One of the ways to make improvements at your ENT practice or clinic is to hire a company like MD Pro Solutions to complete a professional consultation that includes auditing and reviews. Offside CPA audits, surgical chart auditing, annual fee schedule review, and an analysis of account management are just some of the areas that will help you to improve. When we perform these reviews, our team will be better equipped to offer solutions for Otolaryngology management billing and coding, including comprehensive record-keeping and issues with fast and accurate credentialing for staff.
The data collected can help us to implement helpful changes and improvements to your ENT practice that will get you on the road to success. We can continue providing consultant services through a system of ongoing audits and reviews to help you stay on top of coding and billing completed by staff or through an outsourced billing solution. We do not pressure our clients to switch software or providers. Our goal is to help you maximize the return on your investment with whatever programs, tools, and services that you are currently using, as long as you are satisfied with the results. If you want to make a change, we will work with you to find a solution that best meets your requirements.
The Medical Billing Cycle
The process that is done for the purpose of medical billing is essentially a communication between the medical provider or practice and the insurance company. Other third-party payers, including Medicare and Medicaid, also operate in the same way, accepting claims submissions for covered patients. The communication process is known simply as the billing cycle, which can take anywhere from days and weeks to weeks and months to complete. In some situations, more than one communication is required to achieve a resolution for the information that is submitted.
- The first step in the medical billing cycle is when the patient visits the provider for diagnosis or treatment. The provider collects all essential information and includes it into the patient record. A procedure code is used to identify the services that were provided during the visit from the code database, which is used in claims submissions during the billing process.
- The next step is to send these codes to the proper insurance company. Today, most ENT practices and clinics submit this information electronically so the claim can be processed as soon as possible. The claim is processed by a medical claims adjuster or examiner. If the cost is significant, it may even be evaluated by a medical director.
- Once the claim has been approved, the next step is to reimburse the physician at the ENT clinic or practice based on a pre-negotiated percentage. However, if the claim has been denied or rejected, it is sent back to the provider in what is known as the Explanation of Benefits form.
If a provider receives a rejection, they must first review the information, reconcile the billing statement based on the data obtained, make any required corrections, and then resubmit the claim. In some situations, this process may be repeated multiple times until the reimbursement is made. Some practices have a rejection rate that is as high as 50 percent. The cause for this high rate is due to the complexity of Otolaryngology management billing and coding. Sometimes it is because the services are not covered under the patient’s policy. The provider must carefully submit proof of services provided if they hope to overturn the original denial decision.
How MD Pro Solutions Can Help
If you are experiencing an unusually high percentage of rejected or denied claims, we can help. Our team will work with you to perform a series of offside CPA audits and reviews to ensure that you and your team are working to maximize your earnings and that all coding is being done accurately and according to the provider’s requirements. Comprehensive record-keeping and other good habits are essential to make a marked improvement in this area. We can also help with online coding support, education, and training, fast and accurate credentialing, and other essential services. Give us a call at 508-946-1665 to learn more about our services for Otolaryngology management billing and coding.