OMS Coding and Billing Services

The Vendor is required to provide revenue cycle services for the Oral Maxillofacial Services (OMS).
- The revenue cycle operations involved in this clinic span both Medical and Dental coding/billings/collections.
- While OMS is confident in its abilities to maintain revenue cycle operations around the dental claims – other clinics throughout the university are finding that it does not have the bandwidth (or expertise) to maximize its workflows around the medical claims.
- Detailed work plan, describing all phases of the proposed services; to include but not limited to:
•    Development
•    Training
•    Transition
•    Implementation
- Current OMS Billing Process, currently includes but is not limited to:
1. Patient Scheduling:
•    Most appointments are created over the phone.
•    Insurance / Referrals / Authorizations are verified.
•    EPIC EHR encounter creation
2. Initial Evaluation / Treatment Plan Proposal:
•    Meeting with provider to create treatment plan.
•    Create proposal breakdown of costs.
•    Get pre-authorization for procedures requiring medical claims.
3. Treatment:
•    Treatment provided to patient.
•    Provider signs off on encounter form.
4. Medical Billing:
•    EPIC EHR documentation posted
•    Coder applies ICD10s and CPT codes and creates medical claim.
•    Central Billing submits physical claims.
5. Medical Billing – Follow-Up:
•    Call insurance or check portal.
•    Verify claim is on file with insurance.
•    Verify USPS return receipt.
•    Submit additional information or resubmit claims.
6. Dental Billing:
•    EPIC EHR transactions
•    Use Fast Attach for documents.
•    Submit electronically.
7. Dental Billing – Follow Up:
•    Call insurance or check portal.
•    Verify claim is on file with insurance.
•    Submit additional information or resubmit claim(s).
- Take over the medical claim physical mail process for insurance providers that require physical mail.