OUR MEDICAL BILLING SOLUTION
By using our Medical Billing service, we manage your Coding, Claim Submissions, ERA/Payment Processing, Appeals, Patient Statements, Patient Collections, and more! You will have less overhead in your office, and your staff can focus on office workflow and overall patient care. We will dedicate a specialist to your account to handle your Account Receivables. The main priority is to help your practice grow, maintain a healthy cash flow, and increase revenue!
Your Office Handles:
Initial Patient Demographic
Initial Insurance Verification
Our Company Handles:
Appeals and Follow Up
Many providers may ask, "Well, what's the difference if I hire a personal biller versus outsourcing my billing?" Well, there are a few distinct differences between an in-house biller, and a third party billing company, such as us. Here is why:
Although it may seem like you're paying less when hiring an in house biller, you are actually paying more overhead. You are not only paying their salary, but you are paying for their employee benefits, vacation time, sick days, training, overtime and workers comp. Besides employee expenses you also incur the cost of software fees, hardware fees, supplies and more. This total can actually amount to more than a billing service! A third party biller only takes a percentage of what the provider has earned during the month.
We dedicate a specific account manager to each practice. We go through an extensive hiring process to select experienced billers to professionally handle all incoming request from insurance reps and patients. Whether they specialize in demographics, coding, payment adjudication, accounts receivables, or collections, they are committed, and get the job done!
When it comes to who is responsible, nothing is more frustrating when the blame goes on you. This is where we come in. We take all that responsibility, and if we're liable for any issues, we'll take care of it right away. We take all the headaches away from your office.
What Our Billing Service Has to Offer...
Insurance Verification - Although it is the responsibility at doctor's office, 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, real-time eligibility checks, or government agencies.
Claims Scrubbing – Coding errors can cost you thousands of dollars annually. To reduce these coding errors we screen and scrub all incoming encounters. We examine all your CPT codes, create Local Edit errors applicable to bundled codes or missing information, and verify through third party vendors if additional codes can be billed or if modifiers can be added for additional reimbursement. The results are reduced denials, and faster reimbursements.
Electronic Claim Submission – Our medical billing service manages all claims submissions for you. We have the capability to transmit claims electronically to insurance carrier.
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 – All patient statements are sent automatically and on a monthly cycle. 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.