Billing Services

Charge Entry & Validation
-Accurately key all charges into the practice management system based on provider documentation.
-Validate billed amounts to ensure they align with the current-year fee schedule and contractual payer allowances.
-Apply annual fee schedule updates and verify correct pricing prior to claim submission.

Coding & Compliance Review

-Ensure all required CPT, HCPCS, and ICD-10-CM codes are correctly assigned.

-Apply appropriate modifiers in accordance with payer, CMS, and coding guidelines.
-Confirm diagnosis-driven requirements are met and support medical necessity for billed services.

Place of Service (POS) Verification
-Validate correct place of service codes based on clinical setting (office, facility, telehealth, etc.).
-Ensure POS consistency with payer-specific billing rules.

Payer & Authorization Management
-Confirm the correct insurance payer is billed as primary, secondary, or tertiary.
-Verify all required prior authorizations, referrals, and certifications are obtained and documented.
-Ensure authorization details (numbers, dates, units) are accurately reflected on claims.

Claim Submission
-Submit clean claims electronically via EDI or mail CMS HCFA-1500 forms when required.
-Adhere strictly to payer-specific claim formatting and submission guidelines.

EDI & Claim Rejection Management
-Monitor EDI reports for rejections and errors.
-Research, correct, and resubmit rejected claims promptly to ensure successful transmission.
-Identify root causes of rejections to prevent recurring issues.

Post-Submission Follow-Up
-Follow up with payers after electronic submission or mailed claims to confirm receipt and processing status.
-Maintain systematic follow-up schedules to ensure timely adjudication.