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Standard Medical Billing Service
• Data input of medical billing charges and payments
• Correction of data entry in the system when needed (such as patient demographics, insurance etc)
• Verify superbill codes selected are accurate
• Submit claims via electronic and paper form to the patient’s primary, secondary and tertiary insurance
• Manage payment posting
• Engage in follow up activities with payers inquiring about unpaid claims, denials and appeals
• Manage electronic remittance notices (ERAs) and electronic claims (EDI) from payers
• Provide patient billing
• Submit claims for professional services provided in the hospital and/or nursing facility
• Handle billing correspondences
• Provide standardized reporting to show current claims status, Account Receivables and aging reports which will be reviewed with the company's management on a regular basis
Additional Services
• Review contract including capitation rates and fee-for-service reimbursement schedule for different insurance groups including PPO and HMO insurance.
• Perform analysis with contracts rate versus reimbursement rates to ensure correct reimbursement amounts.
• Perform diagnosis and procedure coding audits on a routine basis; make operational recommendations to the providers. This will help achieve the highest Medi-Cal, Medicare and private insurance reimbursement with compliance.
• Implement HCC coding guidelines to meet documentation requirements of the Independent Physician Association (IPA) or Medical Groups which account for increased incentives and bonuses.
• Update and maintain facility’s charges up to date
• Provide clinician’s education on the incentive programs and ensure competency of the provider and staff of internal tools and systems for compliance.
• Evaluate quality of coding, and develop criteria and methods to reduce coding error rates and increase reimbursement.
• Provide training on coding techniques and standards including coding on the highest specificity, right combination codes to include the manifestations, coding chronic conditions and qualified conditions to the provider/s.
• Review medical records, assist the medical staff on issues of proper documentation for optimum reimbursement, and advising on proper diagnosis on problem charts to maximize the highest capitation reimbursement based on risk adjustment rates for Medicare/Senior patients.
• Provide assistance in provider enrollment & credentialing on behalf of the provider.
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