The medical claims management process starts with patient registration and ends when the physician practice gets proper payment for services rendered. If the internal workflow in between is not optimized for every member of your staff, there are numerous places where mistakes can waste time and money.
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Registration

Patients can preregister and check in online to save time and reduce staff requirements. Online insurance benefit verification can also be done ahead of time.

Clinical Documentation

Physician or clinical staff inputs history, symptoms, diagnosis and treatment into the patient’s electronic health record and assigns appropriate codes to be passed along in the super bill.

Checkout

Registration staff collects patient’s balance and schedules the next appointment.

Coding

Physician codes are verified, reviewed and the insurer is contacted for pre-authorization, pre-certification or pre-determination of the patient’s benefit coverage, then claim is sent to billing staff.

Billing

Biller enters codes and fees and generates paper or electronic claim. Claim is reviewed for completeness and accuracy before submittal.

Health Insurer

The health insurer processes claim and, if approved, routes payment and EOB copy to the practice. The original EOB is sent to the patient.

Collections

Collectors follow up with the insurer to verify receipt of the claim and ensure it’s being processed. Collections staff verifies payment and posts it in accounts receivable. Appeal is filed if the payment is incorrect and examined for why it was not paid correctly initially.

Service Paid in Full

Leverage the advanced technology and expert support of Concierge to automate and streamline the entire revenue cycle to get you paid more in less time.