Services Provided

Insurance verifications serve as the gatekeeper in the billing process for healthcare services. This verification process not only streamlines billing but also ensures accuracy and efficiency. Our team of professional coders will verify eligibility and benefits for every claim before submission to the insurer. This crucial step determines whether pre-authorization is required and clarifies any out-of-pocket costs for which the patient may be responsible.

The verification process is designed to ensure smooth payment processing, prevent unexpected outcomes, and significantly reduce the likelihood of claim denials or rejections. In essence, insurance eligibility verification is the foundational step that guarantees the delivery of healthcare services without financial disruptions for both the provider and the patient. It is an essential element in effectively managing healthcare costs and ensuring that patients receive the necessary care without undue stress.

Our end-to-end medical billing services provide maximum reimbursement for our clients while reducing overall costs. We just don’t monitor your account we actively manage it.

• Daily claims entry
• Electronic and paper claim submission
• Dedicated follow-up
• Claim correction and/or re-submission
• Government, commercial and private billing
• Weekly / monthly customized reports
• Patient statements* (soft collections, up to 3 past due notices)
• Payment posting / adjustments
• Denial management
• Tracking/claims management
• Managing collections
• Patient inquires
• A/R recovery
• Dedicated Account Manager

 Most providers do their own Coding. But if your practice need Coding help, we’ve Certified Coders available. Our Coders work with all specialties, they can help you maximize revenue. 

• Clean Claims
• Fewer Denials
• Certified Coders
• HIPAA Compliance
• Latest Coding Tools & Software
• CPT, ICD-10 and HCPCS Coding
• Meet Insurance & Government regulatory requirements
• Fast turnaround times

Credentialing in the medical billing process is a critical step that ensures healthcare providers are qualified and authorized to offer services and receive reimbursements from insurance companies. Here’s a summary of what the credentialing process involves:

1. Gathering Provider Information
2. Verifying Provider Credentials
3. Completing Application Forms
4. Submitting to Payers
5. Awaiting Payer Review
6. Receiving Credentialing Approval
7. Obtaining Provider Numbers

The credentialing process is vital for compliance with regulations, gaining patient trust, improving reimbursements, reducing errors, and increasing network participation. It’s a thorough vetting process that upholds the integrity of the healthcare system, ensuring that practitioners meet rigorous standards before administering care to patients.

The Accounts Receivable (AR) process is a systematic set of actions that businesses follow to invoice clients, track payments, and collect funds owed for goods or services provided. Here’s a summary:

• Create and Send an Estimate/Proposal: The process begins with creating an estimate or proposal for the client.
• Receive Approval/Purchase Order: Once the client approves the estimate or sends a purchase order, the process moves to the next step.
• Create and Send an Invoice: An invoice is created detailing the goods or services provided and sent to the client.
• Track Payments: The business keeps track of payments made and still owed.
• Address Invoice Disputes: If the customer disputes their bill or refuses to pay, the business addresses these issues.
• Write Off Bad Debts: In cases where the debt cannot be collected, it may be written off.
• Collect the Payment: The business collects the payment from the client.
• Reconcile the Payment: Finally, the payment is reconciled, ensuring it matches the invoice.

This process is essential for converting sales into actual revenue, which is vital for the financial health and growth of a business. It also helps ensure that credible customers are approved, invoices are sent on time, and incoming payments are processed and collected for regular cash flow.

The process for denials and appeals is a systematic set of actions that individuals or organizations follow when they disagree with a decision made by an insurance company or a government agency. Here’s a step-by-step summary:

• Identify the Problem: Understand the reason for the denial. This could be due to a billing error, lack of medical necessity, or other issues.
• Gather Preliminary Information: Collect all relevant information related to the denial. This could include medical records, insurance policy details, and the denial letter.
• Understand the Illness and the Insurance: Gain a thorough understanding of the illness and the insurance coverage. This will help in making a strong case for the appeal.
• Write the Appeal Letters: Draft a formal letter disputing the denial. The letter should clearly state the reasons for disagreement and provide supporting evidence.
• Submit the Appeal: Send the appeal to the appropriate entity (like the insurance company or Medicare Administrative Contractor) within the specified time frame.
• Track the Appeal: Keep a record of all documents sent and received during the process.
• Evaluate the Result: If the appeal is successful, the service or item will be covered. If the appeal is denied, you can move on to the next level of appeal.
• Repeat the Process: If the initial appeal is denied, you may have the right to further appeals. Each level of appeal has its own requirements and deadlines.

This process is essential for ensuring that individuals or organizations receive the coverage or benefits they are entitled to. It also helps in addressing any errors or misunderstandings that may have led to the initial denial

Patient invoicing management is a vital part of the healthcare revenue cycle, focusing on the accurate and efficient billing of patients for services rendered. Here’s the invoicing process: 

1. When the claim is finalized and if the patient has a responsibility an invoice is mailed to the patient. 
2. If no payment is received within 30 days, a statement is mailed to attempt to collect payment.
3. If no payment is received within 60 days,  a third statement is mailed to attempt to collect payment.
4. If no payment is received within 90 days, a 15 day warning letter is mailed informing the patient that if the account is not settled in 15 days it will be turned over to collections.

This process ensures that healthcare providers receive payments for the services rendered by them.  It's important to note that any errors in this process can lead to claim denials, affecting the organization's cash flow.