medical coding training at home.
When filing medical claims against health insurance providers, there are a few simple rules that will get you paid. It starts when the patient enters the door.
The person that controls the first encounter is the person that will get paid. Make sure that person is you-the doctor. You should have trained your personnel well enough to know how to handle each patient. They are all unique and need to be handled as such. With that in mind though, you still must gather certain information. You should have a patient profile form that requests each and every piece of information necessary to send to the insurance company. You should also get a copy of numerous pieces of identification, not just the insurance card but drivers license and any other supporting documents. This should occur on each and every visit. I know of so many practices that think once they have some of the initial information, they do not have to go through that anymore. They also do not get paid. You must verify that the insurance is in effect on the date of service (DOS) and determine if any or all of the deducible has been met.
Make sure all co-pays and deductibles are paid at the window before seeing the physician. You have now established a pattern that will get you paid.
It is now time to hand off the patient to the nursing staff. On the surface, it appears the nursing staff is to focus only on the health aspect of the visit. That could not be further from the truth. The nurse has all of the demographics right in front of her and it is now a good time to go over all of that information to verify that what you have is what you need. This not only helps you get paid, but could by extremely valuable should there be a recall on a vaccine you use on this particular visit. By verifying insurance, address, work, and especially all phone numbers (cell, home, work) you now have a method of contacting the patient.
The patient has now been placed in a room waiting on the physician. The physician now has an opportunity to review the chart to ensure that all of the information has been collected before he sees the patient. If not, he can get the nurse to update the needed information.
Once the physician has completed the exam, the process moves to the medical billing office. The physician should have selected the appropriate procedures and the supporting diagnosis codes. It is incumbent on the billing office to ensure those codes are current, adequately supporting and up to date. The information is entered into your claims processing software and is now ready to transmit to the insurance company.
medical coding training at home.