Medical billing is the process of preparing, creating, submitting, following up on, and resolving claims for payment for medical services rendered to patients. It involves creating and submitting invoices, known as claims, to insurance companies or government healthcare programs, and working with payers to ensure that the claims are processed correctly and payment is received for the services provided. The process involves a complex set of rules and regulations that must be followed, and typically involves the use of specialized software and a trained medical biller.

Revenue Cycle Management (RCM) in Medical Billing is the process of managing the flow of financial information and patient data from the point of service to payment, ensuring efficient and effective reimbursement while maintaining compliance with industry regulations and standards.

The medical billing cycle is a process that starts with patient appointment, entry, eligibility check, coding, charge entry, claim submission, payment posting, AR review, and denial management.

CPT (Current Procedural Terminology) codes are standardized codes used to describe medical procedures and services performed by healthcare providers. HCPCS (Healthcare Common Procedure Coding System) codes are used to describe supplies and equipment used in patient care. ICD (International Classification of Diseases) codes are used to describe diagnoses and medical conditions. These codes are used by medical billers and coders to accurately communicate information about medical procedures and conditions to insurance companies and government healthcare programs, and play a crucial role in determining payment for medical services.

Handling denied or rejected claims in medical billing requires a systematic approach to avoid payment delays and improve revenue cycle management. To handle denied or rejected claims properly we ensure that we review the reason for denial, check for errors, resubmit the claim with necessary corrections, appeal the decision, negotiate with payers, keep detailed records and stay up-to-date with regulations.

At Advanced RCMS, we ensure accurate and timely submission of claims to insurance companies by maintaining thorough and up-to-date patient information, using the correct codes for procedures and diagnoses, double-checking for errors, staying current with insurance company and government regulations, utilizing medical billing software and trained medical billers, following up on denied claims and making any necessary appeals, and regularly communicating and building relationships with insurance companies.

Insurance providers, co-payments, and deductibles play a crucial role in medical billing by determining the amount of coverage for medical expenses, and the financial responsibility of both the patient and the insurance company.

At advanced RCMS, we Manage and track patient payments, outstanding balances, and collections by using a robust medical billing software, implementing effective follow-up procedures, and consistently reviewing and reconciling patient accounts to ensure accuracy and timely payment.

We regularly attend industry events and conferences, consult with professional organizations and industry experts, and regularly review industry publications and websites to stay up-to-date with changes in insurance policies and reimbursement rates.

The process for appealing denied claims and securing payment for services rendered involves reviewing the reason for denial, correcting any errors, resubmitting the claim with supporting documentation, negotiating with the insurance company, and appealing the decision through a formal appeals process if necessary, while consistently documenting all steps taken.

We maintain confidentiality and compliace with HIPAA regulations by implementing strict security measures, such as encryption and secure storage of patient information, training employees on HIPAA requirements, regularly reviewing and updating policies and procedures, and ensuring that all third-party vendors also comply with HIPAA regulations.

Providing a clear and detailed breakdown of charges for patients can be achieved by using clear and concise language, breaking down the costs into individual components, such as the cost of the service, any supplies used, and any applicable taxes or fees, and providing a comprehensive and easy-to-understand bill or statement.