Medical & Billing Services
 

CHARGE ENTRY / CLAIM SUBMISSION ACCURACY

The Medical billing process begins with accurately entering charges and creating claims.

Every claim is verified to check:  Patient Demographics, Medical codes, DOS, POS, Provider Info, Units, Modifiers, CPT code, Facility billed from, Referring Doctor. Your fee schedule is taken into consideration and bills are raised accordingly, ensuring a reduction in claim denials. Medical Claims are submitted electronically no later than 24 hours after we receive them from your office. 98% of our claim submissions are accepted the first time by the insurance companies.

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PAYMENT POSTING

Reading EOBs is a skill and one must be aware of all the nuances of payer communication when handling a payment posting account. Payment Posting is also evolving with ERAs (Electronic Remittance Advice) from payers, our billers support ERA posting by verifying the payments posted. Our specialty lies in working on the most advanced electronic remittance scenarios, including denials, underpayments, overpayments, multiple adjustments, automatic cross-over, secondary remittance, reversals, and more.

Enter the allowed amount

Paid amount and

Patient responsibility information

Then calculating the contractual adjustments

This also helps the insurance follow up easier

ACCOUNT RECEIVABLES

Our billers believe that the accuracy of the claim and the time spent on retrieving the payment are key points in optimized revenue collections. Our aim is to improve the client's cash flow by reducing days in accounts receivable and improving profitability, by increasing the ratio of the collection. We organize the Account Receivables timeline-wise (AR days between 30 to 45 days, 45 days to 60 days, and beyond 60 days) and work on critical claims first.

We run reports on account 21 days past due and call insurance companies to check claim status, re-file, or gather additional information. They keep the average age of accounts receivable at 25 days or less.

DENIAL MANAGEMENT

Denial Management has only one key – ANALYSIS, once the root cause of denial is figured, correcting it and getting paid for it is not a task. The skill of a specialist is required to get the perfect analysis into a claim. Our billers are specially trained to recover the collectibles from

• Worker's compensation

• PIP

• Medicare

• Medicaid

• Attorneys

Denial claims also require "Appeals" – Appeals are requests an explanation of the claim sent earlier and conditions on which the claim now is again eligible for payment. Some appeals are time-sensitive. Our Billers review your most commonly denied claims, prioritizing both for volume and dollar value, and file them in a timely manner.