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Medical Billing and Coding

Healthcare Revenue Cycle Management, Revenue Cycle Outsourcing

Medical Billing and Coding is the layman’s term for Revenue Cycle Management services. While usage of this term might include portions such as AR follow-up and Denials Management, it typically does not include Insurance Verification, Physician Credentialing or Data Indexing services that are the other portions when outsourcing medical billing.

The major areas in Medical Billing and Coding are:

Patient Registration/Demographic Entry

Medical Coding Services

Charge entry Services

EDI-Set up/Electronic Claims transmission

Payment Posting

AR follow-up

Denial Management

The process starts either with entering or auditing of the patient Demographic information, when the charting is still done on paper. In cases where an EHR (Electronic Health Record) or HIM (Hospital Information Management) system is used, then the Demography information automatically gets ‘pulled’ into the Billing system and only an audit might be required.

The next step which is critical to the whole process is medical coding. Medical coding is the process of assigning Diagnoses (ICD) and Procedure (CPT) codes. In addition, there are other codes used such as the HCPCS (Hospital and supplies) and ASA (Anesthesia) codes and ADA (Dental) codes. e-care is one of the few medical coding companies located offshore that has got many of its medical coding staff complete the online ICD-10 CM certification.

On completion of the medical coding service, the next step is to enter the charges for the coded encounters. The charges vary by payer and also by location (county specific), in addition to being unique for each service or procedure done by the physician.

After the charges are entered, a ‘claim’ is created which is ready to be sent to the payer through EDI process. The transmission of claims is electronic which facilitates quick insights into ‘rejections’ that can be immediately re-worked at the billing or medical coding level and transmitted again.

The payer processes the claim and sends an electronic document in the form of ERA (835) which might contain both payment and denial information. The payment posting team then segregates these and performs the payment posting where the paid amounts are reconciled against the charges that were created earlier. The Denials are then sent to the Denial Management team for further analysis and re-work.

Outsourcing medical billing and medical coding services to e-care ensures that the entire process is handled with accuracy and within the agreed turnaround times, resulting in increased cash flow and ROI.

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