Our medical billing services team works with individual practitioners & physician groups. We can work with your billing team or can help you with entire revenue cycle management processes.
We are huge fans of HFMA MAP keys – in case you are wondering. Trust us to handle your revenue cycle management processes – end to end.
|Full Service||Claim Filing|
|– Patient eligibility and authorization|
– Demographics and claim information entry
– Claims submission and printing paper claims
– Secondary claims submission
– Follow-up on unpaid claims and appeals
– Sending monthly patient statements
– Answering patient billing inquires
– Monthly reporting
– Posting insurance and patient payments
– Soft collections
Fixed pricing per month based on team size needed.
|– Claims submissions either electronically or paper CMS-1500 |
% of collections with a monthly minimum
Provider Enrollment and Credentialing
Many denials can be attributed upstream to provider credentialing and enrollment. We maintain a credentialing matrix to stay abreast of the credentialing status for each payer, plan, provider. This ensures reduced denials. We leverage a few of our technology solutions to help achieve the same and can help you with 855 forms, PECOS, CAQH.
Pre-certification (Authorization) & Insurance Eligibility Verification
- We leverage our eligibility verification solutions in addition to using payer IVRs and payer CSRs to verify coverage on primary, tertiary, Medicaid etc
- In conjunction with our patient contact center team, we reach out to patients & get updated insurance information (if anything has changed since their last visit)
- Keep up-to-date/current member ID, group ID, coverage end and start dates, co-pay information etc
- As needed, we also obtain pre-authorization codes and PCP referrals as needed
- We not only stay up to date on patients’ issues with coverage or authorization but we also keep your team in the loop about the same.
Patient Demographic Entry
While insurance eligibility verifications is a crucial aspect of revenue cycle management, patient demographic entries play a big role in reducing denials downstream as well. Our team ensures that there are no issues with patient demographics with respect to name, DOB, address, phone number, medical history, guarantors (if any), insurance details etc. If any of these are missing or has been missed by your front desk, we ensure that our patient contact center team gets in touch with the patient to sort out the details. This becomes very important if we want to avoid having to rework claims.
CPT and ICD-10 Coding
Some denials are rooted in CPT -> ICD10 coding. There’s no getting around that. We work with your superbills and completed visit notes. While it is ideal if the ICD/CPT codes are noted in the same, it is not mandatory to do so. Our team is equipped to work with your superbills to ensure that work can progress with as much or as little assistance as possible. We need to ensure and prevent any up/downcoding related challenges to avoid possible future denials.
We work with your fee schedules and ensure that they are as per state/provider contracts.
Our team ensures that all patient demographics have been provided in the claim and are ready to be filed. After we do this, we ensure that we run it through a round of quality checks to ensure that our clean claims rate remains at the highest levels.
First things first – we ensure that the claims are submitted electronically. While we have met practices that do not do this, we strongly encourage our clients to submit claims electronically (we can help you with the set ups as well). Should there be an insurance requirement for paper to be used, we can do the same with the clearing house. Rejections are part of the day to day world of claims. While keeping our clean claims rates at the highest performant level, we will still see rejections for some reason or the other. This happens with everyone in this ever changing healthcare industry. We ensure that rejections are corrected and resubmitted within 24 hours.
Hopefully you are enrolled in EFT/ ERA to avoid delays in payments. If you are not, we ensure that your providers are EFT/ERA enrolled to reduce the time wasted on paper checks and payments. We post and reconcile ERA / EOB / Denials on a daily basis. We can work using your payment management system or we can also utilize our own. Either way, the net result is that your payments are posted at the earliest.
Account receivables follow up
Accounts receivables are broken down into buckets based on the age of the account. Our team analyzes the account receivable buckets and comes up with appropriate course(s) of action for each bucket. Thereafter, we prioritize our plan and work accordingly to help you slice through your A/R and recover monies due at the earliest. Typical to our communications plan, we keep you informed on a daily/weekly/monthly basis and also ensure that we have quarterly business review calls to be on the same page.
Depending on the buckets we are working on – whether they are denied, underpaid, pending / no responses etc, our team will call patients, payers, 3rd party facilities as needed to ensure we maintain the latest status of why and where the claim is “stuck”. After that, we ensure that our team takes the next corrective step to ensure that the current claim is paid for. In addition to that, we ensure that the learnings from this claim are sent to the upstream teams / processes to ensure non-recurrence of the same.
Our patient contact center team constantly monitors aged accounts, patient responses and works closely with our payment posting team to ensure that patients’ payments are posted within 24 hours. As we all know, sometimes, patients simply do not pay regardless of how many statement balances or reminders we send them. In these cases, our team evaluates whether the balance is high enough (e.g. > $50) to call and collect or not. This decision is made in conjunction with your practice and is assisted by looking at the life time value of a patient as well. Our team calls as first party collectors (on your behalf). We go above and beyond to make patients happy with the outcomes so that they pay their balances and at the same time, the relationship is still maintained for future visits.
Can we help you today?