Medical Billing Process

MEDICAL BILLING PROCESS

The medical billing process at CPA's Outsource, LLC follows a series of clearly defined steps with a complete focus on accuracy, quality and process audits.

The following are the steps involved in the medical billing proces:

1. Claims Transmission to CPA's Outsource: The medical's office forwards the claims to CPA's Outsource's medical billing team as scanned documents. The medical claim is supported by patient details such as demographics, superbills, charge sheets, insurance verification data, a copy of the insurance card and any other information pertaining to the patient. All such documentation is scanned and uploaded onto our secure FTP server for access by CPA's Outsource's expert medical billing staff.

2. Retrieval and Checking of Medical Claims by our Team: CPA's Outsource's medical billing staff access the medical claims and supporting documents from our secure FTP servers. All documents are checked for illegible or missing documents and the medical billing office is notified immediately so that they can re-scan and send missing documents.

3. Medical Coding: An important step in claims processing is to fix the procedure and diagnoses codes for each patient based on standards such as CPT ('Current Procedural Terminology')and ICD-9 (International Classification of Diseases, Ninth Edition). The 'level of service' determines the associated 5-digit 'procedure code' while the 'diagnosis code' is based on the medical diagnosis made by the doctor. Our trained Medical Billing professionals will then create appropriate medical claims based on billing rules pertaining to specific carriers and locations. All medical claims are created within agreed turnaround times - generally 24 hours.

4. Medical Claims Audit: A thorough audit and checking of the completed medical claims is done at multiple levels within CPA's Outsource. The medical claims are checked for valid and complete information, correct procedure and diagnosis codes and veracity of all other relevant information about the patient since incomplete/incorrect information is one the single most common cause for rejection of medical claims.

5. Medical Claims Transmission: Medical claims created are filed for follow up before they are sent electronically to the claims transmission department with all relevant information on each medical claim.

6. Claims Submission to Insurance Agencies: The audited, listed and recorded medical claims are now printed out and dispatched to concerned Insurance Agencies or governmental departments with any attachments or supporting documents that may be required for ultimate settlement.

7. Follow-up and Settlement: This involves the final stages when our expert medical billing team follows up consistently with the insurers and payment agencies until the final settlement is disbursed.