Credentialing and Contracting
Credentialing and contracting are the starting points for successful claims processing. We provide this service with the understanding of the importance of these. This allows us to identify potential issues quickly and resolve while acting on your behalf.
Demographic and Insurance Review
Critical data is captured by your front office to allow for correct filing of claims. When we begin entering a charge for you, our staff can identify demographic or insurance issues that may cause a claim to reject or deny. Identifying these at the beginning of charge entry can make a tremendous difference in shortening the revenue cycle. We also offer training for your staff to help them understand the carrier plans and any changes that take place.
Medical Coding
Our coding staff will review your charges as they are entered, review any notes when necessary, and code to meet AMA, CMS and other carrier guidelines. Changes or trends are communicated to the office manager, clinical staff or physician. This allows you to make any changes that may benefit your practice or the services you offer.
Electronic and Paper Claim Filing
Electronic claims are filed throughout the day using our clearinghouse and paper claims are printed and mailed daily. For paper claims such as workers’ compensation or surgical/procedural claims, we pull a copy of the notes to mail or fax with the CMS-1500.
The clearinghouse will give guidance through CCI edits to identify any potential conflicts in patient information that could result in a denied claim such as patient eligibility on the date of service, submitted provider not eligible to submit to a carrier or simple coding edits of inclusive CPT codes. These are reviewed and corrected for resubmission daily or if the problem is more complicated, we review the clinical note, carrier manual or coding issues to resolve.
Patient and Insurance Payment Posting
Patient payments are posted daily. Any refunds identified are forwarded to the practice manager or physician for processing.
We post electronic and paper remittance advices daily once confirmed the funds have been deposited to your bank account.
Reconciliation of Daily Deposits
We work with your accountant, office manager or physician to make sure all deposits are accounted for and posted.
Denial Management
We are passionate about denial management. Our expertise and experience in this area allows us to quickly identify issues and troubleshoot problems that can be complicated to solve. We are familiar with the carrier rules and steps in the appeal process that can make a difference in successful resolution. We appeal things to the highest level possible including CMS and the State Insurance Commissioner. We have been successful in denials being overturned and with CMS and LCD’s being corrected when the MAC may have misinterpreted the rules applied at the federal level.
Patient Collections
We respect your patients and the relationships they have with the physician and the practice. We work hard to offer a friendly, though firm collection process on your behalf. We will work with you to put in place a policy that we have found to be effective while allowing you to tailor the policy based on how you want to practice medicine.
Reporting
Monthly reporting is your roadmap to a successful practice. We will work with you to develop, monitor and report information that is useful to you in making short- and long-term decisions managing the financial aspects of your practice.