Medical Billing

Electronic Claims Submission

  • Claims are submitted electronically within 24 hours of receipt. Almost all unquestioned claims are paid within 30 days,and in some cases even earlier.

Paper Claim Submission

  • We will process paper claims for those payers who do not have the capability of processing claims electronically.

Patient Statements

  • Monthly statements are mailed out for each account with a deductible or patient responsibility balance.
  • Payments and Posting
  • Each EOB is analyzed and appropriate payments are posted to the proper claim. At the end of each month you will receivecomprehensive reports reflecting all transactions

Billing Inquiries

  • We handle all patient inquiries about their medical statement. Patient billing inquiries can be very time consuming foryour office staff. Rest assured that we will take the time to answer any and all questions regarding your patient’s statement in a prompt and courteous manner.

We Also Provide

  • Follow up on unpaid insurance claims, denials and outstanding patient balances
  • We will consistently and proactively review, correct and resubmit any unpaid claims, denials and outstanding patient balances.
  • Process Appeals to Insurance Carriers
  • Phone calls and mailing letters for soft collections

Medical Practice Billing Analysis

Dynamic Medical Practice Impact Analysis

Offers you a complete and powerful perspective on the business side of your medical practice. It gives you the information and insight to make important decisions to increase your bottom line.

  • Identify and maximize profitable revenue centers
  • Real-time information regarding billing and reimbursement performance
  • Comprehensive reports and analysis
  • Practical information about your productivity
  • Efficient procedures to ensure maximum reimbursement
  • Establish realistic expectations for practice revenue based on services offered and actual payer reimbursement

Reimbursement Review and Analysis

  • Implementing efficient processes to handle and manage reimbursements are vital to ensuring all the revenue generated in your office is captured.
  • Assess current coding and billing protocols identifying opportunities to increase revenue and profitability.
  • Recommendations regarding methods for coding and revenue audits to maximize reimbursement, claim submission, and payment facilitation
  • Recommendations to optimize clean claims submission
  • Evaluate denial rate and recommend processes to reduce those rates in order to maximize revenue

Payer Analysis

Knowing which services payers actual pay for, how much they pay and when they pay is essential for sound practice planning. Our payer analysis gives you this information and more.

  • Analyze payer mix and profitability derived from that mix
  • Establish reimbursement comparisons between payers for all services offered by the practice
  • Provide realistic reimbursement expectations and timelines for all payers and services
  • Analyze contracted payer fees for purposes of internal benchmarking and contract negotiations with payers
  • Provide recommendations on patient mix to maximize actual payer reimbursement
  • Provide recommendations on which patient services should be offered based on actual reimbursement
  • Analyze impact of new payer contract developments on practice revenue

Fee Schedule Analysis

  • Your fee schedule is a vital financial tool, which gives your patients and payers a clear picture of how your practice defines the value of its services. We utilize the Resource Based Relative Value Scale (RBRVS) methodology to create a fee schedule based on relative productivity and today’s competitive reimbursement environment..
  • Set fees that maximize revenue without inflating the accounts receivable
  • Keep fees up to date

Additional Services

Denial Management and Benchmarking

  • Denial Management and Benchmarking is a dynamic way of enhancing your practice revenue cycle. Your denial EOB will be proactively reviewed to identify errors and missed revenue opportunities
  • Identify significant denial patterns and payer payment variances.
  • Reports will summarize the total dollar amount of denied claims along with the reason for denial.
  • Detailed information of each denial and potential reimbursement issues.
  • Provide recommendations to avoid the same denials in the future

Provider Credentialing

  • Credentialing requirements and guidelines are ever changing. They are time and labor intensive. We provide credentialing and credentialing maintenance for both new and established providers.
  • Process and file documents for
  • Hospital privileges
  • Government plan enrollment
  • Third party payers
  • CAQH and expired licenses

Comprehensive, easy to read, monthly reports

  • At the end of every month we will provide you with essential monthly reports that gives you vital information about your monthly revenue/collections
  • Snapshot report summarizing your monthly collections, accounts receivables, and denials.
  • Denial Report, detailing the reason for the denial
  • Feedback and Recommendation report
  • Access to customizable reporting feature

Monthly Feedback and Recommendations to maximize your collections

At the end of every month we will provide you with a Feedback and Recommendations report for your internal office to use to make changes regarding patient files (ie updating insurance information), and internal office processes (ie change in codes).

And because we are web based we provide You with a 24/7 Access to your Account

24/7 Access to your Account

  • We believe in complete transparency
  • Access your account at any time from any computer with internet access
  • View real time status of your claims and denials
  • Access to a variety of reports as well as having the capability of customizing your reports