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Physician billing is the systematic process of submitting and handling claims with health insurance companies to secure payment for services provided by physicians. The billing process includes accurately coding medical procedures and diagnoses, submitting claims to insurers, and overseeing the billing cycle to ensure timely payments. However, this type of medical billing is challenging due to the complex physician medical codes, complicated billing rules and regulations, etc. The billing complexity becomes more pronounced due to the absence of a proficient billing team while maintaining service excellence.
At Invensis, we comprehend the challenges associated with physician billing and, therefore, offer tailored solutions designed to tackle these challenges and relieve you of the burden. Our physician billing team works dedicatedly to keep your billing process compliant and streamlined by:
- Collecting patient details, including demographics, physician referral information, relevant insurance numbers (Medicare, Medicaid, or Social Security, and medical history.
- Confirming the patient's insurance coverage, eligibility, and benefits before providing services to avoid claim denials and unexpected out-of-pocket costs.
- Assigning billing experts for physicians to handle multiple billing models, including value-based billing, telemedicine billing, capitation billing, episode-of-care billing, etc.
- Translating diagnoses, treatments, and procedures into standardized ICD-10 diagnoses, E/M codes for service complexity, HCPCS Level II codes for specific procedures and supplies, relevant modifiers, and CPT codes required for insurance claims for the services rendered.
- Maintaining specific physician billing with correct CPT code ranges including 99201–99499 - office visits, hospital visits, consultations; 00100–01999 - anesthesia services; 10000–69999 - surgical procedures; 70010–79999 - radiology procedures, etc.
- Preparing and electronically submitting claims to insurance companies, ensuring they comply with payers such as Blue Cross Blue Shield Association, Humana, etc, maximizing potential reimbursements.
- Logging payments received from insurance companies and patients and applying them accurately to the corresponding accounts.
- Identifying and analyzing the reasons for claim denials, then taking corrective action to resubmit claims and recover revenue.
- Generating and sending bills to patients for any outstanding balances after applying insurance, including co-pays, deductibles, and non-covered services.
- Monitoring unpaid claims and patient balances and following up with insurance companies or patients to ensure timely payment.
- Generating regular financial reports and analyzing the physician billing data to identify trends, improve processes, and optimize revenue cycle management.
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