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The medical billing environment is increasingly complicated and challenging.  Management and tracking of the entire revenue cycle is a necessity to ensure your practice is receiving appropriate payment.  Allow us to review your entire process and apply best practices to optimize cash flow.  There are many areas to review including:

Claim Creation includes capturing and editing the information needed to create a medical billing claim.  Demographic information includes patient insurance details and personal medical information.  Charge information includes a combination medical practice information, visit or procedure information, and diagnosis information.   The accuracy of this information is vital to a claim being processed correctly.

Coding and Scrubbing is the next step in the process.  Coding adds information pertaining to the medical services that were provided.   Coding rules are complex and change on a regular basis and coding must be done accurately or the practice will face compliance risk.  Our staff of CPC certified medical coders can perform audits to ensure compliance. 

Scubbing and Edits of claims ensure that all information is accurate and consistent so that the claim will be accepted by the payer.   The measure used is typically “first pass claims acceptance rate.”

Claims Submission occurs either electronically through a clearinghouse or manually by paper.

Payment Posting occurs when payment associated with the claim is received.  The Explanation of benefits (EOB) or Electronic Remittance Advice (ERA) provides the information necessary to correctly reconcile the payment and forward information to the secondary payer or patient.

Denial Management occurs when claim is denied payment and further action is required to process the claim.  There are many reasons for claim denials and analysis is necessary to resolve underlying problems that may be causing significant issues with cash flow.  Often a timely response is required to overcome the objection and resubmit the claim for payment.

Accounts Receivable Management is necessary to track outstanding balances and to assure payment is made on a timely basis.  It is also important to analyze underpaid claims by comparing payments to contracted amounts.  Follow-up on these situations is critical to achieving strong collections results.

Patient Collections typically include receiving payment for  co-pays, deductibles, and other forms of “patient responsible” billing.  A medical statement is sent to the patient.  The advent of High Deductible Health Plans makes this step even more important.  Patient follow up is critical ensure the highly level of collection.

To understand the financial and operational health of your practice, reporting is an integral part of the revenue cycle management.  Your electronic health record (EHR) system may or may not provide the necessary reports to accurately asses your practice.  Most EHRs can provide the initial data to begin the analysis.  Even with a good EHR, understanding which metrics to review can be challenging.  We can provide proven assistance in understanding the financial health of your practice.