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medical billing & coding services

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Introduction & Process of Medical Billing


The medical billing starts from registering the patients by front desk staff, and obtaining their personal details (called demographics) and insurance coverage & benefits information. Based on a patient’s insurance plan, a medical biller can determine what services will be covered and which ones the patient will be responsible for, including non-covered charges, co-pays/co-insurances/deductibles. When the patient has checked out by a physician, the patient’ medical data and doctor’s notes being sent out to a medical coder who read out that and apply codes for the diagnostic and cure procedures performed (usually called CPT and ICD codes) used after for creating a superbill (technically called CMS/HCFA-1500 and UB-04). At next, a medical biller creates a claim including the cost of each procedure(CPT) code. The medical biller must be a professional to ensure that the claim is good to go or “clean” in compliance with state and federal regulations for coding and format. Some healthcare practices decide to even use a third party, known as a clearinghouse, to format claims according to the specifications of each insurance company and in accordance with HIPAA. This is necessary to see that one must be educated on the technical formalities and updates of this process or it could easily result in a denied or rejected claim otherwise, which means no or late and less reimbursement. The hurdles and complications in medical billing can be more for large scale practices providing a range of medical services under a healthcare setup. Solo and small practices can have managed their billing operations easily at their own (by keeping billing in-house) as compared to large ones but in absence of professionalism in billing they might be suffering and losing a part of their valuable revenue. So the popular and ultimate solution of all that is outsourcing the billing services to a full time professional (certified) company expert in handling your billing needs. It may have some disadvantages like data control issues but the solutions are always available and the advantages of outsourcing the billing services are much more. A physician or a practice could have different preferences while taking decision of have billing services in-house or take as outsourced but outsourcing will be the best option if a physician/practice wants to achieve max revenue from min cost.

Our Medical Billing Services:


Though SoftareMD offers all type of services related to your Practice Management (PMS), Revenue Cycle Management (RCM) and much more but from billing perspective, we are expert and perform all the standard billing services through our local office in collaboration with your office managers, paramedical staff and doctors. We believe on open and friendly environment with our clients so make a great coordination through our most efficient, effective and qualified client support team that will be open to you for guidance and assistance as per your need and demand without any time restrictions. You will always be entertaining in fully professional manners at any time through our 24/7 live support.


Types of Billing Services We Offer:


  • Professional Claims Billing (For clinical practice doctors/MDs/DOs, physicians, Surgeons, chiropractors, Nutrition’s and others)
  • Institutional, Hospital & Facility Billing (For out and in patient services)
  • Laboratory Billing (For medical diagnostic test claims under CLIA rules)
  • Dental Billing (For dentist’s private and group practices)
  • Pharmacy Billing (For pharmacies provide prescribed medicines to insured members)
  • Durable Medical Equipment (DME) Billing (For equipment provided to temporary and permanently disabled patients)
  • Medical, Surgical and Other Office Equipment Billing (Formally called Material Management Services)
  • Other Valuable Professional and Customized Services Those Required Billing (within the industry)



SoftcareMD provides the complete professional billing services in the following manner with surety of quality.


Free Billing Assistance Services for Your Office:

Exclusively for billing clients, SoftCare MD provides help and assistance (free of cost) to their front desk and other administrative staff in the matters below as billing is concerned:


  1. Front Desk Management: We help you to establish an effective and helpful desk for patients and other visitors.
  2. Appointment Scheduling: We assist your staff and patients in scheduling an appointment. Further it includes Dr. scheduling (required in case of group practice and special services), entry in EMR/PMS and other daily schedule management.
  3. Appointment Confirmation: Reminder calling t patients and rescheduling (if required), appointment cancellation handling.
  4. Eligibility & Benefits Verification: Our office assists you with patient eligibility and other benefits verification from insurances and other payers as required.
  5. Copay/coinsurance Calculation and Collection: We help you in patient responsibility calculation, adjusting and posting in claims and provider account collections in case of online/credit card payments.
  6. Prior Authorizations: For some type of services, there’s required pre-certification/authorization by patient’s plan benefits. So we help you with obtaining and getting verify the authorization.
  7. Referrals Management (by coordination with patient’s PCP)
  8. Purchasing of office equipment (its maintenance cost management), purchasing of drugs/injections/vaccines, surgical material, other daily items using in care of patients (there invoicing, quotation filing and record keeping/posting etc.)
  9. Overall Doctor’s office record keeping (accounts management) other than regular billing/revenue management services




Integrated Services Through Our Office: (includes in billing service pack)


SoftCare office have very organized setup under professional environment. It will be considered as your secondary or subsidiary office for all your billing operations when you have connected with us. We take care all the financial matters of a client in professional manners through our best human work force under the supervision of qualified and experienced managers of relevant expertise. Our billing department will be responsible for doing the tasks further define below:


  • Registration of NPI/TIN, enrollment of Practice location(s) & billing addresses, etc. (in case of new practice)
  • Credentialing, Plan enrollment and network participation
  • EDI setup with payers for electronic claims, ERA and EFT
  • Medical Coding (CPT, ICD) according to WHO, CMS, & HCPCS standards
  • Charge/Claim Entry (electronic & manual through superbill) according to most updated fee schedules
  • Clam submission (electronic under EDI and manual on paper by post) as per payer requirements
  • Clam review, scrubbing, and rejection handling
  • Claim Follow up, working on Account receivables(AR), Handling of claim denials and resubmissions with corrections and other requirements
  • Preparing/printing and dispatching of patient statements
  • Handling of Patient Calls, incoming and outgoing (for assistance and collection of remaining claim balances (copay/coinsurances) which for make them responsible by plans
  • Charge/payment summaries, reporting to doctor office on daily/weekly/monthly basis
  • Client support for assistance on daily issues, training and schedule meeting between two offices to discuss maters required special attention.
  • Medical Transcription is a separate domain but covered under billing to some extent as billing is concerned.
  • Document Management: All kind of electronic and paper documents are handled safely and secure just according to HIPAA regulations.
  • Practice analysis and consultation services: We provide the consultation as well through our critical analysis system. It means to you to find out where your practice loosing potential revenue and how you can control and overcome on that.
  • Business Development: We have different training manuals to learn how to improve your daily practice and overall business by guiding patients about their future health and precautions. We make aware and encourage patients for regular wellness and preventive care visits through our patient support channel. We keep our clients updated with industry changes to timely meet the challenges and requirements.
  • Quality Payment Program (MIPS): We assist clients to enroll and qualify for MACRA incentive program called MIPS that enables you to safe Medicare payment reductions. For further details, call our client support.
  • Practice Audit: Our QA department perform the audit for our billing clients (free of cast) twice a year. It includes the complete diagnostic review of your current year account to make sure the accuracy and quality.
  • Accounting and Finance: Our finance department is professionally concerned about all the receipts and payments of your billing accounts and your bank statement reconciliation. They professionally maintain all the record of your accounts in the way that could be easy to you to understand.


Our Custom Solutions: We also offer the customized and integrated professional services of patient’s eligibility & benefits verification, Pre-authorization/referral management, Material management and accounting services or any other billing related services exclusive from the whole package independently through our dedicated departments with the full guaranty of quality and responsibility at very affordable cost. Call to our sales department for further assistance.