims just because they are generated in the software. Before submitting claims, we make sure proper patient information is reflected on the form and we also check for correct provider information and health information of patients. Our billing team audits all exams and billing codes to make certain all coding is done correctly and coded for the highest reimbursement. We also review all exams for appropriate level of coding. We review exam documentation to make sure it supports codes that have been billed. Our comprehensive scrubbing process is put in place to send proper information to the insurance companies and maintain highest integrity in patient health documentation. When we find conflicting information on a claim, we immediately report this to the provider and wait on provider’s written directions before submitting claims.
Our work toward submission of claims begins as soon as the provider finalizes the exam. We review exams for supporting documentation. We check all documentation for Doctor’s notes on testing, and details or operative notes. We make sure all services provided by the doctor are billed according to individual insurance rules and regulations. Every single claim form narrates a patient’s visit to the doctor. One single form has the burden of carrying immense amount of information. The claim form tells the insurance, who was treated by the doctor, why did the patient come in to see the doctor, where did the patient see the doctor, how long was the visit, what were the special circumstances for the visit, what was done, and why was it done. Once claims clear our scrubbing process, they are then submitted to insurance and followed carefully for expedite processing.
Billing and Coding
MBS takes a holistic approach to billing. Successful billing takes a well organized team. We keep updated on all eye related news and updates. We also attend CME courses for billing and coding and HIPAA throughout the year. We research on any revision proposed or enacted for CPT codes and diagnosis codes. We keep doctors and staff updated on new rules and regulations as well. We study billing patterns and give regular feedback to providers. MBS helps doctors code efficiently by equipping them with latest information on the ever-changing world of billing codes. We attend all Academy meetings to stay current on billing and coding. We also have established communication with AAO coding experts for research on billing issues. We check each claim to make sure diagnosis codes support the billed CPT codes before submitting claims.
We have been successful in increasing practice earning for all our providers. Before we start billing for any practice, we spend a lot of time studying and researching on past billing reports and current outstanding. We take notes on what has been done correctly and what part of billing needs improvement. By knowing the pitfalls of the past, we are able to avoid claim processing troubles for future. We work closely with practice staff and doctors to process claims efficiency and swiftly. We assure payment on all claims billed through us. Since we take the time to study accounts before taking on the billing, we are ready to hit the ground running on the first day. We also work on aged claims which are still within the timely filing limit and try to get those claims paid. We can also review provider’s contract and fee schedule to verify all are in order.
The insurance web gets more complicated each year. There are constant changes in laws and regulations. Insurances are branching out to provide coverage for special groups and at times small groups are combining under a bigger umbrella. Even established practices have to do new credentialing for newly created insurance plans. It is of utmost importance to retain a copy of all contracts. Each contact comes with designated fee schedule for the provider. Contracts must be maintained and updated to assure proper payments of claims. We are prepared to do any credentialing needed by established providers in the practice as well as new providers. We can help with building CAQH and state licensing process. We can also work on new contracts with insurances.