The Medical Billing Specialists   
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Services

Claims Submission

Track Payments

Patient Statements

Eligibility Verification

Scheduler

Document Imaging and Storage

Accessibility to the System

EMR

Data Backup

 

Claims Submission

We submit your medical claims within two working days of receiving your charge form (Superbill). We submit electronic claims to over 2,500 payers nationwide including Medicare, Medicaid, BlueCross & BlueShield, as well as Commercial payers; for those few payers that still do not accept electronic claims, we submit the claims on paper. We use both CMS 1500 (HCFA 1500), professional and CMS 1450 (UB 92), institutional; forms to submit your claims to payers.

 

We check your claims against LMRP (Local Medical Review Policies) in order to make sure that procedures are justified by the diagnosis included in the claims; we also add the required modifiers according with the requirements of each payer. Claim errors can be significantly reduced by using our system, they are checked for consistency before being saved including: ICD9-CM codes, CPT-4 codes, DOS, POS and much more; they are later checked by the Clearinghouse for payer ID and insurance ID formats and much more. As a result we achieve a very high percentage of clean claims reaching more that 97% on average.

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Track Payments

We track all payments, from third parties and patients, being able to provide you with accurate aging reports of your account receivables. We understand that having an effective tracking system is paramount in order to obtain acceptable collection rates.

 

Our tracking system get started the day after the claims are submitted with the acceptance and exclusion reports from the Clearinghouse, those claims that were excluded by the Clearinghouse are fixed and resubmitted immediately. In the following days (usually 2 or 3), with the acceptance reports from the payers, we continue tracking the claims. For those claims that are rejected by the payers, we act immediately by gathering the required information from the insured party or the providersí office. These reports may become very useful in order to proof timely filing in an appeals process.

 

The next step in tracking claims is once EOB (Explanation of Benefits) are received. We act immediately (within the same day) on denied claims; either by fixing the problem, calling the payer in case is their error, by calling the insured party if the issue is eligibility, COB etc.. We keep track of the resolution of these issues using a spreadsheet and are also documented in the billing software. The tracking information is available for our customers to see and audit.

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Patient Statements

We print and send patientsí monthly statements on your behalf with different customized messages depending on the aging state of the account receivable, customized specifically for your practice. These statements are professionally printed on a daily basis with a detachable portion including the account information, the ďPay toĒ address, etc.; we also include an envelope for the patient to mail the payment. We provide your patients with a toll free number to for them to inquire about their statements.

 

Since our customers have access to our billing service, at the patientsí registration, they can see if there is an outstanding balance for that patient and collect it before the patient sees the doctor. For delinquent accounts, we can work with your collection agency or we can propose one to you.

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Eligibility Verification

We offer you an eligibility verification tool that checks eligibility of the patients electronically with one click of the mouse, covering must insurance companies in a central location. The results of each verification are stored in the system for future references.

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Scheduler

We offer you a professional Scheduler included in ClaimGear for each one of the providers, resources and locations of your practice. Insurance eligibility of the patient can be verified from the schedulerís window.

 

There are activity reports that can be obtained from the scheduler in order to search for appointments per provider and resources in different status like: scheduled, cancelled, confirmed, checked in, in room, checked out and no show.

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Document Imaging and Storage

Our document and imaging feature lets you view scanned documents and images (such as insurance cards, lab results, reports, EOBs and encounter forms) directly from the patient record, even if they were scanned at another location. It also allows us to work closer with our customers, once the original documents are scanned and uploaded into the system at our customersí site, we are able start working on them immediately, and these documents are link to each patientís record.

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Accessibility to the System

We provide you access to the system for as many users as you need, the users do not need to be in one location, all they need is a computer that meets the minimum requirements and an internet connection to access the system. The userís access could be restricted according to the functions they perform and the information they need to know from different sections of the system and several reports, it can also be restricted by time of day and day of the week.

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EMR

The billing software can be dynamically interconnected with any Electronic Medical Records system as long as the later is HL7 compatible, some of those systems are Practice Fusion,  Physicians Back Office, Sevocity, Patient Now, and MediNotes. The interconnection can be setup within ten days.

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Data Backup

The systemís information is backed up several times a day in real time in a tier 1 datacenter facility; it is also backed up once a day to a datacenter across the country for disaster recovery purposes.

Some of our clients would like an individual backup/snapshot of all of their data to be stored at their office. This provides the customer with their own backup in addition to the backups that are performed in real-time at the datacenter.

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