Medical revenue cycle management services

The traditional model of a private practice has been physicians providing excellent medical care while leaving the business details to their administrative staff.

The modern healthcare system is more complex. Physicians must not only demonstrate their value to patients but also to manage care organizations, hospitals and other healthcare consumers. Health Insurance companies have created a system so confusing that the average physician has to increasingly devote time, effort, and resources merely to sustain their practices. Presently the challenge for physicians is to provide inexpensive, high quality care while simultaneously maintaining a profitable business.

The primary and most easily preventable reason for delayed and diminished cash flow in a medical practice is improper medical billing. Physicians can expect to lose up to 15-20% of their annual revenue if proper attention is not given to their accounts. The complications of medical billing now require a specialist. With reduced reimbursement rates from insurance companies and ever-changing policies, it is now more important than ever that claims be processed accurately the first time.

DEMOGRAPHICS AND CLAIM ENTRY
For Claim creation the process starts with Demographics entry and insurance verification. Either through scanning documents to our billing team or having it shipped in packages we collect all the information necessary to generate an encounter: demographics, insurance information, and icd/cpt codes. 

Once the information is retrieved the claim can be created using two methods:

  • Manual Claim entry: Claims are created directly into the PM system from a route slip or superbill. Before any claim is generated verification is done for patient's insurance eligibility. At the time of icd/cpt entry various online tools will be used to insure correct coding is done with modifiers, units, and charges.
  • Autogeneration: Claims are automatically created directly from the appointment scheduler. ICD/CPT codes, modifiers, and units are entered into individual patient appointments along with Demographic information and patient insurance details. If any copayments are posted into the appointment details they are directly transferred into the encounter. At the end of the autogeneration process auditing of the newly created claims can still be done before submission.

  • CAUTIOUS APPROACH
    The goal of any medical practice is to be sure that claims are billed for every patient visit and sent to the insurance companies in a timely fashion to insure the highest possible reimbursement. Our philosophy has always been to take a proactive approach to medical billing. In other words, 30 seconds of effort in checking a patient's eligibility saves a practice from waiting an extra 30 days for a denied claim to be fixed, resubmitted, and finally paid.

    Claims are entered within 48 hours of receiving information regarding the patient's visit. Through the use of high level scanners and file transfer protocols superbills/route slips/encounter forms are received from any doctor's office regardless of practice size and location. Claims are generated for every type of patient care including office, hospital, and nursing home. Intense scrutiny is given to every claim generated and any missing details are requested from the doctor's office before transmission.

    CLEARING HOUSE REPORT TRACKING
    A significant number of all claims sent electronically (15-20%) are never processed at all due to failed transmission at the clearinghouse level. We track every single claim transmission and verify its successful submission by using an online tracking utility which receives confirmation and denial status from the clearinghouse and electronic payers. Claims with expired icd/cpt codes and missing demographic information are corrected and resent immediately.