Lump Sum Purchase of DME, Prosthetics, Orthotics

For injection codes with more than one possible TOS designation, use the following guidelines when assigning the TOS:
When the choice is P or 1,

• Use TOS P if the drug is administered through durable medical equipment (DME); or
• Use TOS 1 if the drug is administered in the office.

Medical Billing Process in Back Office Work

Demo Entry

  Entering Patient Details, Guarantor Detail, Employer Detail and Insurance Information into the system. ROI and AOB obtained in front office from patient.

  Coding:

  Assigning predefined alpha numeric codes to procedure and diagnosis. The coding department take this work. They will also undertake hospital component other than professional component. 

  Charge

  Super bill / Encounter Forms are used to capture details like Date of Service, Referring Physician, Rendering Physician, Place of Service, Type of Service, CPT Codes, ICD Codes, Modifiers, Authorization or Referral Details and Copay Details.

  Claim Submission

  Claims can be submitted through Electronic or Paper format. Paper claims sent directly to the insurance. E-Claims initially sent to clearing house. Clearing house converts into insurance specific format and dispatch to the insurance.