- Charge Capture – Charges are the heart of the process. Depending on the services you choose, we can pull charges from your EHR or start with charges entered by your practice personnel. Charges are scrubbed to eliminate errors and reconciled with appointments to assure none are lost. Charges are filed with the clearinghouse daily.
- Payment Processing – Payments made by insurance and patients at the time of service or later are posted daily by line item to patient accounts. Reconciliations are made to assure all payments received are accounted for.
- Claims Resolution – There are three distinct areas to our claims resolution process: denied claims, improperly processed claims and lost claims. Working each of these claims is critical to a high collection percentage. Denied claims are reviewed by account managers to determine if the denial is an error that can be corrected, resubmitted and paid or requires an appeal. Reasons for denials are tracked to improve front end processes at the client.
- Improperly processed claims – Includes claims where some line items are not paid, claim is not paid to the practice’s contracted fee schedule, improper take backs of paid claims etc. All of these claims are reviewed by account managers and corrective action taken.
- Lost claims – Include claims where the insurance company has not paid or responded in any way. These claims are tracked and insurance companies are contacted for payment.
- Refunds and Credits – Credit balances from patients and insurance are worked monthly.
- Patient Account Services – Our in-house call center is staffed with knowledgeable, empathetic account reps who take calls from your patients, explain why claims processed as they did and why a patient amount due occurred.
- Reconciliation – We work with each practice to assure that revenues in the billing system balance to the accounting system. This is a key function to assure all processing occurs.
Another benefit of letting us manage your revenue cycle is that we never take a day off. We handle your business with a staff of professionals who are expert in all types of insurance. When your patients call with billing questions, these are the people who actually answer the phone. When your own personnel have questions, these same professionals are there to help them.
With our ongoing support, you will no longer have to worry about what to do when someone goes on vacation, takes personal time or sick leave or, even worse, moves on. You won’t worry that a key person might be gone during the fourth week of the month when you normally meet your month’s financial goals.
The ultimate result of all of this is that we have a track record of helping practices increase collections simply by being there, understanding the rules and using a disciplined process of following up on problem claims.