Frequently Asked Questions

Medical Billing

  • Our Team: Having a team that is knowledgeable, managed by experienced leaders makes us the best.
  • We keep abreast of all coding changes as well as payer regulations and guidelines
  • We can work on your software or ours (a secure FTP or HIPAA-compliant document exchange).
  • There are no training or setup costs and no long-term contracts to sign
  • No administrative hassles of managing an in-house billing and coding team or investing in billing software.
  • With our medical billing services, you can save 30% to 40% on your operational costs.
  • We understand and abide by all government policies and programs.

Our certified professional medical coders and billing experts can effectively work with almost all medical specialties, which include but are not limited to anesthesiology, cardiology, hospitalists, endocrinology, pain management, physical therapy and radiology. Our specialties page will provide you details on the different specialties we serve.

 

Please call us to discuss more about your requirements in your specialty of practice.

Yes. Our dedicated Account Managers will be your first point of contact. These experienced managers will assist with all your practice’s billing needs on a day-to-day basis. We understand that project integrity is maintained when the team works together So, we assign a separate team of billing and coding specialists for each project.

 

With the right experienced team handling your account, you can stay focused on delivering excellent medical care to your patients.

Yes, you can. The dedicated account manager we assign will coordinate with your office or your contact person and serve as your day-to-day communication channel through email/phone and oversee all aspects of your business.

We understand that every office is different.The patient as well as pay or mix will determine the amount of work that is involved in running the practice. We provide this services with the most competitive pricing in the industry. We offer two pricing structures, one being a piece rate and the other an FTE model. Our pricing is based on a percentage of receivables (amount a practice actually gets paid from insurance companies). There are no hidden charges or setup costs. Our goal is to improve productivity and increase revenue for your practice, while reducing cost.

We know that communication is key in a Revenue Cycle Management project. We maintain communication through, emails secure instant messaging, and telephone for immediate assistance. Our project managers are always available to you, just a phone call away.

After receiving the check and/or EOB copy from the doctor’s office via our secure FTP server, the files will be sent to the payment review department. Our payment team reviews each EOB carefully and applies the payment into the billing software against the appropriate patient account. The under/over payments and denials are immediately identified and necessary refund requests or appeals are generated. This is then forwarded to the analysts for further action.

Our medical billing and collection charges are affordable for full cycle medical billing and collections. Every specialty is different and prices may vary. We are confident that by increasing productivity and reducing your expenses with our outsourced medical billing services, you can see a positive impact on your operational costs.

Sure! Our Managers can give you references as soon as it is appropriate. With vast professional experience in providing medical billing services, we have assisted a large number of medical practices, healthcare centers and hospitals. We have provided MRA coding – HCC coding services for Independent Practice Association (IPA), along with insurance verification and authorization services across US., Our case studies page will better reflect our experience in helping medical practices boost their collections and improve revenue.

We use a HIPAA-compliant VPN (Virtual Private Network) to log in to your billing software. The data exchange occurs in this network, which is encoded through secure 256 bit encryption. Our team will perform the medical billing functions on your system. Our secure 256 bit SSL FTP server can download completed reports directly into your system automatically. We provide you with a user ID and password to access your data through this network any time you require. All your processes and reports remain exactly the same.

Our assigned project manager will conduct weekly meetings with your team to discuss the progress of the work and generate reports on a weekly or monthly basis. Additional meetings will be held as per client request.

Our team is well versed in managing patient responsibility. Our patient responsibility management services include sending patient statements in a timely manner (sometimes adjusted according to client preference). In addition, we follow up with a demand letter and phone calls. We see that timely follow-up helps in obtaining quicker reimbursement. If for any reason we find the efforts futile we will work with a collection agency or an attorney for collections if our client feels that step is necessary.

Yes. Our medical coders are certified either by the AAPC (American Association of Professional Coders) or by the American Health Information Management Association (AHIMA). They have in-depth knowledge in medical codes, including CPT, HCPCS, ICD-9, ICD-10 and the latest ICD-11. They are up-to-date on correct coding initiatives, payer-specific requirements and all state and federal government compliance issues.

You don’t, we realize that, which is why we do not ask for long term commitments. We believe in our ability to work hard and earn your business. As we evaluate each client we are very careful and do not take on any accounts that we feel we can’t handle.

 

Read our testimonials to know how satisfied our clients are with the services we provide.

We take certain steps to ensure that all required details are collected even before the transition takes place.

 

  • We gather information from your office that will include all aspects of your present billing and collections cycle.
  • We evaluate your current billing practices to identify gaps, shortcomings and other issues.
  • Based on there metrics, we create an appropriate, effective and more efficient solution.
  • We finalize our plan after discussing it with you and then educate your staff on the processes they will be responsible for.
  • We will ensure that our billing and collections department understands the protocols and rules that you have set in place along with other specifics concerning the practice.
  • A few dry runs will be conducted to make sure every area in the billing and collections process functions properly and that all expectations are met.
  • We will have staff, software and everything on hand to ensure a smooth transition.

Depending on the need, this can include patient demographics, insurance information, patient registration forms, Hospital Face Sheets with procedures and diagnosis, and encounter sheets. Speak to one of our knowledgeable managers and they can walk you through everything.

Yes, we are fully compliant with HIPAA requirements and standards. We understand the importance of maintaining data confidentiality and security. We follow HIPAA guidelines to ensure that all patient information remains safe and secure. Security measures are taken in-house as well as in transfer of files:

 

  • 24 X 7 security personnel manning our office
  • All our employees must sign a confidentiality and non-disclosure agreement
  • Contractual agreements with all business parties are maintained and up-to-date
  • The entire workforce is trained on privacy, security, and confidentiality
  • System of random checking on a regular basis
  • Firewalls and antivirus software on all the computers are updated daily

A lot of hard work! We realize AR is not something that anyone wants to see and when it starts adding up, it creates a cascading effect. AR management really comes down to meticulous systems and following the status on all claims after submission. Our team ensures that EOBs and claims are assessed, prioritized and followed up on immediately. Our team is trained on proper collection methodology including compliance with state and federal laws specific to the practice locality. Our AR analysts research the claims denied by the carriers, rejections received from the clearing house and underpayments by the carriers. They plan and execute necessary actions to collect all outstanding AR. We aggressively follow up on all unpaid claims by calling the insurance carriers.. We can also follow up on all non-payments from patients.

 

We realize that AR is a lot of hard work and having the right people managing this process is critical and that is what we do.

Yes. We can login via VPN or the web to work on your software via secure FTP. We can also work on our own HIPAA-compliant medical billing software.

Our HIPAA-compliant medical billing software incorporates unique features such as multiple account management from a single login, central reporting capabilities and the capability to switch accounts at the click of a button. We provide your staff with 24-hour online access to our internal billing system. We can link our software with your system for accessing data. Our software includes HIPAA-compliant real-time reporting and a secure file encryption that safeguards sensitive information.

We provide performance reports to our clients such as weekly collection reports, denial reports or month-end reports that include physician financials, procedure code usage reports, collection by carrier reports, aged summary reports, detailed management summaries, and year to year analysis. We assure that the informative medical billing reports we provide are accurate and easy to follow for proper financial analysis and comparisons. We assess your billing collections performance by comparing your practice to industry benchmarks.

Yes. We work as an extension of your office and will be glad to take calls from your patients about their account. Our support team is also always ready to handle queries from your office. We are available during business hours to answer any question that you might have.

Medical Coding

Medical coding involves assigning the correct ICD, and CPT and HCPCS codes to the various diagnoses and procedures reported in the medical records. Accurate coding is absolutely vital for receiving the correct reimbursement from government and private insurers.

We are fully HIPAA-compliant follow all protocols necessary to protect the security and confidentiality of client data. Our entire work force is trained and monitored on HIPAA privacy, security, and confidentiality. Our security measures include system checking on a regular basis, 256-bit encryption for all file transfer, up-to-date contractual agreements with all business parties, and more.

 

Speak to one of our Solutions Managers and they can share our HIPAA Documentation.

  • Our team of AAPC or AHIMA certified medical coders and billing specialists are well-versed in HCC, MRA, CPT, ICD-9-CM, ICD 10, and HCPCS diagnostic coding. They were also trained and are prepared for the implementation of ICD-11.
  • We use advanced technology and coding software. Our medical coding services are based on AMA (American Medical Association) and CMS (Centers for Medicare and Medicaid Services) guidelines.

After receiving the scanned documents or patient charts from the physician via FTP, our certified coders assign procedural and diagnostic codes based on all documentation. All associated modifiers are then added as well to ensure proper reimbursement.

We welcome you to take our free coding trial. Send us a few charts and let our certified coders code them for you for free. Try us before you make a decision.

Call our toll free number: 1-800-670-2809. One of Our Solutions Managers will assist you with the process.

Insurance Verification

  • We perform verification services for diverse specialties such as dental, orthopedics, radiology, chiropractic and more
  • Our team is experienced in authorizing up to 300 DME cases per day
  • Comprehensive and customized verifications before the patient’s appointment date
  • We can handle STAT requirements as well
  • We can work on your practice management software (via secure FTP)
  • All patient deductibles, coverage levels and out of pocket costs can be outlined before the point of service
  • Regular QA checking with readily available reports
  • 30 to 40% savings on operational costs
  • Free trial service before signing up
  • Quicker turnaround time
  • Often health insurance claim denials occur because the patient is not eligible for the services billed to the insurance carrier by the provider. Insurance eligibility verification plays a major role in all denial management programs. Verifying insurance eligibility and obtaining authorization is essential to
    • avoid financial burdens
    • ensure accurate medical billing
    • minimize claim rejections, denials
    • improve cash flow
  • Our insurance verification and authorization services ensure that your patients are going to be provided with all details of their responsibility before the point of service. This can be done for all walk-in patients as well as patients who have been scheduled for future appointments.

Our expert staff verifies payable benefits, co-pays, co-insurances, deductibles, patient policy status, effective date, type of plan and coverage details, plan exclusions, claims mailing address, referrals & pre-authorizations, lifetime maximum, and more. We do this by calling the insurance companies directly and not relying on the website information which may be outdated. All calls are logged with the insurance companies’ agent name and a reference number.. Most calls are recorded for added efficiency and quality assurance purposes.

Our verification process involves the following steps:

 

  • Receiving schedules from the hospital, Physician Practices or other Healthcare Facilities via EMR, encrypted email or fax
  • Verifying patient insurance coverage on all primary, secondary and even Tertiary payers
  • Verifying demographic information and updating patient accounts in the system
  • Contacting patients for additional information, if necessary
  • Updating the billing system with eligibility and verification details

 

You can learn more about our process here:

 

We can work directly on your software(via secure FTP) or EMR right from your scheduler.

Our team can help you obtain authorization for medical treatment from the concerned insurance carrier. The process includes

 

  • Obtaining pre-certification number from the insurer when needed for a procedure, visit or other treatments
  • Completing appropriate criteria sheets and forms
  • Contacting the insurance companies on the physician’s behalf to obtain approval for your authorization request
  • Once the forms are filed either online or via a web portal, then the specialist will follow up until authorization is received.
  • If any further documents are necessary, we will coordinate that with you.

We offer faster turnaround times from immediate to 2, 4, or 24 hours, or the next day. We can work on future appointments as well as same day add-ons.

Our skilled insurance verification team is experienced in handling small as well as large volume for healthcare practices of any size. We have excellent computer skills and possess in-depth knowledge of insurance guidelines of various providers, healthcare terms and more.

Yes we do, if you prefer working on our software we can accommodate that. Also, we can work with your software (a secure FTP or HIPAA-compliant document exchange) as well if that is what you prefer.