You provide Practice Partners with a completed fee ticket, demographic sheet, a copy of the insurance card, and copies of the EOB’s when you receive them. We take it from there:
- Enter patient demographics
- Post all charges
- Submit all claims electronically where possible, and by paper where necessary – including workers compensation and accident claims
- Post all payments – whether from patients or carriers
- Follow-up with insurance carriers on delayed or denied claims
- Post denial codes
- Bill patients for balances owed
- Resubmit claims as required
- Provide guidance on when to submit unpaid claims to collections
- Handle all patient calls pleasantly and with professionalism
But those are just the basics. We provide additional focus on the following:
Accurate Coding. We review your coding for appropriate use of modifiers, correct CPT/ICD-9 combinations and other coding pitfalls. In cases where coding rules vary by carrier, we make sure the code is correct for that carrier. While we will always bill what you code, we can help you improve your coding skills for maximum reimbursement.
Problem Identification and Management. Insurance carriers deny or delay claim payment for numerous reasons. The most common are eligibility issues, incorrect demographics and coding errors. We measure and analyze your billing processes to look for trends like these that reduce your collections. Then we work with you and your staff to improve or change the process, reduce the errors and get you paid.
Our Core Billing Service also includes the following services:
Front Desk Training. Your front desk has an enormous impact on your collections rate. Ensuring that you have correct demographics and insurance information, effective management of your appointment schedule and collection of co-pays and delinquent balances are just some of the ways good front desk staff can improve your practice. We work with and train your staff to make sure these critical functions are working smoothly.
Document Review. Sometimes, simple changes in your fee tickets or other documentation can save time and improve your financial performance. We can review and revise the documents you rely on in your practice to make sure they are state-of-the-art:
- Fee Tickets
- Patient Registration Form/Demographic Sheet
- Patient Waivers/Advance Beneficiary Notices
- Notification to Patients of Payment, Appointment and other Office Policies
- Notification of Participating Insurances
Review of Internal Controls. Effective procedures for managing patient and insurance payments are critical in ensuring that all monies are accounted for. We can help you establish office procedures to ensure that all monies that flow through your office are posted into the system and make it to your bank account.
Payer Profitability Analysis. When your practice grows to the point when you are seeing all the patients you can, you should start looking for ways to increase the profitability of your patient base. One early step is to drop low-paying carriers and replace them with the patients of higher-paying carriers. We can identify your lowest paying carriers and the financial impact of dropping them.
Insurance carriers rarely pay promptly in the best of circumstances, and over time, an accumulation of small problems can result in a significant amount of reimbursements unpaid claims. Tracking down these problem claims and getting paid is extremely time-consuming. Most practices can not cost effectively do so and as a result, these amounts often go unrecovered.
We can collect these payments for you. Because we charge a percentage of what we collect, the process is essentially risk-free for you. And perhaps equally as important, we can identify the issues in your billing processes that are driving these problems so that you avoid the situation in the future.
To collect these amounts, we can do the following:
- Enter the patient demographics and charges into our system
- Follow-up with the insurance carrier to determine why the claim has not been paid
- Fix the problem and resubmit the claim
- Provide regular reports on how much is collected, how much is uncollectible and the reasons why any amounts should be written off
- Identify the problems that led to the situation so that you can correct them for the future
