After you complete a patient encounter, finish your documentation and coding inputs, and sign-off to close your charge notes for billing, Avosina deep-dives into your notes, reviews and corrects all elements, and creates a superbill from which medical billers can manually or electronically prepare a claim for submission to payers. The claims are formatted precisely for different federal and commercial payers on various forms, each appropriate for a different type of charge or payer; such forms include the CMS-1500 form, the UB-04 form, etc.
Upon preparing the claim, the medical billing team will initiate the claim submission process. First the claim will be transmitted to the provider’s contracted Clearinghouse, which ensures that the claim has all of the appropriate data and formatting necessary for claim submissions to payers. If an error is found, the claim will be rejected, and the biller will have to resubmit the claim. Once approved, the claim gets transmitted to the payer.
When the payer receives the claim, the settlement process initiates, wherein the payer assesses the claim and makes a decision to accept the claim totally, deny the claim totally, requested additional medical records documentation to support the claim, or provide partial payment of the claim. An electronic remittance form will be sent by the payer to the provider’s practice detailing services paid, services denied, and what additional documentation may be needed for reimbursement.
Our charge entry transactions remain consistent throughout:
We’re on a mission to fully harness the robust internal infrastructure of our RCM and IT expertise coupled with our vast external professional healthcare management and leadership networks in order to continually maximize our clients profits and drive the development of prosperous, hassle-free private practice independence.
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