Our Platinum Program
Appointment Confirmation
Appointment Scheduling initiates a number of activities that when performed sets forth a game changing approach towards a highly successful practice.
A fully utilized scheduler is the hallmark of a high revenue practice.
An appointment confirmation call is never complete when just a voicemail is left when the patient could not be contacted. A more holistic approach is when all alternate numbers have been attempted to contact the patient or his/ her next of kin. Our experience tells us that more than 90 % of patients respond when Text Messages are left if they could not be contacted over the call. We all agree that appointment confirmations work as a true reminder to patients and gives them an opportunity to reschedule in time if they are not going to be able to make it, giving the practice to make best use of the empty slot. Billing Advisors team carries out each of these responsibilities to ensure premium value is given to both the patients and the Front Desk staff at the practice office.
Eligibility & Benefits Verification
Every scheduled patient having active insurance coverage is every practice’s dream and we make just that happen. In addition to active coverage, knowing and collecting the amount of patient cost share has helped our practices see a substantial improvement in patient collections. New Insurance Card for an existing patient or a New Patient always requires caution to be setup correctly in the PMS. Most practices rely on Front Desk to carry on this task, whereas this should be best left to be handled by dedicated Insurance Experts. At Billing Advisors, we simplify this task by limiting the Front Desk responsibilities on this to just scan the new card information if available or just ask one of our Insurance Experts to take care of the Insurance Change or New Insurance information, and we carry out a methodical approach to this task.
The exercise of coverage validation for every scheduled patient begins three business days ahead of Date of Service. In addition, we also do Spot Coverage Validation for same day scheduling. A daily report is run to make sure that all additional scheduled appointments are also validated for their coverage. We get you every patient’s detailed visit-specific information regarding copay, coinsurance, deductible, plan limitations, in-network, or out-of-network benefits. We also take all pains to deal with COB issues.
Referral Management
If you are a specialist and seeing HMO patients for instance then your staff will quickly recognize the pain of getting a Referral on time before the Date of Service. We ensure zero denials due to Referrals.
The process of Referrals begins seven days in advance and up to one day before the date of appointment. The process begins with identification of the patients (like HMO Patients) at the time of Eligibility and Verification process. The dedicated Billing Advisors team collects from practice or EMR the relevant CPT, ICD then begin faxing and corresponding with the PCP’s referral departments and then follow up with the respective insurances to ensure that the referral got processed and the patient is good for the visit. Our team will follow up multiple times if required with the PCP office. Any patient for which a referral fails to get processed before the date of service, is rescheduled so that the service does not go uncompensated for the physician.
Prior Authorizations
Sooner or later practices begin to understand that the seemingly simple process of obtaining an authorization can turn into a nightmare for the practice staff with long payor turnaround time and lengthy hold time on calls. An authorization not obtained resulting in uncompensated claim can seriously jeopardize the reimbursements.
The process to obtain Authorizations begin 15 days prior to the date of scheduled appointment. Procedures requiring prior authorizations are identified and other relevant information such as diagnosis codes, service location and clinicals are collected before the authorization is processed by online, fax, and/ or over calls. For same day appointments up to appointments booked couple of days earlier, we have dedicated teams to act promptly upon them to get their authorizations processed. Billing Advisors team work with your clinical teams for cases requiring additional documents during the approval process. Urgent cases are proactively followed up to ensure a service is not rendered to the patient in the absence of an authorization. Our team will follow up umpteen times if needed to ensure authorization is in place on time. On rare occasions, when an authorization fails to get processed, the patient appointment is rescheduled so that the service is rendered by the physician in the presence of an authorization. The practice is always kept in the loop and is informed of all developments.
Medical Coding
Billing
Advisors has a team of AAPC certified coders with extended experience across
all specialties. The team keeps itself
up-to-date with the very latest releases and changes in the industry. We have expertise in auditing a physician for
his/ her documentation and coding practices.
Medical Billing
At Billing Advisors, we are your trusted partner in the complex world of medical billing. Our comprehensive suite of services is designed to streamline your revenue cycle and maximize your financial performance. From charge posting to claims scrubbing, secondary claims management to clearing house management, we have the expertise and technology to ensure accurate and timely reimbursement for your medical services. Our dedicated team also excels in payment posting, patient funds posting, and refund processing, ensuring that your finances are in order. Additionally, our patient statement management services enhance patient communication and satisfaction. And when it comes to A/R recovery management, count on Billing Advisors to help you recover every dollar you're owed. With our industry-leading solutions, you can focus on providing excellent patient care while we take care of your billing needs. Choose Billing Advisors for a healthier bottom line and peace of mind.
Charge Posting
Once the patient has been seen any delays in sending out the claims must be minimized as much as possible. We put in place automated to quasi-automated processes whereby the Lag Days is at its minimum.
A routine cross check is performed between the scheduler and the charges received to be processed for claims. Any exception is sent back to the practice to ensure that not a single patient who was seen by the physician is left out and his/ her claim not sent. Billing Advisors team double checks and ensures that correct modifiers are added to the correct line items. We also make sure that the primary diagnosis has been selected appropriately. We refer to NCD/ LCD to make sure and ICD sent out on a claim is compatible with the CPT that is being charged. All billers in the team are trained to make use of NCCI guidelines. An authorization is always selected and attached to the relevant CPT codes wherever required. It is important to note here, that the Billing Advisors team right at the stage of Eligibility and Benefits verification and Referral and Prior Authorization stages make sure that such authorizations are obtained comfortable ahead of date of service to avoid any denials as a result of “No Authorization on File”.
Claims Scrubbing
We are all aware of the EMR/ PMS software level scrubbing of claims as soon as they are transmitted out, and we are also aware of the payor level scrubbing rejections. This is one sore area for most billers and are often neglected or not addressed in a timely fashion.
A scrubbing rejection not fixed and sent again as soon as they are received only throws that claim closer to the timely filing limit and/ or causes delays in compensation from a service that the physician deserves to be paid after the patient has been seen. Billing Advisors keep a time bound target to fix each of these Level – I and Level – II rejections as soon as they are received in the software. As a matter of good practice our team run the transmission process twice a day to make sure that such rejections are received within the same day that they got generated. This helps in addressing these in a timely fashion.
Secondary Claims Management
Every claim that has received a primary insurance payment and has a secondary coverage too must get paid by the secondary insurance as well and this is the motto that guides our processes for secondary claims.
Secondary Claims management for the clients of Billing Advisors begin right at the time of Eligibility and Benefits management. We make sure the primary and secondary insurances of a patient having two both coverages are setup in the correct order. Often Medicare advantage patients face problems of claims being sent out to the wrong insurances. Most secondary claims, if not all, today are submitted electronically and the primary payment information are passed down to the secondary insurances to adjudicate their share. We make sure secondary claims are posted correctly to ensure that claims where patient statements may be mandatory as the next stage of compensation process are processed in a timely fashion and no claims continue to sit in secondary aging indefinitely.
Clearing House Management & Troubleshooting
Most practices have login credentials to their clearinghouses but seldom make use of this to ensure a bunch of possible transmission errors that may result for technical reasons.
We monitor and keep a track that what got transmitted by the EMR/ PMS using a third-party clearing house was actually received and further transmitted to the respective payers by the clearinghouse. There can be several other technical and non-technical issues that may require to be addressed with clearing houses even as part of accounts receivables recovery process. Billing Advisors clients enjoy the benefit of outsourcing this complicated clearinghouse management to us and enjoy a piece of mind while our team keep a tight tap on such matters.
Payment Posting
All that gets paid is not always received by the practice. Furthermore, manual or Electronic Remittance Advice payment postings, both get challenging on such odd cases where payment received cannot be easily reconciled. Billing Advisors payments team is well trained to handle all kinds of situations and post payments.
Billing Advisors team has a time bound process to go over step-by-step in following up with payers in multiple ways to ensure that the paid claims are received and posted line by line into the EMR/ PMS. While the effort is to receive all payments as ERA, there still maybe paper EOB’s being received and they can get delayed before being received for any odd reason. We take it as our responsibility to ensure that all such payments getting delayed are tracked and posted into the system. We also monitor and match Medicare payments through its IVR. Patient payments get typically posted the same day as received.
Patient Funds Posting
Often patient payments received from patients responding to statements being sent out to them are posted by the Front office as patient funds. Billing Advisors payments team routinely run such funds reports and posts them to the correct line items.
Only after patient funds are posted to the correct line item that a correct patient statement can be generated. Billing Advisors team makes sure that all patient funds are posted timely and to the correct line items. Often there are patient payments received by the Front Office but not posted into the system. Billing Advisors team run system reports to track them down and after getting details from practices, these are posted to the patient accounts.
Refund Processing
It is not uncommon to see payers recouping payments made earlier, however it is not common to see practices complying with such requests in a timely and correct fashion.
Billing Advisors payments team processes all recoups and refunds right at the time of payments processing in order to ensure every single penny is accounted for during the batch posting. Any check partially posted is not a good practice and we never practice it.
Patient Statement Management
Billing Advisors clients have witnessed substantial improvements in their collections from patients and one simple reason behind all this is the dedication with which every single patient statement is worked upon by the Billing Advisors team.
All patient statements are run and then reviewed for any possible errors in past postings. All errors, if any, are corrected and then the patient statements are sent out. Every single call from the patient calling in response to having received a bill are answered to the best of patient’s satisfaction. It has been observed by our team that often than not once a patient has been explained the details of the bill, he or she is willing to make the payment.
A/R Recovery Management
An existing AR balance of a practice is a good indicator of not only practice’s health but also the health of each of its sub processes starting with appointment scheduling, eligibility and benefits verification, referrals and authorization processing, charge posting and payments postings. A job well performed at each of these sub processes stage dramatically reduces denials and therefore, the accounts receivables. Often the lack of clarity and direction in handling accounts receivables results in their piling up to make the AR days look large.
Fee Schedule Management
With continuing reductions in conversion factors and much more, Medicare and other insurance Fee Schedules present challenges that are not easy to keep up with. Our team of experts follow and remain on top of all such developments not just annually but on a month-to-month basis. We review the top 15 to 20 insurance carriers which account for 90% of your payments. Fee schedules are adjusted annually and whenever required. We also assist in adding or deleting any CPT codes in the PMS/ EMR as may be necessary or upon request from the practice.
Miscellaneous
Experience unmatched client service with Billing Advisors! Enjoy the convenience of having a dedicated Account Manager available round-the-clock, 24/7, 7 days a week. Rest assured, your practice retains full ownership of your EMR/PMS. Plus, we ensure transparent billing for any additional third-party expenses, including clearing house charges, patient statement vendors, and more.