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Our Services

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Our Services

Full service Virtual/Remote Office Assistance

  • Receptionist

    A dedicated receptionist or live receptionist service to answer patient calls and questions.

  • Phone

    A local or toll-free number with phone forwarding or live call answering for patient calls and questions and virtual patient payments.

  • Mail & Faxing

    Mail handling, Virtual Secure Fax handling, Paper Claims and Patient Statements

  • Virtual Meeting rooms

    Access to secure virtual meeting rooms and co-working spaces

  • IT

    Access to secure IT infrastructure, EMR software, and reporting

Insurance Credentialing and Enrollment

What is provider credentialing or physician credentialing?

Provider credentialing (also known as physician credentialing or medical credentialing) is a regulated process of assessing the qualifications of specific types of providers. This important safety check requires providers such as doctors, dentists, and other allied healthcare professionals to show they have the proper education, training and licenses to care for patients. Hospitals and health plans verify the information supplied by the provider before they are included as an in-network provider.

The Centers for Medicare and Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) also require this credentialing process. CMS requires it before a provider can be eligible for Medicare or Medicaid reimbursement. And most hospitals pursue a Joint Commission accreditation to demonstrate their commitment to providing high-quality care.

How the provider credentialing process works

There are several steps in the provider enrollment and credentialing process. A provider has to complete this process with every health plan they want to enroll with.

  • The physician supplies the information required, including contact information, current CV, education and training history, licensing and certificates, medical group and hospital affiliations, Board certifications, sanctions or malpractice history, proof of liability insurance and peer references.
  • The health plan or provider organization checks that all the information is correct and up to date.
  • If no problems are encountered, the provider organization or health plan awards a credential to the provider.

    • The physician credentialing process can take as little as 30 days to complete up to as much as six months or more, particularly if the credentialing information is being transmitted via fax or mail.

Our Resources for health plans are proven to speed up credentialing

Insurance Verification and Prior Authorization

Insurance verification and prior authorization are important processes that occur when a patient needs a medical service or medication covered by their insurance.

Insurance verification

  • Confirms the patient's insurance coverage details, including policy numbers, coverage start and end dates, and any specific limitations or restrictions
  • Any discrepancies at this stage can lead to errors throughout the process

Prior authorization

  • A process that determines if a prescribed product or service will be covered by the patient's health insurance
  • Also known as pre-authorization, precertification, prior approval, and predetermination
  • Prior authorization does not guarantee payment, but it does make it more likely your health plan will cover the cost
  • The process can be long and can often delay patients from receiving the care they need

We request prior authorization, a healthcare provider submits a request to the patient's health insurance. The request includes:

  • Patient name, date of birth, insurance policy number, and other relevant information
  • Physician and facility information
  • Relevant procedure and HCPCS codes for products/services to be provided

Auditing/Pre-Code Scrubbing

We provide revenue integrity and compliance audits, medical coding support, and clinical documentation audit services. Trusted by hospitals, ambulatory surgery centers, clinicians and physician groups, MediCoder, LLC offers both PRN and total outsource support to enhance healthcare accuracy and efficiency.

  • Coding
  • Audits
  • CDI
  • Software
  • Education

We support CDI - Clinical Documentation Improvement

Work Que Scrubbing And Management

Our skilled certified coders and billers identify and fix potential issues within a patient's medical record before it is used for billing, including missing or incorrect demographics, diagnosis codes, procedure codes, insurance information, and more.

How it works

Users access specific work queues within a Software - example EPIC, where flagged items are displayed based on predefined criteria, allowing them to review and make necessary corrections.

Benefits
  • Reduced denials : By proactively addressing errors, the likelihood of claims being rejected by insurance companies decreases.
  • Improved revenue cycle : Efficient claim submission leads to faster payments and better cash flow.
  • Enhanced data quality : Regularly scrubbing work queues helps maintain accurate patient information within the system.

    • Common types of Epic work queues that might be scrubbed:
    • Charge review workqueue : Checking for accurate charges and coding on patient encounters.
    • Claim edit workqueue : Identifying potential issues with claims before submission to payers
    • Referral workqueue : Verifying eligibility and authorization for referred services
    • Follow-up workqueue : Managing outstanding claims that require additional action

Charge entry-Certified Coding and Cpt 4, HCPC and ICD 10 – Provider training on upcoming ICD-11

Our certified coder's code of ethics include principles like accuracy, integrity, confidentiality, competence, fairness, responsibility, and ongoing education, meaning they are obligated to code patient records truthfully, protect sensitive information, maintain their coding skills through continued learning, and always act in the best interest of the patient while adhering to ethical and current official standards and coding guidelines.

Key aspects of our certified coder's code of ethics:
  • Accurate coding : Selecting the most precise diagnosis and procedure codes based on the medical documentation provided.
  • Patient confidentiality : Protecting patient health information according to HIPAA regulations.
  • Compliance with coding guidelines : Following established coding rules and regulations set by organizations like the American Medical Association (AMA). ICD-10, CPT, and HCPCS.
  • Professionalism : Maintaining a high standard of conduct and ethical behavior in all interactions.
  • Continuing education : Actively seeking out new knowledge and updates to coding practices to stay current.
  • Non-discrimination : Avoiding bias in coding decisions based on patient demographics.

    • Organizations that outline coder ethics:
    • American Academy of Professional Coders (AAPC):

      A leading organization that sets standards for medical coding ethics and professional conduct.

    • American Health Information Management Association (AHIMA):

      Provides certification for medical coders and includes ethical guidelines in their credentialing process.