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Practice Management monitors Accounts Receivable monthly and follows up at regular intervals no greater than 30 days until the claims are adjudicated. Diligent Receivables Management and monitoring of best practices minimizes the risks of revenue falling through the cracks.

Practice Management monitors:

Productivity
• Production Summary
• # claims transmitted
• Clean claims rate
• Claims by Payer

Denials
• Initial Denial Rates
• Top 5 to 10 denial reasons
• Registration Error Rates
• Coding Error Rates
• Denied claims as a percent of revenue

Coding
We notify the clinic of potential coding errors identified through the billing process as part of Complete Revenue Cycle Management Services. In addition to notification, PM will make recommendations regarding correct coding for provider consideration.

Coding Audits
Coding Audits can be requested that will analyze the progress notes and compare provider Evaluation and Management coding with recommended Certified Coder Evaluation and Management codes of the same elements. CPT coding, modifier application and diagnostic coding will be reviewed and documentation deficiencies will be identified. A summary of the errors by type and frequency will be provided.

Technical Assistance and Training
If needed, coding and documentation specialists are available remotely to conduct provider Evaluation and Management documentation and coding training sessions. Remote follow-up or more extensive training is available for individuals or small groups dependent upon audit findings.

Physician and provider credentialing are the most important tasks to keep cash flowing for new, changing, and growing practices. Proper medical credentialing eliminates many of the cash flow pitfalls seen in changing practices.

Practice Management provides Complete Credentialing Services for physician billing service clients, including all payer, physician group, and hospital credentialing. We also handle CAQH and NPI applications and updates. The Practice Management credentialing team maintains contact and tracks the progress of every enrollment through completion. We keep a record of every credentialing document and communication. A few of the credentialing services we offer include:

  • Medicare Credentialing
  • Medicaid Credentialing
  • Blue Cross and Blue Shield
  • Commercial Payers
  • Workers Compensation Payers
  • Durable Medical Equipment
  • Hospitals
  • Physician Organizations
  • CAQH Credentialing
  • NPI registry

Charge Entry
Practice Management (PM) typically remotely accesses your EHR/PM and processes charges after they have been entered by the providers in the EHR system and approved. If there are additional charges that are not entered into the EHR, Practice Management will manually enter the charge data required for claim submission.

Practice Management procedures include:

  • Receive billing information from practice (either from EMR or encounter forms/billing sheets). PM provides a secure method of exchanging Protected Health Information.
  • Acknowledge paper batches upon receipt.
  • Reviews and posts batches from EMR and paper if needed. (EMR batches are processed daily and clean manual encounters are posted within 2 business days or less.)
  • Pre-bill scrubbers identify missing or erroneous data elements.
  • Correct errors (contact practice if needed).
  • Transmit Claims (Daily).
  • Confirms claims are received by clearinghouse and payers.

Payment Posting
Practice Management procedures include:

  • Electronic Remittance Advice (ERAs), Explanation of Benefits (EOBs) and patient payments are posted daily.
  • Balances are transferred to secondary payers or patients when primary payment is posted.
  • Secondary payments are posted and if a balance remains it is transferred to the patient.
  • Payments posted are balanced to each check or EOB received

Practice Management procedures include:

  • Prebill scrubbers identify missing and erroneous data elements that are corrected prior to claim submission.
  • Review clearinghouse report, correct all errors (if any) and resubmit claims.
  • Review denial report from carrier, correct all denied claims (if any denied claims, contact practice if needed) and resubmit claims.
  • Work Accounts Receivable Aging (Monthly).
  • Continue to work claims until adjudicated and resolved.
  • Professional Handling of Patient Billing Inquiries
  • Reliable Entry of Service Charges
  • Reliable Entry of Insurance & Patient Payments
  • Reliable Entry of Contract Adjustments
  • Invaluable CPT & ICD-10 Coding Specialist
  • Collection of Delinquent Insurance Claims
  • Regularly Scheduled Report Reviews with Provider
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