We offer a wide range of physician billing services, medical billing and electronic medical coding.Our company works on the basis that Claim errors are avoidable. Our commitment is to improve the revenue of the healthcare facilities with our extensive expertise in healthcare billing services:
Management of Physician Charges We accept the charges in the format your practice is comfortable using, including super bill, chit, notes, or electronic interface. All charges must be specified in writing. If incorrect or omitted charges are discovered, your practice will be contacted for authorization to make changes.
CPT Fee Schedule Structuring We will help your practice establish your uniform (usual and customary) CPT fee schedule prior to beginning billing (if needed). Your fee schedule will be entered into our computer system, which will recognize variance. Allowable schedules for major, high volume carriers where reimbursement is mandated or contracted are recognized by our system. Fee schedule consultation and recommendation is included in our base pricing structure.
Office Notes/DictationFrom time to time, we receive requests from insurance carriers for additional supporting documentation for a patient. In these instances, we may ask your practice to provide them. If it involves a hospital patient, documents will be obtained directly from medical records.
Input of Charges
Charges are checked, coded and input to our computer system by our Reimbursement Specialists, generally within 48 hours of receipt. If additional information is required to process the charge, your practice will be contacted immediately.
Electronic and Paper Insurance ClaimsOnce charges are entered, they are automatically sent to the EMC (electronic) claim file, depending on the carrier, and are transmitted via clearinghouse a minimum of three times per week.
Patient StatementsRegular monthly statements are generated and mailed on the 15th (or the closest working day). If we do not receive payment or a telephone call within 30 days of sending a statement, the patient is placed into follow-up status. Follow-up status places the account on our internal Patient Account Follow-up report. We will then make several attempts to reach the patient by telephone. This gives patients a "last chance" to make arrangements to settle their accounts prior to our recommending collection company intervention.
Insurance Follow-UpIf an insurance carrier has not responded to a claim within 45 days of submission, the accounts appear on our internal Insurance Follow-up report. We will call the carrier to determine the reason for the delay and take corrective action.
Posting of PaymentsWe will post payments to your patient accounts generally within 48 hours of receipt. Prior to processing monthly patient statements, and at month end, all payments on hand are posted.
CollectionsIf an account must be referred to collections, one final letter is sent notifying the patient they will be sent to collections if payment is not received within 7 days. If no payment or response is received, the account will be turned over directly to the Collections Company we are subcontracted with, without any additional action required by your practice.
Customer ServiceWe provide incoming telephone service for your patients and insurance carriers. All lines are answered very professionally "Billing Office". This incoming telephone number is printed on all patient statements, thereby minimizing billing calls to your practice. We also provide a toll free line for patients located outside our exchange.
Patient Relations We make every attempt to maintain the best possible relations with your patients. Notes from all conversations are commented on the patient's account. Patients making negative comments are immediately referred to a Manager for handling. Our courteous Reimbursement Specialists are trained to treat your patients with the same care and consideration with which you treat them. We consider ourselves an extension ofyour office, so your patients are our patients, too!
Patient account adjudication is a Client defined guideline. Our Clients may choose to have all patient concerns sent to their designee, or we will handle everything but clinical concerns. This applies to charity care and other patient issues as well.
Audit Resolution Should your practice receive notice that you are being placed in a "pre-payment" ZPIC (Zone Program Intergrity Contractor), MAC (Medicare Administrative Contractor) or RAC (Recovery Audit Contractor) audit, you will need a team of experienced professionals on your side. We have worked closely with CMS on numerous occasions and can provide the necessary tools to navigate the audit process.
Month-End ReportingEach month is closed within seven working days after the last day of the month. At that time, monthly reports are printed and a statement containing the monthly billing fees is issued. A member of our Management team will review the reports with your designee.
The standard MONTH‑END REPORTS generated for each Client includes:
MTD/YTD Transactions Reports
MTD/YTD Charges Report by Provider
Accounts Receivable Analysis
Aged Accounts Receivable.
Several additional reports are available upon request. Virtually any report using our existing database can be developed for your practice and provided on a one‑time or regular basis.
