Our medical billing Services and Solutions
Medical billing is the process of submitting and following up on claims with health insurance companies for the purposes of receiving reimbursement for services rendered by a healthcare provider. The entirety of this interaction is commonly known as the billing cycle and many times referred to as Revenue Cycle Management. Our goal is to simplify and streamline your billing processes while increasing your bottom line.
revenue cycle management
Claim Submission + Payment Posting + Patient Collections +AR Management
We offer a complete suite of revenue cycle management services. We customize our processing integrity guidelines for each practice to ensure our claims submissions are processed timely, accurately and completely. When claims are processed our expert Associates resolve rejected and denied claims based on the unique payer guidelines that may cause payment delays. To monitor our revenue performance, our management team generates regular customized reports to analyze and ensure the resolution of:
Claims Submitted Over 60 days without Payer Response
X12 Claim Adjustment Denial Reason Code Patterns and Trends
Status of Insurance and Patient Accounts Receivable Greater Than 90 days
Contracting and Credentialing
Correcting Mistakes, Avoiding Reimbursement Loss or Delays
Although it might seem simple, credentialing and contracting mistakes can cost you months of lost revenue. Provider enrollment, timely demographic updates, re-credentialing and re-validations are essential to ensure timely claims processing and full reimbursement from Medicare, Medicaid and managed care plans. Effective credentialing takes upfront planning and the management of tedious tasks and details that require continual follow-up efforts. We help you navigate the endless maze of information, questions, applications, specific guidelines, procedures and terminology. In addition to offering traditional credentialing and contracting services, we also perform the following:
Periodic commercial contract competitive reviews
Post payment auditing to ensure new contract reimbursement rates are paid
Request network exceptions for closed panels or products
Customized data analysis
We welcome the opportunity to keep you informed of your revenue performance! We are open and transparent about how we manage your claims. In addition to offering our standard month-end reports, we offer Revenue Cycle Management clients additional reporting services which generate useful information for making informed decisions.
Vital Information For Decision Making
practice management systems
HIPAA Compliant, 24/7 Support,
For clients who use our secure, HIPAA compliant practice management software or document management system, we offer 24/7 technical support to ensure systems and applications operate effectively. Our cost-effective technology options are managed and designed to meet all the following five trust service principles:
Security – Information, systems and company policies are designed and implemented to protect against unauthorized physical and logical access.
Availability – Information and systems are available for operation and use.
Processing Integrity – System processing is complete, valid, accurate, timely and authorized.
Confidentiality – All information deemed confidential is protected.
Privacy – Personal information is collected, used, retained, disclosed and disposed of in accordance with our client’s objectives.
Medical code auditing
Reviewing for Accuracy, Ensuring Regulatory Compliance, Fixing potential Problems
Medical coding is the interpretation of procedures, diagnoses and equipment into universally accepted alphanumeric codes. Code auditing is the process of conducting internal or external reviews of coding accuracy, policies and procedures to ensure providers are managing an efficient and regulatory compliant operation. Healthcare professionals have several reasons to conduct a code audit including:
Help identify potential problems before insurance or government payers challenge inappropriate coding
To remedy under-coding, unbundling habits, code overuse and to bill appropriately in accordance with documented procedures and payer guidelines
To identify reimbursement deficiencies and prevent the use of outdated, deleted or incorrect codes for procedures
Follow-Ups, Monitoring, Comprehensive Policies and Procedures
Accounts Receivable management is the tedious and time-consuming process of following-up with payers to resolve payment on any rejected or denied claims as well as aged claims where there has not been a timely response or payment from the payer or patient. To effectively manage outstanding receivables, medical practices must maintain comprehensive policies, procedures and oversight to:
Work through denials, rejected and past due claims to ensure aged AR balances over 90 days do not exceed 20% of total AR
Hire the right people within the practice to: (i) verify eligibility, (ii) collect patient co-pays and co-insurance, and (iii) Pre-certify all potential medical procedures
Monitor Key Performance Indicators to ensure policies and procedures are followed and identify opportunities for improvement
patient customer service
Providing Detailed Explanations, Freeing
In many cases the practice’s non-clinical personnel spend more time interacting with the patient than the provider does. Practices want to ensure sufficient and efficient uses of resources to provide patients with a positive experience. For billing matters, refer your patients to your designated billing organization or specialist who can provide detailed explanations to patients’ questions which will free up time for the front desk to greet and check-in patients, verify eligibility and accept calls for patients needing to make future appointments.