Our Medical Billing Process

1. Patient Registration and Insurance Verification:
   • Patient Registration: We verify patient demographics, including name, date of birth, and address.
   • Insurance Verification: We verify patient insurance coverage, including the type of insurance, coverage limits, and any specific requirements or restrictions.
2. Medical Record Review and Coding:
   • Medical Record Review: We review medical records to identify all relevant services and procedures performed.
   • Coding: We assign relevant ICD-10 and CPT codes to ensure accurate billing.

Example Codes:

• Diagnosis Codes (ICD-10):
  • M25.511: Sprain of the shoulder joint
  • M25.512: Strain of the shoulder joint
  • M25.513: Dislocation of the shoulder joint
• Procedure Codes (CPT):
  • 97110: Therapeutic exercises, including therapeutic activities, to improve joint mobility and strength
  • 97112: Therapeutic exercises, including therapeutic activities, to improve muscle strength and endurance
  • 97116: Therapeutic exercises, including therapeutic activities, to improve balance and coordination

3. Claim Preparation and Submission:
   • Claim Preparation: We prepare claims using the coded information, including patient demographics, insurance information, and services and procedures performed.
   • Claim Submission: We submit claims to insurance providers electronically or on paper.
4. Claim Processing and Reimbursement:
   • Claim Processing: Insurance providers process claims, verifying services and procedures performed and patient insurance coverage.
   • Reimbursement: Insurance providers reimburse providers for services and procedures performed, based on insurance coverage and contracted rates.
5. Follow-up and Appeals:
   • Follow-up: We follow up with insurance providers to ensure claims have been processed and to address any issues or denials.
   • Appeals: If a claim is denied, we work with the provider to gather additional information and appeal the decision.

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