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The process begins with capturing accurate patient information, including personal details, insurance coverage, and contact information. This step ensures a comprehensive and error-free record for billing purposes.
Verification of patient insurance coverage is crucial to determine eligibility and benefits. This step involves confirming the patient's insurance details, policy limits, and any pre-authorization requirements, minimizing claim rejections.
Medical coding involves translating the healthcare services and procedures performed into universally recognized alphanumeric codes. Accurate coding is essential for billing accuracy and compliance with industry standards, such as ICD-10 and CPT codes.
Once coding is complete, the next step is to submit claims to insurance providers. Claims can be submitted electronically or via paper, depending on the payer's requirements. Timely and accurate submission is crucial to expedite the reimbursement process.
Adjudication is the process where insurance providers review and evaluate claims for accuracy and compliance with their policies. During this stage, claims may be accepted, denied, or sent back for clarification. Any discrepancies are addressed to facilitate smooth reimbursement.
After claims are approved, payments are received from insurance providers. The amounts are posted to the patient's account, and any remaining balances are billed to the patient. Additionally, ongoing follow-up is conducted to address claim denials or discrepancies, ensuring maximum reimbursement for the healthcare provider.
Stars Pro® Medical Billing inventive model is one of the fastest growing physician practice communities in the United States. We are dedicated to lashing change in the medical community by providing progressive, state-of-the-art solutions. Through our Channel Partnerships.
