Full Cycle Medical Billing
Step 1
Verification of Patient Insurance and Eligibility
We check the patient's eligibility and benefits prior to submitting a claim to ensure that the claim will be processed appropriately and reduce the risk of the claim getting denied.
Step 2
Authorizations
We will request and obtain a prior authorization from the insurance if it is required for the specific procedure being performed.
Step 3
Claims Submission
We will extrapolate the proper ICD-10 and CPT/HCPCS code from the encounter and documentation and submit the claims to the insurance company within 24 hours of the date of service. We submit claims through electronic clearinghouses, but we will also mail paper claims to the payers that do no accept electronic claims.
Step 4
Claim Status Verification
Our team will follow up with the insurance companies to make sure claims were received and the adjudication process is moving along appropriately. This helps reduce the risk of claim denials.
Step 5
Payment Posting
We will post insurance and patient payments to the patient's accounts. We post payments that are electronically paid via EFT/ERA as well as posting payments that are received by check and paper EOB.
Step 6
Denial Corrections
If a claim gets denied by the insurance, our team will investigate the denial, correct the claim if applicable, and resubmit within in 24 hours of the denial. This will help expedite payment to the provider.
Step 7
Appeals
If a claim is being unjustly denied and needs an appeal, then our team will collect the appropriate documentation and submit an appeal letter. We will check the status of the appeal and We will follow through with all 4 stages of the appeal process if the provider chooses to or until the appeal gets upturned in the provider's favor.
Step 8
Patient Billing
We will send monthly statements to patient's that have a balance after the insurance adjudication process is complete. We will send paper statements in the mail as well as electronically if they have an email address on file. We will post any incoming patient payments if they call our office to make the payment.
Step 9
Accounts Receivable Follow-up
Our team will continue to monitor denials and appeals and follow up with the insurance companies to make sure that the claims are in process. Our goal is to lower the AR balance and continue to produce more payments to the providers.
Step 10
Patient Collections
We will call patient's with an outstanding balance on a monthly basis. If no communication or payment is received within a time frame set by the provider, then the patient's will be subject to collections. We will gather the proper documentation and submit the patient to a collections agency of the provider's choice.
Additional Services
Provider Credentialing- We will submit any applications to the insurance companies that the provider's wish to credential with. We will remain in contact with the insurance company during the process to make sure that a contract is on the way. We will also provide any additional information that the insurance company may need.
Prior Authorizations- If a provider does not choose to use our Medical Billing Services, then we can help obtain prior authorizations only.
Billing Consults- Our experienced and certified team can help with inhouse billing teams that may be struggling to get claims to pay. We can provide training and help, to the best of our skills and knowledge to promote success for the provider.
Fees and Prices
Medical Billing Services- We prefer to use a monthly flat rate pricing method. A flat rate fee allows us to bill for providers in all states, as some are not allowed to bill with a percentage rate. This fee is also typically lower then the salary of a full-time in-house biller which allows for more money for the provider. This fee is determined by the approximate hours that our team will be working on the account. If the provider prefers a percentage rate fee, and if the provider's state will allow it, the percentage rates typically start at 5%.
Provider Credentialing- The fee starts at $50 per application and can go as high as $150 per application, depending on the level of extent of the application process. Please note that this fee is for credentialing services only. We include credentialing as a part of our Medical Billing Services. If a provider uses our Billing Services, then credentialing is included with our monthly fee.
Prior Authorizations- Determining a fee for authorizations depends on the volume of applications submitted and for what procedure, Infusion, DME or Specialty drug. This can range from a monthly fee starting at $100 a month or can be a per application fee, starting at $25 per application.
Billing Consults- Start at $45 per consult, but the fee is subject to change depending on how much time is spent training and assisting the in-house billing team.