Our Gold Features

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

  • Post all patient funds to the appropriate line items.

Refunds Processing

  • 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.
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A/R Recovery Management

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

  • Perform annual Fee Schedule updates in consultation with practice.
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Miscellaneous

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

  • $1,000  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.

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.