Family medicine
Medical billing for family medicine offices
A Tuesday morning might bring a newborn, a teenager on Medicaid, a retired teacher on Medicare and a self pay patient, each with different rules for us to keep track of.
It's free, and you can keep your current biller
What makes family medicine billing different
- Every payer type at onceMedicaid, commercial, Medicare and self pay can all show up before lunch, and your front desk has to remember what each one requires.
- Vaccine and administration codesThe product and the administration both have to be coded correctly. Program rules can change with the patient's age and coverage, so the same shot can bill differently for two people in one family.
- Age based preventive codesThe preventive code depends on the patient's age and on whether they're new or established, so a birthday can change which one's right.
- Minor procedures in the officeFreeze a wart during a visit and bundling rules can cut the payment if the visit and the procedure aren't billed correctly.
Common family medicine billing checks
- Preventive by age9939199395 The correct code depends on age and patient status.
- Vaccine administration9046090471 Which code applies depends on age and counseling.
- Office procedure with a visit1711025 Modifier 25 goes on the separate E/M visit and depends on separately documented work.
- Office visits9921299215 Level is selected by medical decision making or total time, and the note must support it.
These codes are examples. Rules change by year and payer, so we check current guidance.
Where to start
- Medical billingWe prepare, check, submit and follow up on claims within your agreed scope.
- Insurance verificationWe check coverage before the visit and tell your front desk about the problems.
- Denial managementDenied claims worked by cause and deadline, and tracked to an outcome.
- Coding supportWe check CPT and ICD-10 codes against the note and take questions to the provider.
Further reading: common claim denial codes and where to start on each and claim rejections and denials, and how to handle each one.
Questions
Questions about family medicine billing
Can you manage a lot of Medicaid plans?
Probably, but tell us your state and your plans first. Medicaid rules vary so much that we'd confirm the specifics during the audit.
Do you review vaccine billing?
Yes, as part of claim checks. We look for an administration code that doesn't match the product, or a product that doesn't match the patient's coverage.
What do you need from our front desk?
Accurate demographics and insurance details at check in, mainly. If we need fixes, we'll send a short list.
Find out what your family medicine claims are leaving behind
Send us your denial and A/R reports and you'll have a written report within 48 hours, for free. You can keep your current biller while you decide.
