ONCOLOGY & HEMATOLOGY PRACTICE MANAGEMENT SERVICES AND SOLUTIONS

 

Precise Medical Billing Incorporated, a practice management service organization with over thirty years of experience, offers services and solutions to expedite insurance claims reimbursement.

Our mission is to assist our clients in perfecting the entire scope of the medical billing process through increased awareness of proper billing techniques, coding, compliance and knowledge of current industry guidelines.

We focus on maximizing your income for services provided, thus allowing you to concentrate on the care of your patients.

 

 

 

OUTSOURCING YOUR ACCOUNTS RECEIVABLE

 

obama signs 3

United States President Barack Obama signs The Patient Protection and Affordable Care Act (PPACA) 2010 shaping current insurance industry guidelines.

 

 

In your efforts to transition into the policies being shaped by the 2010 Patient Protection and Affordable Care Act, having our services year round could prove to be a very wise decision. Our mission is to assist our clients in perfecting the entire scope of medical billing process through increased awareness of proper billing techniques, coding, compliance, information technology and knowledge of current industry guidelines.

Our short-term goal is to increase insurance revenue by 5% within the first 120 days of contracting with a new client, with a 1-year goal of 15% growth for clients averaging around 80% claims reimbursement percentage.

Credentialing and Provider Enrollment with Medicare, Medicaid, BCBS and HMOs, is an essential part of our strategy to attain higher claims reimbursement percentages. Registering Providers with Insurance Company Internet web sites for Direct Data Entry claim submissions, Checking Eligibility, Claim Status, and to receive Electronic Remits (EDI 835 files) speeds up the over-all payment cycle and gives us more time to resolve claim payment denials.

As Health Maintenance Organizations grow in membership, the window to get claims adjudicated has gotten smaller, especially when patients insurance can change in the middle of the billing process. Diagnosis coding is changing, as ICD-9 is converting over to ICD-10, which will surely have some impact on the billing process.

Many Practices around the country are gravitating towards having professional billing services handle the accounts receivable follow-up end of the billing process to ensure additional resources are in place in the midst of the above mentioned changes to the insurance industry.

Precise Medical Billing Incorporated is ready for full implementation of The Patient Protection and Affordable Care Act. We are committed to creating and maintaining professional business relationships. We always stand by our word and exceed client expectations through the development of billing department solutions that increase production and maximize insurance claims revenue.


ELECTRONIC DATA INTERCHANGE (EDI) ANALYSIS

IDENTIFYING THE CAUSES OF LOSS REVENUE 

4.1.1

 

  • Eligibility (Insurance Information)
  • Patient Demographics (Name, DOB, Insurance Number Do Not Match)
  • Prior-Authorization (Auth not obtained or Auth # Not on Claim)
  • Medical Necessity (Diagnosis Coding)

A. Patient Eligibility

  1. Verification of whether or not the patient has active insurance benefits
  2. Verification of Insurance Payer *If the patient is enrolled in a HMO
  3. Contacting HMO/MCO * Check benefits
  4. Obtain Prior Authorization if required
  5. Updating patient information
  • Correctly adding HMO Information and New Contract Number (#) to Patients Insurance information database


Our professional knowledge is that Medicare, BCBS, Medicaid, and their affiliated HMO/MCOs have policies in place such as timely filing limitations that are designed/calculated to negate claim reimbursement in as little 90 days from a patients date of service. If eligibility is not checked on every visit the potential for Loss Revenue drastically increases.



**EDI Analysis Code Examples**

 

Claim is billed to Medicaid and rejects (data analysis code 24).
*24 – Claim not covered by this payer/contractor = HMO/MCO

Claim is billed to Medicare and rejects (data analysis code 109)
*109 – Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor = HMO/MCO

If the proper steps are not taken to resolve these claim denials, it usually results in Loss Revenue (data analysis code 29)
*29 – The time limit for filing has expired



Our staffs of Oncology and Hematology Medical Billing Experts, Analysts and Claims Research Specialists follow a trained methodology when approaching EDI edits, rejections, and delinquent claims tracking. Once patient information/demographics and claims issues are resolved, notes are typed behind each claim highlighting the problem and correction that was made prior to claim resubmission. We use Excel spreadsheets to keep record of all Claims Tracking and Follow-Up.

Your assigned analyst reviews the results of the Claims Tracking and Follow-Up efforts; the data is converted into narrative and chart form and held over for the next meeting with Practice Representatives for discussion on ways we can improve collectively in our efforts to increase insurance revenue.

We have proven Solutions for Accounts Receivable and Loss Revenue.  Oncology and Hematology practices first and last line of defense against EDI rejections and insurance claim denials should be Precise Medical Billing, Incorporated.

  Contact Us Today 1(866)722-1596

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