Medical billing & coding

Medical billing and coding is the process of converting diagnoses, medical tests, treatments, and procedures into standardized codes. These codes are then used to bill patients, insurance companies, and government entities for medical services provided. Medical coding is the translation of medical procedures into a universal language, while medical billing is the submission of claims and receipt of payment.

We know that we work for you. Each practice is unique, and our services are customized to meet the needs of each individual practice. Your dedicated Account Coordinator will work with you to achieve optimum efficiency of claim submission. We work in conjunction with the practice staff, the insurance companies as well as the patients to ensure that we have all the required information to minimize errors and delays in payments.

Hiring a medical billing company can be beneficial for several reasons:

• Expertise and Efficiency: Medical billing companies specialize in navigating the complex landscape of healthcare billing and coding. They have trained professionals who are knowledgeable about the latest regulations, codes, and billing practices. This expertise can lead to fewer billing errors and quicker reimbursements.
• Cost Savings: Outsourcing your medical billing can potentially reduce costs compared to maintaining an in-house billing department. You save on salaries, benefits, training, and the overhead costs associated with managing billing staff and software.
• Focus on Patient Care: By delegating billing responsibilities to a dedicated company, healthcare providers can focus more on patient care and less on administrative tasks. This can improve patient satisfaction and overall efficiency in the practice.
• Improved Cash Flow: Medical billing companies are skilled at following up on unpaid claims and ensuring timely reimbursements. This can lead to improved cash flow for your practice, as payments are processed more quickly and efficiently.
• Compliance and Risk Management: Staying compliant with ever-changing healthcare regulations is crucial. Medical billing companies stay updated on these regulations and help ensure that your billing practices are compliant, reducing the risk of audits or penalties.
• Access to Technology: Many billing companies use advanced billing software that integrates with electronic health records (EHR) systems. This integration can streamline the billing process and provide comprehensive reporting and analytics.
• Scalability: As your practice grows, a medical billing company can easily scale its services to accommodate increased patient volume and billing complexity.
  

Benefits of a Smaller Medical Billing Company:

• Personalized Service: Smaller companies often offer more personalized service. You may have direct access to the owners or managers who are more involved in day-to-day operations. This can lead to quicker response times and a more tailored approach to addressing your practice’s unique needs.
• Flexibility: Smaller companies may be more flexible in adapting to changes in your practice or specific billing requirements. They may be willing to customize their services to better fit your workflow and preferences.
• Focus on Client Satisfaction: With fewer clients to manage, smaller companies may prioritize client satisfaction and building long-term relationships. They may go the extra mile to ensure your billing processes are efficient and effective.
• Cost: In some cases, smaller companies may offer competitive pricing compared to larger firms. They may have lower overhead costs and pass on savings to clients.
• Expertise in Niche Areas: Smaller billing companies may specialize in specific medical specialties or niche areas of healthcare billing. This specialized knowledge can be beneficial if your practice has unique billing requirements.
  

The time frame to get set up to start billing for a practice can vary depending on several factors, including the complexity of your practice, the types of insurance plans you want to bill, and the efficiency of the credentialing and billing process. However, here is a general outline of the steps involved and the typical time frames:

• Credentialing and Contracting: This is often the longest part of the process. Credentialing involves submitting applications, verifying credentials (education, licensure, certifications), and waiting for approval from insurance companies and government programs (like Medicare and Medicaid). This process can take anywhere from 2 to 6 months or longer, depending on the complexity and the responsiveness of the insurance companies.
• Setting Up Billing Systems: Once you are credentialed, you’ll need to set up billing systems. This includes choosing and integrating billing software with your practice management system (if not integrated already), setting up fee schedules, and ensuring that billing staff are trained on the software and processes. This typically takes 1 to 2 weeks, but can vary depending on the complexity of your practice and the software chosen.
• Provider Enrollment: After credentialing, you may need to complete provider enrollment with specific insurance plans. This involves additional paperwork and processes to ensure that your credentials are updated and that you are listed as a participating provider. The time frame for provider enrollment can range from a few weeks to a couple of months.
• Testing and Implementation: Before you can start billing for actual patient visits, it’s important to conduct testing to ensure that your billing system is working correctly. This involves submitting test claims to verify that they are processed and paid correctly by insurance companies. This testing phase typically takes 1 to 2 weeks.
• Go-Live and Initial Billing: Once testing is successful, you can go live and begin billing for actual patient visits. This transition period can vary depending on the volume of patients seen and the efficiency of your billing processes. Typically, practices aim to start billing within a month after completing credentialing and system setup.

Overall, the entire process from initial credentialing to starting billing can range from 3 to 9 months or more, depending on various factors. It’s important to plan ahead and start the credentialing process well in advance of when you anticipate opening your practice or beginning to see patients.

Medical insurance credentialing is the way insurance companies verify that medical providers are legitimate and qualified to receive reimbursement for services provided. When a provider is credentialed with a given payer, they can bill the payer directly and receive reimbursement.