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Appointment Confirmation

  • Confirm appointment one business day in advance.
  • Conducted during normal business hours.
  • Contact patient via phone and /or SMS.
  • Update EMR/ PMS when patients reply.
  • Reschedule appointment when necessary.
  • Send personalized text messages as may be requested by practices.

Eligibility & Benefits Verification

Coverage Validation

  • Advise reception of the actual amount to be collected from the patient at time of check-in. (i.e., past due balances plus any co-pays and deductibles.)
  • Communicate to practice via EMR / scheduler notes.
  • Update billing software.
  • Update EMR/ PMS with new insurance carrier information, policy, or both.
  • Obtain new or replacement insurance carrier from patient.
  • Confirm eligibility and benefits three business days in advance.

Patient Demographic Validation

  • Benefits Validation.
    • Determine copays.
    • Determine deductible (met or unmet).
    • Determine coinsurance.

Referral Management

  • Identify patients requiring a referral.
  • FAX patient’s PCP for Referral Request providing all requisite details.
  • Advise PCP that a referral is required.
  • Follow up online to obtain referral and download and update EMR.
  • Follow up with the PCP referral department in case a referral is not obtained to ensure referral is in place before DOS.
  • Collect procedure, Dx codes and location details from Practice via EMR.
  • Follow up with the PCP referral department in case a referral is not obtained to ensure referral is in place before DOS.

Prior Authorizations

  • Collect procedure, Dx codes and location details from Practice via EMR.
  • Follow up online to obtain referral and download and update EMR.
  • Advise PCP that a referral is required.
  • Identify patients requiring a prior authorization.
  • FAX patient’s PCP for Referral Request providing all requisite details.
  • Medical coding of charts performed by AAPC/ AHIMA Certified Coders.

Medical Coding

Medical Billing

Charge Posting

  • CPT and ICD (Coded by the Practice).
  • Modifiers – Adding them where relevant.
  • Adding Authorization numbers to charges.
  • Copay posting to the correct line.
  • NCD/ LCD (Ensuring CPT to ICD compatibility).
  • NCCI.
  • Claims Transmission.

Claim Scrubbing (Level I and II)

  • Resolve and refile rejected claims within 48 hours.

Secondary Claims Management

Clearing House Follow Up & Other Troubleshooting

  • Call and resolve any sort of issues with the clearing house.
  • Call and resolve any sort of issues with the EMR/ PMR.

Payments Posting

  • EOBs posting - (Explanation of Benefits).
  • ERAs processing - (Electronic Remittance Advice).

Patient Funds Posting

  • Process all insurance refunds and recoupments.
  • Process all patient refunds for overpayments.

Patient Statements Management

  • Run statements report, once monthly.
  • Review all statements for accuracy before sending out.

Refunds Processing

  • Post all patient funds to the appropriate line items.

A/R Recovery Management

  • Old patient A/ R recovery by making soft patient collection calls.
  • Old Insurance A/ R recovery.
  • Current patient A/ R recovery by making soft patient collection calls.
  • Current insurance A/ R recovery.

Fee Schedule Management

  • Perform annual Fee Schedule updates in consultation with practice.

Miscellaneous

  • Physician has access to a dedicated Account Manager at Billing Advisors (By Phone) 24 hours & 7 days a week.
  • All additional third-party payments to be billed as per actual, such as clearing house charges, patient statement vendor, etc.
  • EMR/ PMS ownership lies with the Practice.

Pricing

  • $1,500 per physician - Invoiced on the first of each month payable upon receipt.
  • 3% of the collected revenues at the end of each month for charges with Date of Service AFTER the effective date, and;
  • 15% of the collected revenues at the end of each month for charges with Date of Service BEFORE the effective date.

Client hereby expressly authorizes BA to prepare, process and submit claims to commercial and government payors. BA will apply its best efforts to obtain reimbursement for Client’s charges for all clinical procedures and medical services provided to patients. All such claims shall be submitted by BA in the Client’s name and utilize provider numbers assigned to the Client by the respective insurance payor. Claims will be submitted by electronic, facsimile, or paper means. Payment of all claims filed on behalf of Client shall be directed to such accounts to which Client has control. BA shall post payments received from the insurance companies to the patient's record.

It is the responsibility of the Client to contact the patient directly, when necessary, to secure full payment for the Client. Client is the only party to this Agreement to negotiate a repayment plan with patients.

Client hereby expressly authorizes BA to medically code any services performed by client for which a superbill is not used. This can be for services performed at a facility other than the Client’s office (i.e., hospital, clinic, other practices, etc.) The coding fee is $2.00 per chart.

BA will be responsible for the collection of claims and submissions both after and before the effective date of this contract. For claims, whose date of service, is posted after the effective date the fee on collected funds shall be 3%. For claims, whose date of service, is posted before the effective date the fee on collected funds shall be 15%. For claims posted before the effective date, BA will review each outstanding claim and assess whether it should be written off, needs to be resubmitted, or any other actions that would work towards the collection on such claims.