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The complete process of tracking a patient encounter from registration and appointment scheduling to the final payment and closure of the account. It ensures practices get paid correctly and on time.
The overall service of submitting claims to insurance payers and patients, following up on denials, and ensuring proper reimbursement for services provided by the doctor.
Seamlessly connect systems for streamlined workflows and optimized performance
The process of actively managing and pursuing all claims that are currently unpaid by payers or patients. The goal is to maximize collections from submitted claims.
The accurate recording of payments (from both insurance companies and patients) into the practice management system. This process closes accounts and identifies any remaining patient balances or claims that need follow-up.
The process of verifying a patient's active insurance status and understanding their coverage details (e.g., co-pays, deductibles, and covered services) before the service is rendered.
Obtaining official approval from the patient's insurance company for a specific service or referral before the procedure is performed. This is critical for preventing claim denials.
An administrative role focused on handling the initial contact, scheduling, insurance verification, and paperwork for new patients to ensure a smooth, compliant entry into the practice.
The process of organizing, maintaining, and securely retrieving a patient's clinical and demographic documentation, ensuring all records are accurate and compliant with HIPAA regulations.
Translating the doctor's documentation of diagnoses and procedures into standardized codes (like CPT, ICD-10, and HCPCS) required by insurance payers for billing and reimbursement.
The professional responsible for generating claims based on coded services, submitting them to insurance companies, and managing follow-up on outstanding payments.