Communication is essential and why we strive to work together with each practice for missing or incomplete information to avoid denied claims.

• Invalid or missing claim information: CPT, diagnosis code, modifier, referral, authorization number.
• Incomplete patient intake form: incorrect date of birth (DOB), invalid member ID number, incorrect name, or address.
• Incomplete or missing documentation: lab reports, x-rays, detailed progress notes, workman’s compensation insurance information.
• Status on Hospital Round claims: admit date, discharge date, authorization numbers are critical for in patient stay, reminder on any pending claims that were not completed by the providers.
• Status Report on Unlocked claims: It is essential for a practice to complete claims within 3-4 days from date of service to avoid untimely filing and to receive payments faster.

Posting of insurance payments involves logging EOB (explanation of benefits) and ERA (electronic remittance advice) into the practice management or billing software system.

• Setting up ERA for all insurances except for insurance companies that do not have an ERA facility.
• ERA’s are extracted daily and payments are posted and audited.
• Paper EOB’s will be audited and posted.
• Daily audit on patient payments.

Accounts receivable requires following up on unpaid and denied claims, also reopening them to receive maximum reimbursement from insurance companies.

• Biweekly AR report will be pulled and worked on by 30/60/90/120 and above. We will focus to keep less than 5% on 120 aged claims.
  
• Claims will be audited and unpaid claims with payer issues will be scrubbed and worked by managers.

Proper denial management quickly and easily determines the cause(s) of denials, reduces the risk of future denials, and allows for faster reimbursements.

• Denial reports are run to sort out errors, verify and fix any credentialing issues and rebill claims.
• Denials that need provider attention will be addressed.
• EOB’s scanned by providers will be audited and posted.
• Recoupments will be identified and valid recoupments will be addressed to the provider.

Being consistent and timely on sending patient statements help maximize revenue.

• Customized Contract: Customized plan and contract will be set-up with the provider on processing patient statements and or collections.
• Confirmation of Patient Statement: Per contract from provider patient statements and collections will be sent and confirmation will be recorded.

Our monthly cadence reports provide a payment scope at a variety of levels for where practices currently stand, where they were, and where to improve.

• Procedure Level – verifies payment per procedure level by payers.
• Facility Level – analyze reimbursement at facility level.
• Claim Level – shows payments received at a procedure level.
• Payer Level – analyzes reimbursements at an individual insurance level.
• Patient Level – verifies insurance properly processes claims and remaining balances are solely patient responsibility.
• Provider Level – shows a combination of both claim and payer level for individual provider.
• Quarterly Reports – each practice will be presented with previous reports and collection totals.