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.

White Swoos

revenue cycle management

Yellow Swoosh

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:

  • Claim Underpayments

  • 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

  • CAQH maintenance

 

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,

Cost Effective

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

accounts 

receivable management

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

Up Time

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.

Blue Swoosh

Contact us for a free assessment

We would love to take the time to assess your practice and determine your needs and how we can best help you! Drop us a line and we'll get back to you as soon as we can to discuss what your business needs most. 

Asset 56.png
Asset 56.png