Insurance and Patient Billing
Our goal with this service is to produce clean claims and patient statements that result in timely and complete reimbursement for your clinic.
Key Benefits
- Improving the claims acceptance rate increases the number of claims paid on first submission. This increases your cash flow and lowers the total cost of processing claims.
- Use of electronic billing improves the timeliness of responses to your claims - both payments and denials - allowing us to decrease the time required to clear your claims.
- All patient statements are hand reviewed to ensure the highest levels of accuracy possible.
Capabilities
Insurance claims are sent out weekly, or more frequently if advantageous, to ensure timely and complete payment. Patient Statements are sent every 30 days or sooner. Electronic Billing and other advanced billing methods are used extensively to promote timely and complete payment. When paper claims must be used (some carriers do not accept electronic claims), they are hand reviewed for accuracy prior to mailing.
Patient Registration
Our focus is to enter the correct information, correctly, the first time. Providing training and feedback about opportunities to improve accuracy at the clinic is a hallmark of our success. It is imperative that when we, the clinic and CPM, make mistakes, and human beings do make mistakes, that we learn from those mistakes.
Charge Entry and Optimization
Our focus is to optimize the panel of charges for services provided. We inform you when panels are limiting reimbursement due to contract limitations or coding conflicts. Use of correct modifiers, reviewing claims for Correct Coding Initiative (CCI) conflicts, and knowing about specialized coding and payment schemes allows us to get our claims sent our correctly the first time. Providing training and feedback to the clinics is critical here too. It is less expensive to focus on accuracy at the point of origination than to spend money, and lose valuable time, correcting rejected claims later. Many times operations never get around to fixing things later - by preventing them in the first place we avoid this problem altogether!Insurance Claim Filing
We use Electronic Billing for all payers that accept electronic claims. Electronic claims may go as frequently as daily if it contributes to more timely and complete payment. Paper claims are hand reviewed. We handle CMS 1500 claims and, when required, CMS 1450 (UB92) claims. We bill in the manner that minimizes transactions costs without impacting timely payment.Patient Statements
Patient statements are reviewed for accuracy manually prior to sending them out. This maximizes correct statements. Where appropriate, the collector will add personal notes to the patient encouraging them to pay. Our experience is that when patients understand their balance, they are more prone to pay it. The patient statement, as an integral part of this approach, is seen as a educational tool in helping the patient to understand, and ultimately pay, their out of pocket expenses.