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Our team of certified coders (CPC) and professional billers (CPB) has an in-depth understanding of the intricacies of current rheumatology coding and billing guidelines. Empowered with the right technologies, our team leverages their expertise for accurate claims submissions for rheumatology-relevant medical services like imaging, infusion therapy, laboratory testing, medication management, etc. We customize our approach to assist healthcare providers in various settings to minimize claims denials and maximize reimbursements. Here’s how we do it:
- Use specialized billing software integrated with digital technologies such as electronic health records (EHR), electronic medical records (EMR), and electronic data interchange (EDI) to simplify billing and ensure all codes and procedures are current.
- Employ a checklist-based approach to capture comprehensive patient details (demographic details, physician referrals) and insurance information (primary, secondary, ID numbers, effective date, expiration date, and relevant financial details like co-payments, deductibles, and coinsurance responsibilities for each payer).
- Expertise across various rheumatology billing types, including capitation billing, global billing, episode-of-care billing, telemedicine billing, etc.
- Ensure zero-error claims filing by maintaining code specificity (HCPCS level II codes, ICD-10 codes covering rheumatoid arthritis, osteoarthritis, gout, etc., and CPT codes covering ranges of evaluation and management (E/M) codes (99201–99499), injection and infusion codes (96372–96379, 96401–96549), laboratory and pathology codes (80047–89398), and more ).
- Submit claims using the precise fee schedules and payment regulations set by Medicare, Medicaid, and various private insurance payers like Kaiser Permanente, Cigna, and others, aiming to optimize reimbursements to their fullest potential.
- Appoint a specialized expert in claims status to handle patient inquiries and serve as a liaison with insurance providers. The expert will actively monitor the status of claims to ensure prompt adjudication.
- Engage with payers and verify EOBs to know about services covered and not covered under claims. If needed, we resolve errors and discrepancies to initiate the appeal process.
- Generate a comprehensive report on out-of-pocket expenses such as copayments, deductibles, coinsurance, etc., to inform patients about their payment responsibilities for uncovered services. This helps our clients prevent unpaid claims.
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