Medical billing to MF

Outsource Medical billing to MF

Medical billing is the process of generating healthcare claims to submit to insurance companies for the purpose of obtaining payment for medical services rendered by providers and provider organizations

Medical billing is a department that provides support services to hospitals and physicians. Medical billing and coding broadened into independent companies of all sizes, inevitably becoming an essential component of the healthcare system, as standards and requirements for proper medical coding and billing procedures increased. Medical billing is continuously a complex process of documenting and obtaining the correct insurance carrier reimbursement for the treatment and care given to patients. Correct medical billing necessitates not just a broad range of knowledge and comprehension of the medical billing process but also a blend of provider specialty billing experience and knowledge of the periodically changing regulations and norms of health insurance companies.

An array of procedures is routinely taken during the billing process in order to ensure precise and timely invoicing. Depending on the organization's particular billing process, the steps may differ, however a few typical ones are as follows:

Collection of data in medical billing: This entails gathering all pertinent information regarding the goods or services offered and their costs, and other billing-related data.
Making a claim in medical billing: After gathering the data needed, a claim is prepared and contains the details of the goods or services delivered, the cost, the terms of payment, and the contact information for both the service provider and the patient.
Assessment and confirmation: The authorized staff evaluates and approves the invoice after it has been produced to verify accuracy.
Claim sent out: The claim/invoice is sent to the payer by mail or electronically upon approval.
Maintenance of records: Keeping complete records of all the bills, payments, and follow-up activities is crucial. This makes it easier to monitor cash flow and spot inconsistencies.

Medical Billing – Patient's Demographic Entry

When a doctor or other healthcare facility treats a patient, they have a right to compensation. The medical billers job is to recover these unpaid sums from the insurance. The medical biller in MF determines whether services were rendered by reviewing the super bill or encounter forms that are linked to the patient's record after each medical appointment. MF Medical biller's double-check the patient's insurance coverage and record the name of the insurer. The data entry/keying skills of our MF team are exceptional for the following headers.

Patient information: Patient id #, Patient name, Date of birth, Gender, Marital status, SSN#, Address (physical & mailing address), home telephone number, work mailing address and telephone number.
Guarantor/Account details: Guarantor name, date of birth, Gender, marital status, SSN#, Address (physical & mailing address), home telephone number, work mailing address and telephone number.
Insurance Details: Insurance name and address, Insurance identification number, Group name/Group number, policy effective and termination date, Name of the insured (subscriber), date of birth & Gender of the subscriber, Relationship of the insured to the patient/guarantor, Financial Class (FC).

Medical Billing – Claims/Charge Entry

Charge entry is the process or set of processes by which charges for medical services and other patient-facing services are submitted to the appropriate payors for billing. One of the key aspects that make up a crucial element of medical billing is charge-entry. It is the Medical Billing department that handles keying-in. Once the super bills and encounter forms (patient registration forms, doctor office notes, and prescription notes) have been received from the doctor's office, they move on to the first phase of billing, where the pre-coding and coding department extracts the procedure codes, HCPCS, diagnosis codes, modifiers, place of service, type of service, and units from the super bills. The claim is then prepared in the charge-entry department after the captured codes have been entered in the relevant forms. For each patient's demographics that arrive for the first time, the charge entry person creates an individual account and issues an individual account number. A charge-entry employee additionally performs a quality check on the coding and immediately alerts the supervisor to any up- or down-coding that has been carried out. Only experience and expertise in that doctor's speciality billing can provide this. Once the claims entry is finished and combined with the patient demo data, it is ready for auditing and is sent electronically through the clearing house to the insurance provider.

Claim line item entry - CPT codes/Diagnosis codes/Place of service/Modifiers/Units/Type of service/Price per line item.

EDI rejections: Once the insurance company receives the claims electronically through the clearing house, we receive the clearing house's acknowledgements on transmission, which are referred to as EDI reports, whether or not the claims reached the payer side. All clearing houses perform a preliminary check of the data they receive for any inaccuracies or missing claim information. According to thier guidelines, clearing house would reject claims if there were any data input errors. The type of error and its location would be made very apparent in this EDI rejection report. These claims are returned for revision to the charge entry department.

Navigate to where your clearinghouse stores your rejections.
Review each claim and adjust the incorrect information accordingly.
Resubmit each claim for another clearinghouse level review.
Rejected claims aren’t denials
Rejection messages tell you what you need to adjust within the claim
If the rejection message relates to the Billing Provider, Rendering Provider, or Tax ID, you’ll have to verify provider credentials with the payer
Clearinghouse-level rejections happen instantly, provider-level rejections take at least two days
Your clearinghouse should be able to act as the middleman between you and the payer so that you don’t have to worry about claim submission requirements

Medical billing - Payment/Cash posting.

Payment Posting in Medical Billing is a process wherein the payments are logged into the system. This provides us an overview of the entire payment details and help us understand the collections through various payers. Payment posting gives a clear picture of doctor's office payment and the financial practices of the healthcare organization. In addition, the process gives you an overview of your entire economic cycle, including the revenue leaks, so that you can sort the issue promptly.

MF's payment posting solutions save your office important time, increase data accuracy, and ensure that money flows into the right accounts by managing your denials along with posting payments. Insurance payments must be posted, which takes time. A practice must post the information into the appropriate accounts with codes and adjustments along with the correct tallying of the check received and the EOB notice when it gets payment and an EOB notice. This will make it possible to evaluate aggressive AR management and proper revenue flow. It is simple to deal with additional problems like capitation insurance contracts, co-pays, deductibles, global payments, AR adjustments, refunds, and supplementary insurances.

Payments may be distributed among several recipients or locations in some instances or same recipents with multiple tax id/NPI number in multiple locations. Due to the necessity of retaining numerous bank deposit slips, each one needs to be reconciled and posted separately.

The payment poster prepares after downloading the scan files.

Payment Controls Log: This lists the number of the scan file, the scan date, the number of pages, the deposit date, the batch number, the deposit amount, the posted amount, the un-posted amount, the backlog, and any remarks. Every year, this is kept month by month. The client is not required to use these logs as they are created for internal usage only.
Monthly Transaction Log: Once or twice every week, the client sends this. The deposit amounts are listed here by deposit date. This record is verified at month's end to make sure that all cash has been received and posted.

Medical Billing – Types of payment posting

Patient payments: The patient's payments for the co-pays, co-insurance, and deductibles set by the insurance company.
Payments to Collection Agencies: Accounts are forwarded to a collection agency when patients put off paying for a protracted period of time. In turn, the collection agency will take the required actions to obtain payments from these patients. When received, these payments are designated as Collection payments.
Insurance payments: Posting funds obtained from the insurance company to the relevant open patient accounts, insurance authorized amount, paid amount, patient responsibility, and contractual write off.
No EOB comprises simply payments; it also includes a combination of rejections.
Denial posting: Denial posting is a crucial component of payment posting. In a medical billing cycle, posting denials and starting the appropriate actions are essential steps that will shorten the days that payments are past due.

EOB and ERA posting and reconcilement: Ensure that the posting is done in proper intervals, and during the reconcilement process, the EOB and ERA data match payments.

During the course of cash posting, we may encounter adjustments/offsets, refunds, clarification from insurance etc.

Medical Billing – Refund is processed for the following reasons

The insurance carrier or the patient has overpaid.
Two carriers paid the claim as primary.
Both the secondary insurance and the patient as paid co-insurance.
Stated charge/patient is not in the account

Payment Adjustments

Adjustments, such as contractual write-offs, discounts, or refunds, need to be recorded during payment posting. These adjustments reflect any contractual agreements between the healthcare provider and the insurance company, as well as any discounts or refunds provided to the patient. Charge adjustments for uncollectible sums are made utilizing particular transactions.

Small Balance Adjustment: If the insurance company or the patient leaves a small sum out after receiving payment that can be adjusted as a small balance adjustment. On balances of $10.00 or less, or in accordance with the client's requests, a minor balance adjustment will be made.
Medical Billing: Filing Limit Adjustment: You must accept a filing limit adjustment if the insurance refuses the claim because the filing limit was exceeded even after an appeal or if the claim was really first filed after the filing limit.
Adjustment for Bundled Services: Bundled services are those for which payment is made along with payment for another operation. A bundled services adjustment is made in the event that a procedure has been rejected as a bundled code.

All payment adjustments are made as per clear guidelines from client and confirmation on adjustment notification sent.

Medical billing quality control process: MF follows TWO TIRE quality check on all billing work.

Medical Billing – Level I- Floor QC: The entire demo and charge entered is quality checked by field by field for errors and checking for client specifications error by the floor QA team.
Medical Billing – Level II- Random QC: MF senior QC team who monitors entire operations randomly picks demo and charge entered by the each billing staffs every half hour and quality checks for error and reporting back to the account manager and billing staffs.
Verify for typos
Billing mistake
Specification mistake
System flaw

Everyone on the team @ MF receives weekly quality audit reports, and the billing staffs' work is regularly tracked and evaluated.

Medical billing error rate: With the combined expertise of our operations and QA teams, we have achieved significant advancements in the quality of our deliverables and the satisfaction of our customers. MF has an error rate of 0.99, which is faultless.

Send us an inquiry if you're interested in outsourcing MEDICAL BILLING to MF, and we'll respond with the best possible solution.

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