Practice Management

Appointment Scheduling: 

Practice management starts with scheduling an appointment of the patient.  All the appointments scheduled should be confirmed a day before the appointment.  By this way, the physician can be aware of the schedule for that day and accommodate stat patients, walk-in patients, etc.

Appointment Cancellation:

All the appointments that are cancelled or rescheduled should be tracked.  This helps the physician's office to maintain the resources and use them at its very best.


No Show:

No show is one of the major issues in a physician's office.  No shows should be handled very carefully.  Always make sure your patients are aware of the charge for a no show.  Before sending a bill to a no show, it is better to call the patient and analyse the reason for not showing up.  If there is really a good reason for not showing up, it is always better waive the charge and reschedule the appointment.  This also helps in growth of your practice.


Akurate Management Solutions:  Helping small physician offices with entire practice Management.  

An overview of Medical Billing Process

The Medical Billing Process is basically divided into the following:

1.  Insurance Verification.

2.  Patient Demographic Entry.

3.  Medical Coding.

4.  Charge Entry.

5.  Claims Submission.

6.  Payment Posting.

7.  A/R (Account Receivable) Followup.

8.  Denial Management.

9.  Reporting.

Insurance Verification

• After an appointment is fixed with a provider, the patient submits the insurance details to the provider’s office.

• The provider’s office checks with the insurance if the patient is active and the services that need to be provided are covered by the patient’s insurance or not.

Patient Demographic Entry

• Demographics consist of the following:

1. Patient Name.
2. Date of Birth.
3. Age.
4. Sex.
5. Address, contact number.
6. Insurance Details.

All the above are entered into the EMR once the patient appointment is fixed and the insurance is verified.

Medical Coding

• Once the provider renders services to the patient, the provider documents all the services, diagnosis, and procedures.  The documentation is done through Medical Transcription or the provider enters directly into the EMR.

• All the documented services, diagnosis, and procedures are coded by a Medical Coder giving an alphanumeric code to each service, procedure and diagnosis.

Charge Entry

• Charge entry is the process of entering all the codes into the billing software.

• Also assigning the value for each code as per the fee schedule.

• Entering the insurance details for the respective patients.

Claims Submission

• Once all the charges are entered into the billing software, these are checked for any errors and transmitted to the respective insurance companies.

• If an insurance company accepts claims electronically, then they are submitted electronically or else paper claims are mailed to their respective addresses.

Payment Posting

• Once all the claims are submitted, we start receiving payments from the insurance companies between 7-30 business days.

• The checks/EFTs will be directly transferred to the provider’s account.

• The insurance company will also post an EOB/EOP (explanation of benefit/payment) giving details of the payment and how much amount has been paid for each claim.

• From the EOB/EOP, we need to post into the billing software the respective claim payments.

• We also receive ERAs directly into the billing software, which can be automatically posted.

A/R (Account Receivable) Followup

• We need to follow up on the claims, for which we have not received a payment or any response from the insurance company.

• Firstly, we check online status in the insurance website if any information on the claim is available.

• Then, we call the insurance company and know the status of the claim and reason for the delayed response.

Denial Management

• For the claims which have been denied by the insurance, we need to evaluate the reason for the denial and make necessary corrections and submit them for reprocessing.  This includes:

1. Calling the insurance for reason for denial.
2. Getting information from the provider if anything is required.
3. Getting the information from the patient, if there is an issue with the patient’s insurance plan.
4. Checking with the coding department for coding issues.
5. Finally, resubmitting the claim or filing an appeal with the necessary documents.

Reporting

• Reporting is a very important feature in the billing process through which the provider will know the status of his practice and the changes that needs to be taken in the practice to improve the revenue of the practice.  Some of the important reports are:

• Monthly reports:

1. Payments report:  Payment received for a month.
2. Charges report:  Volume of claims submitted.
3. A/R balance:  The amount still pending with the insurance.

 There are numerous reports, but depending on the provider’s requirement they will be generated.

Coding Preventive Care and Office visit on the same day

If an abnormality/ies is encountered or a preexisting problem is addressed

in the process of performing this preventive medicine evaluation and

management service, and if the problem/abnormality is significant enough

to require additional work to perform the key components of a problem-

oriented E/M service, then the appropriate Office/Outpatient code 99201-

99215 should also be reported. Modifier 25 should be added to the

Office/Outpatient code to indicate that a significant, separately identifiable

Evaluation and Management service was provided by the same physician

on the same day as the preventive medicine service. The appropriate

preventive medicine service is additionally reported.

An insignificant or trivial problem/abnormality that is encountered in the

process of performing the preventive medicine evaluation and management

service and which does not require additional work and the performance of

the key components of a problem-oriented E/M service should not be

reported.

Example: A 50-year-old established patient comes in to the office for an annual wellness visit and at the same time also complains of a severe chest pain.

The physician performs comprehensive preventive evaluation as well as a separate level III elements of an office visit  for chest pain and reports it in addition to the preventive medicine service, then the coding can be done as follows:

CPT       MOD        ICD

99396                   V70.0

99214    25           786.50.