Comprehensive Knowledge of Coding Practices: Our coders possess in-depth knowledge of insurance claim and regulatory considerations, including procedures for new patient interviews, check-ins, return visits for established patients, post-clinical check-outs, and computerized practice procedures.

Claims Processing Proficiency: We excel in completing CMS-1500 and commercial claims, adhering to billing guidelines for various scenarios such as inpatient medical services, in/outpatient global surgery, minor surgeries, and maintaining provider claim files.

Specialized Insurance Knowledge: We are proficient in handling claims specific to Blue Cross and Blue Shield (BCBS) plans, including understanding plan features, correct filing procedures, and completing BCBS claim forms accurately.

Expertise in Government Programs: Our team is knowledgeable about Medicare, covering parts of the program, eligibility criteria, fee schedules, supplemental plans, managed care, and completing HCFA 1500 claim forms effectively.

Understanding of Medicaid: We understand Medicaid services covered under federal programs, eligibility criteria, and services provided and paid for by state coverage, and obtaining preauthorization for services as necessary.

Expertise in TRICARE and Workers’ Compensation: We handle TRICARE claims, including deductibles, cost-sharing, eligibility requirements, and filing TRICARE claim forms accurately. Additionally, our coders are skilled in workers’ compensation programs, classifying on-the-job injuries, preparing First Report of Injury forms, and ensuring qualification for workers’ compensation benefits.

Proficiency in Coding Systems: Our team is proficient in ICD-9-CM coding, including understanding primary vs principal diagnosis, terms, abbreviations, symbols, and using index tables effectively.

CPT Coding Mastery: We excel in CPT coding, understanding the basic format of CPT service and procedure codes on CMS-1500 claims. Our expertise includes comparing CPT with ICD-9-CM coding, applying modifiers correctly, distinguishing new vs established patient visits, assigning emergency department and critical care codes, and understanding consultation vs confirmatory visits and preventive medicine visits.

HCPCS Coding and CMS Reimbursement: Our coders are proficient in the HCPCS system for reporting professional services, procedures, supplies, and equipment. We understand HCPCS Level II coding, CMS reimbursement processes, and rules of the Medicare physician fee schedule payment system.

Coding for Medical Necessity: We ensure accurate assessment and coding from patient medical records, securing correct physician documentation, coding operative reports, and selecting and coding diagnoses and procedures from case studies and sample records to meet medical necessity guidelines.