What Our Billing Service Has to Offer...
Practice Management Software - Many practices in recent years use Practice Management software to handle demographics and to schedule patient appointments. This is not be confused with an EHR, however the majority do include this in their software. If your practice does not have any Practice Management software, we offer our clients free use of our software for demographic entry, scheduling, and checking patient eligibility.
Insurance Verification - Although it is the practices staff responsibility, we also handle insurance verification to ensure claims are submitted accurately.
We verify if they are eligible, when the insurance became effective, research if there are any other insurance a patient may have, verify which insurance is primary or secondary and also research if there are replacement HMO plans. We use all resources available, whether it is by phone verification, insurance portals and government agencies. We also verify with the office, hospital, and patient.
Data Entry - If a practice is still using hard copy encounters, we enter all data into our software. We ensure efficiency quality and attention to detail when entering data. We emphasize speed and accuracy and ensure all work is entered in a timely manner.
Claims Scrubbing – Coding errors costs you thousands, if not, millions of dollars annually. To reduce these coding errors we screen and scrub all incoming encounters. We examine all your cpt codes, we make sure that they are bundled correctly, and we apply any necessary modifiers. Work is double checked and audited if necessary before submissions go out. The results are reduced denials, and faster reimbursements!
Electronic/Paper Claims Submissions – Our medical billing service manages all claims submissions for you. We have the capability to transmit claims electronically to insurance carrier. For the insurance companies that only accept paper submissions, we still send out HCFA-1500 and the UB-92 forms. All secondary insurance billing are submitted automatically via Electronic or Paper submission.
Payment Posting – Upon receiving insurance or patient payment, we properly apply payments to corresponding accounts. At this point, the balance is submitted accordingly to the secondary or tertiary insurance. If there is no secondary or tertiary insurance, any balance will be the patient’s responsibility and we will send the bill to the patient directly.
Claim Adjudication – We monitor EOBs and payments to ensure the highest possible reimbursement rate. Whether it is a contracted rate, or a non-contracted rate, we review each claim to ensure proper reimbursement for you. Any zero dollar denial is followed up on immediately to verify the claim was processed correctly.
Follow-up – Claim follow-up is very crucial! We check outstanding claims to verify that they are being processed properly and timely. Your A/R is the #1 priority. Too much outstanding A/R means a loss of money. The lower your A/R, the better your income. Our staff regularly monitors your A/R and follows up on ALL outstanding claims with insurance companies to make sure you are receiving prompt payments.
Insurance Appeals - Denied claims are one of the largest problems facing health care professionals. Ensuring a denied claim gets reprocessed correctly can be a very arduous process. When handling a denied claim, we call the insurance to find out the specific reason as to why the claim was denied. Some claims can be reprocessed over the phone, or sometimes an appeal may be required. Some appeals may need medical documentation, medical necessity letter, or in some cases proof of timely filing. We make weekly phone calls to ensure the claim is being handled properly and in a timely manner.
Patient Statements, Collections, and Inquiries – When a patient has a balance they will receive four statements. All statements are sent automatically and on a weekly basis. The first two statements will entail itemized breakdown of the bill. The third statement is a past due notice and the fourth is the final due notice. After the fourth notice, at the doctor’s discretion, all balances will be forwarded to a collection agency. Prior to collections we do offer patients payment plans or settlements to collect as much as we can before sending to collections.
Reports – We provide your practice with several reports. Some of which are financial reports, practice analysis reports, daily receipts and payments and adjustment reports. Custom reports can be generated at your request, and a wide range of standard reports are always available.
Super bills – Still working paper based encounter forms? We can work with your staff to develop customized encounter forms!