(Brandon, MS, USA)
We’ve started a medical billing service and we want to understand best practices or the different ways in which we would get the information from our billing client in order to do the claim submissions, denial management, and payment posting.
If you’re planning to assume the outstanding claims and accounts it can get complicated pretty fast. That’s why we try to very clearly define and document the scope of our services and responsibilities in the contract with the client before getting started. If someone else is handling the outstanding or old claims, we will enter each patient in our billing software as a new patient using either the existing clients database or the info from the new patient information paperwork and insurance card.
From our experience access to the existing practice database that includes all of the patient accounts and their status is necessary to assume existing patient accounts. Every client is different but we’ve seen this done electronically where the practices database is exported in a universal format and then imported into your practice management software. This can be messy, time consuming, and expensive if you pay someone to do this. It also depends on whether they are currently billing in-house or using a billing service – and how easily this info can be accessed.
What’s worked for us is getting access to the clients practice management system (or paper reports) and entering the patient info into our system as patients are seen if all of the data cannot be imported into our medical billing software.
Also when using your own billing services practice management/medical billing software, you will need all the provider and practice information such as provider names and NPI’s, facility NPI, tax ID, practice address, insurance contracts, etc. We also recommend getting your provider(s) setup with a clearinghouse for all the claim submissions.
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