Medical billing is the process of submitting and following up on claims with health insurance companies or government healthcare programs in order to receive payment for medical services rendered by healthcare providers such as physicians, hospitals, and other healthcare facilities. The medical billing process typically involves gathering and verifying patient information, verifying insurance coverage and eligibility, submitting claims to insurance companies or government healthcare programs, and following up on claims to ensure timely payment. Medical billing professionals are responsible for ensuring that claims are accurately coded and billed, and that all relevant information is provided to the insurance companies or government healthcare programs. Medical billing is an important aspect of the healthcare industry, as it helps to ensure that healthcare providers are properly reimbursed for the services they provide, and that patients are not responsible for paying more than their insurance coverage allows. It can be a complex and time-consuming process, which is why many healthcare providers outsource their medical billing to specialized companies or hire dedicated medical billing professionals to handle this task.

The medical billing process is a series of steps that billers follow to submit claims to insurance companies or government healthcare programs for the medical services they have provided. The process typically involves the following steps: 1. Patient registration and insurance verification: This involves gathering and verifying patient demographic and insurance information, including their name, address, date of birth, insurance ID number, and policy details. 2. Medical coding: Providers use standardized codes (CPT and ICD-10) to describe the medical services provided to the patient. These codes are used to generate a claim that is submitted to the insurance company or government healthcare program. 3. Claim submission: Once the medical coding is complete, claims are submitted the insurance company or government healthcare program. The claim includes the patient and insurance information, the medical codes, and a description of the medical services provided. 4. Claim processing: The insurance company or government healthcare program reviews the claim to determine if it is a covered service, if the patient is eligible for benefits, and if the medical codes used are appropriate. If the claim is approved, payment is made to the healthcare provider. 5. Payment posting and reconciliation: Once payment is received, the medical billing company posts the payment to the patient's account, and reconciles the payment with the original claim. Any discrepancies or denials are investigated and resolved. 6. Patient billing: If the patient is responsible for any portion of the cost of the medical services, the medical billing company bills the patient for their portion of the payment. The patient is then responsible for paying the balance of the bill. The medical billing process can be complex and time-consuming, and may require specialized knowledge and skills. Many healthcare providers outsource their medical billing to specialized companies such as The Billing Department, Inc to handle this task.

Many billing companies only submit claims. Some of the largest billing companies in the US only send out claims and do not do any follow up or denial management. We are different. We know most of the work involved with billing comes from claims resolution and denial management. We spend the bulk of our time making sure the claims we submit to payers are paid.

We provide complete Revenue Cycle Management. When we take on a new client, the first thing we do is evaluate their accounts receivable. We work with the client to improve the billing process and make the process is as efficient as possible. We utilize technology to improve the time and energy that providers and their staff spend on billing. Once we implement updates to the billing process, we evaluate the effectiveness of the interventions or changes that were made to the billing process. Billing requires constant monitoring and process improvement. We never stop evaluating and updating the billing process.

We never expect our providers to trust that claims are paid, we want to prove to our clients claims are paid. We create systems that allow providers to easily evaluate the health of their accounts receivable and invite open communication and feedback from our clients.

Yes, we collect from both insurance companies and your patients. Collecting from patients can be just as challenging as collecting from insurance companies. If providers do not have solid, clear collection policies with their patients, money can be lost. We strongly recommend implementing Credit Card on File Programs and we help our clients set up these programs with updated Financial Policies and procedures for this.

Billing takes time and it takes time to get your billing going and for the process to run smoothly. Depending on the provider and the amount of process improvements required, some providers may not be through the implementation period for up to 6 months, sometimes more. Changing your medical billing provider is a big deal! And it takes time. We take the time with our clients to ensure their billing process is improved and running optimally.

Yes! If you like your current software, we can use that to manage your medical billing.

You don't have to. We can work with providers to set-up efficient paper systems.

The set-up process is fairly quick. We can usually start billing within 2 weeks of bringing on a new client.

We can help you decide. We can set-up a meeting to look at your exisitng accounts, together. We can help you better understand the current finanicial health of your practice.