Medical Billing and Coding

Medical Billing and Claim Services:

EMPS is not just a claims processing center. Our goal is to provide the highest return on your claims without sacrificing service or patient support. We successfully increase your reimbursements and accounts receivables by providing complete medical billing services including:

24 hours Generating and accelerating of individual claims
Electronic Claims Submission
Creating and mailing of HCFA Claims to Secondary and Tertiary Insurances
Creating and mailing out of Patient Statements
Daily claims generation for faster reimbursement
Daily review of EOBs and immediate follow up on secondary claims
Daily Aging Reports on all unpaid claims
100% claims payment is our goal
Immediate follow up on unpaid or rejected claims
Persistent follow up on claims
Prompt posting of payments
Courteous but effective collection of outstanding receivables
Patient billing questions answered personally and efficiently
Monthly statistical reports and spreadsheets tracking business activity and productivity

Medical Coding Services:

Delivering quality healthcare depends on capturing accurate and timely medical data. Physicians can depend on our well trained and reliable medical coders. Our medical coding professionals possess a thorough understanding of the health record’s content and can find information to support or provide specificity for coding. EMPS medical coding professionals work in a variety of healthcare settings, including inpatient and outpatient healthcare settings and non-provider settings such as third-party payers and healthcare software vendors.

KNOWLEDGE OF INSURANCE CLAIM AND REGULATORY CONSIDERATIONS:

New patient interview and check-in procedures; established patient return visits; post-clinical check-out; computerized practice procedure methods.

COMPLETING CMS-1500 AND COMMERCIAL CLAIMS:

Billing guidelines for inpatient medical, in/outpatient global surgery, minor surgery, and maintenance of a provider's claim files; setting up a filing system for completed claims; determining primary and secondary status; completing common types of claims.

KNOWLEDGE OF BLUE CROSS AND BLUE SHIELD PLANS:

Features of BCBS plans; correct filing procedure; completing a BCBS claim form.

KNOWLEDGE OF MEDICARE:

Parts of the Medicare program; eligibility criteria; fee schedule; supplemental plans and managed care; filling out an HCFA 1500 claim form.

KNOWLEDGE OF MEDICAID:

Services covered under the federal portion of Medicaid; eligibility; services provided and paid for by state coverage; obtaining preauthorization for services.

TRICARE AND WORKERS' COMPENSATION:

Health care for the military; deductibles, cost sharing and eligibility requirements for TRICARE; filing TRICARE claim forms; workers' compensation programs; classifying on-the-job injuries; preparing a First Report of Injury form; qualifying for workers¹ compensation benefits.

ICD-9-CM CODING:

Using the ICD-9-CM coding system; primary vs. principal diagnosis; ICD-9-CM terms, marks, abbreviations and symbols; index tables.

CPT CODING:

Basic format of CPT Service and procedure codes on the CMS-1500 claim; comparing CPT with ICD-9-CM coding; modifiers; new vs. established patient; assigning emergency department and critical care codes; consultation vs. confirmatory visit; preventive medicine visits.

HCPCS CODING AND CMS REIMBURSEMENT:

The HCPCS system for reporting professional services, procedures, supplies and equipment; HCPCS level II coding system; CMS reimbursement; rules of the Medicare physician fee schedule payment system.

CODING FOR MEDICAL NECESSITY:

Assessment and coding from patient medical records; securing the correct physician documentation; coding an operative report; selecting and coding diagnoses and procedures from case studies and sample records.