Insurance Billing for Healthcare Professionals
- MD-supervised Integrative Healthcare
- Physical Therapy
Our Billing Service is very simple to understand:
- Affordable set-up and on-boarding fees.
- One low rate, no sliding scales, and no hidden fees.
- We get paid only when you get paid.
Often problems in revenue come from a small percentage of mistakes that are overlooked. These “tiny” errors add up over time and seriously jeopardize your cash flow. We know how to find these and fix them. Denied claims and ineffective followup can be a daunting problem.
Diagnosis Pointers and Uncollected Revenue
When you set out to treat a patient you diagnose what is ailing him – these are your diagnosis codes.
Then you treat him and communicate this treatment with CPT codes. (Current Procedural Terminology codes are numbers assigned to each task and service you offer.)
Each one of those CPT codes needs a diagnosis pointer (anywhere from one to four), that points to the particular diagnosis that the CPT code is treating. Simple enough right?
Most software systems that providers use in their offices for their health records and billing have defaults set into the software. In most cases this is fine. However, one of those defaults is the Diagnosis Pointer Settings. The default setting is ABCD which assigns all 4 pointers to each CPT code.
You may very well still receive a payment from an insurance company but you will also set yourself up for denials and bundling issues because the information you are transmitting to the insurance company is NOT what really happened in the office.
The numbers and letters you transmit on an insurance form translate into words for the insurance adjuster. You must ensure you are communicating exactly what happened via your codes and your notes.
The more concise the coding and billing is, the easier it will be to get paid for the work you performed.
If you suspect billing errors are costing you revenue, you might need Revenue Rescue!
Accounts Receivable Cleanup
Accounts Receivable common problems:
- Incorrect billing resulting in denials.
- No denial followup if corrections are allowed.
- No posting of payments to patient ledgers resulting in incorrect balances.
- No collection of co-payments from patients.
- No collection of deductible patient liability assigned from the payers.
Our Accounts Receivable Cleanup involves the following steps:
- Audit accounts – determine what, if anything, is still validly collectible (this is primarily determined by timely filing dates to see if claims can be corrected or resent out for payment).
- Ledger correction – ensuring insurance payments are recorded so the front desk can actually determine what a patient owes – if anything – and can then proceed to collect it.
- Denial followup – looking at the EOB denials to see if the denials are small errors that can be corrected – many of them are.
When financial records are not kept up to date patient upsets can occur when they are finally billed for what they owe. Not to mention that the gross income of the practice will be reduced.
This is an important service. It is billed at an hourly rate. Because each practice is different, with varying problems, our Accounts Receivable Cleanup fees are negotiable with each client.
The process of credentialing is the process a provider goes through to become accepted by a payer to deliver services to patients in or out of their network. This process must be done for every provider in the practice as well as for every insurance payer that the office accepts. We offer two credentialing services, Discovery and Full Credentialing.
Discovery entails checking all existing records to see if all credentialing points are in place for the practice, the individual providers and all of the insurance companies. It also reveals when re-credentialing is due for providers and their practices. This may not seem to be a big deal but any points that are out lead to denials and lost revenue that you can’t get back.
Full credentialing is a much broader service and is the entire process from beginning to end to credential a provider with all the insurance companies he will be participating with to deliver services to his patients. This service is delivered on a separate contract basis with the client and Cherry Lane Billing.