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Billing and Credentialing Services

Set up of Billing process, development of Fee Schedule

This service is crucial for new practices in order to ensure that their billing process is set up correctly and that they get properly reimbursed by insurance payers as well as by self-pay patients. We will assist with the development of a fee schedule, which is the billed charge that is associated with each office visit or procedure. We will identify the correct reports to run regularly in order to assess the performance of the billing department, as well as train the manager and billing staff on how to best manage Accounts Receivable, collect payments from patients, and ensure that the practice is collecting as much money as possible.

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Accounts Receivable analysis and review of billing and collection practices

We will review the practice’s current billing operations, focusing on Accounts Receivable and patient accounts. We will make recommendations on how to improve the practice’s billing practices and increase collections both at the time of service and after the services have been rendered. A coding audit will also be performed in order to ensure correct coding practices and prevent unintentional billing fraud.

Service includes:

  • Coding audit – 10 charts reviewed, with final report detailing common errors and areas of potential improvement
  • Review of claims submission process
  • Review of Accounts Receivable process
  • Recommendations for improvement of insurance collection rates
  • Patient Time-of-Service Collections training
  • Patient Statements and Post-visit collections training

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Ongoing Accounts Receivable (AR) Management Assistance

After the initial assessment (see above), we will do monthly AR reviews to ensure that it is being managed effectively.

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Internal Control Evaluation

We will provide a thorough evaluation of all payment posting activity – especially adjustments and write-offs. This service designed to prevent employee embezzlement and to detect lack of diligence or billing errors which result in inappropriate adjustments and loss of revenue.

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Coding Audit

A certified Coder and Auditor will review the practice providers’ charts to ensure coding accuracy and prevention of potential fraudulent billing. A report will be generated reviewing potential areas of improvement, as well as identifying specific provider coding patterns.

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Contracting with health insurances payers

We will work with the practice to determine which insurance payers they would like to contract with. We will then contact those insurance payers and inquire about the physician/practice joining their network. If the insurance payer is accepting new providers, we will proceed gather the necessary practice information and proceed with contracting with that payer.

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