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Billing and Collections

  • Rapid electronic claims processing

  • Audits to ensure error-free claims transmission

  • Submission of UB04 and HCFA-1500 claims for both facilities and individual providers

  • Continued follow-up on all claims

  • Prompt and Immediate posting of payments

  • Custom weekly and monthly reports

  • Analysis and recommendations for fee structuring

  • Monthly patient statements

Utilization Management

  • Assistance with effective clinical documentation, intensity of services, program scheduling, etc.

  • Peer-to-peer reviews and appeals processing

  • Eligibility and verifications

  • Utilization review allows health care providers to review patient care from perspectives of medical necessity, quality of care, appropriateness of decision-making, place of service, and length of stay.

  • In both fee-for-service and managed care delivery models, the physician owes a duty directly to the patient to provide services with a reasonable degree of skill and judgment in a patient’s best interest. That responsibility extends to a requirement that the physician advocate the patient’s needs before that patient’s managed care insurer.

Benefit Verification

  • Information on patient responsibilities, pre-certification, policy exclusions and payer payment estimates.

  • Admission staff benefits training to help facilitate better admission choices.

  • Immediate turnaround.

  • Benefit documentation for reference.

  • Benefit verification system that permits easy re-admission

  • Negotiations and payment Agreements

  • Insurance Forms and Registration

Revenue Cycle Management

  • Electronic charge capture

  • Charge entry and review

  • Electronic claims submission including secondary claims

  • Electronic payments and electronic funds transfer

  • Claims follow-up of denied and unpaid

  • Regular problem notification via web-based dashboard

  • Patient billing and inquiry

  • Collection agency reporting

  • Credit balance and refunds management

  • Informative financial reporting

Contact us Today About Professional Medical Billing Services

Outsourced Medical Billing Does Not Always Mean Offshore

There was a time when the term outsource was not considered a positive alternative for a business. In fact, a lot of people did not even know what it was, just that it was a “bad” thing to do. But when it comes to medical billing, the word outsource actually means a positive alternative that can help streamline your medical practice and help it to grow.   It was probably the different types of outsourcing that led to the confusion behind the use of the term. Some types may be better for your medical practice than others. Outsourcing by going offshore has probably gotten the bad reputation because it shifts jobs from the U.S. to another country. Although a medical billing service can save money employing this solution, doing so is not condoned by the American Medical Billing Association for fear of HIPPA privacy violations and compliance risks. The U.S. also cannot hold a foreign business liable for mistakes or illegalities it commits. Therefore, those who choose to do this should do thorough research on the companies they are considering regarding their security practices.   Other problems with offshoring medical billing could be language barriers, time zone differences, skill levels of the workers, and errors made due confusion. Data storage is also an important consideration, and it must be secure.   There is, however, a distinct advantage to sending your medical billing to an offshore foreign company, and it is that the rest of the countries in the world have been using ICD-10 codes for more than 20 years, the U.S. having been the last country in the world…

Who Makes the Best Medical Billers?

Medical billing is a specialized field. Many medical billers and coders have gone through extensive schooling, earning CPC Certifications, Bachelors and sometimes even Masters Degrees in the subject. The reason the field is so specialized and hard to find a place in without one of these three certificates is medical billing and coding is a very detailed, accuracy based type of work. There are thousands of medical codes, coding guidelines, and types of information that one needs to be aware of in order to actually complete the process of medical billing. And on top of that, certain personality traits are more likely to succeed in the medical billing industry then others. In order to be successful in medical billing, you have to be proficient in medical terminology, anatomy, physiology, medical codes, and medical coding guidelines. This is an enormous feat to conquer, when it comes to simply anatomy and physiology alone, seeing as there are over 200 bones in the body, and significantly more muscles. Knowing these parts of the body is the anatomy aspect, and knowing how they work together is physiology. Without this knowledge, medical billing would be impossible to accomplish, so it takes quite a bit of education in order to earn the title of medical biller or coder. On top of this, medical billing and coding is quite detail oriented. There are thousands of codes and different levels of specification for each code, and it takes a well-trained eye in order to know what needs to be specified and to what level. Medical coding also takes quite a bit of patience. When you are dealing…

Patient Registration and Medical Billing

A number of the problems that medical billers face when it comes to creating and submitting insurance claims can be easily prevented. One of the best ways to increase efficiency in the medical billing process is actually to increase the efficiency of the patient registration process. Some of the problems that arise in medical billing have to do with outdated or incorrect patient information. It is important to get all updated and accurate information at ever patient appointment, otherwise you may be surprised with claims denials and discrepancies with the information that insurance companies have, and this can be detrimental when it comes to reimbursements. Information that should be gathered at patient registration is the proper spelling of all information pertaining to the patient. Claims denials have been known to be caused by something as simple as a misspelled patient’s name, and of course, it that is the case, that is lost time and delayed money, for something that could have been so easily avoided. When patients who do not come in often, or only come in for yearly checkups, or things like that, come in, it is important to verify their insurance information. If you are maintaining a patient database, it is important to assume that the information you have could be wrong, because you never want to be caught in a situation with outdated or incorrect insurance information. If this happens, a patient may not have coverage that will pay for your services, and while you thought everything was fine, you may have just treated someone with small likelihood of ever getting reimbursed for it. Not to…
 




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