Medical billing service comparison

Claim Submission ABC LLC Others

Claims are submitted within 8 hours from claims created

Medical Billing Service Comparison

Medical Billing Service Comparison

Everyday clearinghouse and payer rejections are fixed
and resubmitted

Medical Billing Service Comparison

Medical Billing Service Comparison

Everyday manual claims scrubbing is done

Medical Billing Service Comparison

Medical Billing Service Comparison

Everyday claims submitted batch are checked for errors

Medical Billing Service Comparison

Medical Billing Service Comparison

All worker compensation claims are submitted with
records in initial submission

Medical Billing Service Comparison

Medical Billing Service Comparison

Most appropriate diagnosis is picked from the progress note to match
the procedure before claim submission

Medical Billing Service Comparison

Medical Billing Service Comparison

Medical records downloaded from hospital portal
or requested through fax or phone

Medical Billing Service Comparison

Medical Billing Service Comparison

Missing CPT's and Dx's in a completed progress note is
communicated with the provider to fix it

Medical Billing Service Comparison

Medical Billing Service Comparison

Weekly reminder sent to the provider to complete
unsigned medical records

Medical Billing Service Comparison

Medical Billing Service Comparison

Insurance medical records request by letters
are submitted through Insurance portal

Medical Billing Service Comparison

Medical Billing Service Comparison

Invoice created for Attorneys who request medical records
and payment collected before sending the medical records

Medical Billing Service Comparison

Medical Billing Service Comparison

Payment ABC LLC Others

Downloading paper EOB files through Dropbox,
PMS, FTP, Fax and Email

Medical Billing Service Comparison

Medical Billing Service Comparison

Training practice employees to upload paper
EOBs and Medical records in PMS

Medical Billing Service Comparison

Medical Billing Service Comparison

Payments are posted the same day the money hits
the bank

Medical Billing Service Comparison

Medical Billing Service Comparison

Missing ERA's from clearing house are traced every week
by calling them

Medical Billing Service Comparison

Medical Billing Service Comparison

835 files are directly downloaded from Payspan, PNC, Zelis,
Echo, Redcard, JP Morgan, Optum etc to PMS for small insurances
such as USAA, Aetna continental

Medical Billing Service Comparison

Medical Billing Service Comparison

Sequestration and MIPS penalty are posted with the
separate adjustment code to identify the total deductions

Medical Billing Service Comparison

Medical Billing Service Comparison

Monitoring the CPT downcoding from insurance and
suggesting the correct CPT by analyzing the
Medical records to the providers

Medical Billing Service Comparison

May be

Continuous monitoring of payee address in ERA's/EOBs

Medical Billing Service Comparison

May be

Verifying paper checks cashing detail with providers and insurance

Medical Billing Service Comparison

Medical Billing Service Comparison

Uncashed checks or checks sent to incorrect payee
address are rectified by calling the insurances

Medical Billing Service Comparison

Medical Billing Service Comparison

Updating the charge fee schedule every year depending
upon the changes in Medicare, Medicaid, Commercial and
Self-pay fee schedule to reduce contractual adjustments

Medical Billing Service Comparison

Medical Billing Service Comparison

Sending Missing paper EOB reminder to the providers

Medical Billing Service Comparison

Medical Billing Service Comparison

Paper EOB files are posted within 16 hours

Medical Billing Service Comparison

Medical Billing Service Comparison

Check refund letters are analyzed and emailed
to the provider to send the check

Medical Billing Service Comparison

May be

Educating the providers regarding obsolete ICD, CPTs,
insurance reimbursement policies etc

Medical Billing Service Comparison

Medical Billing Service Comparison

Reconciliation is done every month by comparing
the bank statement and ERA's/EOBs

Medical Billing Service Comparison

May be

Weekly charges and payments report texted
to the providers

Medical Billing Service Comparison

Medical Billing Service Comparison

Monthly payment reports emailed to the providers

Medical Billing Service Comparison

May be

Year-end reports Emailed to the practice to
understand the practice production, collection
and outstanding AR.

Medical Billing Service Comparison

May be

Comparing ACO's fee schedule with the paid
fee schedule for each insurance to make sure
the provider got the contracted fee schedule

Medical Billing Service Comparison

Medical Billing Service Comparison

Denial ABC LLC Others

All denied claims are followed up in 8 hours

Medical Billing Service Comparison

May be

Specific denied claims are researched and analyzed
for the best solution

Medical Billing Service Comparison

May be

Prioritizing denials and evaluating them to appeal

Medical Billing Service Comparison

Medical Billing Service Comparison

Denied claims are appealed to reverse the insurance decision
such as Bundling, no pre-authorization & pre-cert (extenuating circumstances),
timely filing limit, Medically necessity etc

Medical Billing Service Comparison

Medical Billing Service Comparison

Appeal letters are sent along with supporting documents like DOR
(Designation of representative form) with patient's signature,
WOL (Waiver of Liability) form, Provider Complaint form, Dispute form,
Reconsideration form, AOB form and W9 form according to insurance guidelines.

Medical Billing Service Comparison

Medical Billing Service Comparison

All appealed claim are followed up by every day

Medical Billing Service Comparison

Medical Billing Service Comparison

If there is no response for the claims submitted in 30 days
"No payment" appeal sent to insurance

Medical Billing Service Comparison

Medical Billing Service Comparison

Verbal appeals were made by calling for denied claims.

Medical Billing Service Comparison

Medical Billing Service Comparison

Alerts are created for the front office regarding denial such
as out of state Medicaid, COB update and Medicaid yearly
office visit exceeded.

Medical Billing Service Comparison

Medical Billing Service Comparison

Claim denial inquiry are done by live chat and secure
message on insurance portal

Medical Billing Service Comparison

May be

Frequent communication to the provider to avoid future denials

Medical Billing Service Comparison

Medical Billing Service Comparison

Educating the practice employees to obtain prior authorization
for more office visits when the patient exceeds the office visit
for the year.

Medical Billing Service Comparison

Medical Billing Service Comparison

If the insurance deny the claims for LCD and NCD guidelines
for medical necessity, the provider is educated to use high
specificity diagnosis.

Medical Billing Service Comparison

May be

Informing the patient to update COB with the insurance.

Medical Billing Service Comparison

May be

Monthly insurance reversal report Emailed to the practice.

Medical Billing Service Comparison

Medical Billing Service Comparison

Future denials are avoided by analyzing insurance guidelines such as
LCD, NCD, CPB .. etc.

Medical Billing Service Comparison

May be

Account Receivable ABC LLC Others

All claims are followed up on 30th day from claim submitted
date on Insurance portal or by calling

Access created in all insurance portal to check
eligibility and claim status

May be

Claim inquiries are done efficiently by live chat and
secure message on insurance portal

May be

Lost EOBs paper check cashing details are verified
with provider and insurance

Lost ERAs paper check and EFTs cashing details are verified
with provider and insurance

Disability, accident, DFACS and workers compensation claims
are followed up by secure email communication

Delayed VA claims are followed up by submitting medical records
and claims every 45 days

Account receivable reports grouped by primary, secondary
insurance and patients are emailed securely every Monday

Monthly and yearly comparison reports are emailed to
identify increase or decrease in practice revenue

May be

Write - offs are posted only with providers consent

Secondary and tertiary claims are followed up separately for
revenue generation

Missing ERAs are traced and imported from Clearing house portal

Monthly practice analysis is done and suggestion is made to the
providers to increase revenue

Providers requests turn around time is less than 4 hours.

All medical record requested claim are followed up
on the 30th day of MR submission

Claims denied due to Coordination of benefits are resolved by conferencing
the patient and the insurance

Patient Statement ABC LLC Others

Patient-friendly payment solutions

Best in Medical billing

May be

Online Integrated credit and debit card payments option for patients to pay

Best in Medical billing

Best in Medical billing

Outbound call reminders to patients with high balance

Best in Medical billing

Best in Medical billing

Collection process is established with the practice

Best in Medical billing

Best in Medical billing

Immediate patient statement submission after insurance payment

Best in Medical billing

Best in Medical billing

Correct addresses are found for not delivered statements and return
to sender patient statements

Best in Medical billing

May be

Training the front office to collect the patient balance
at the time of service

Best in Medical billing

Best in Medical billing

Handling inbound and outbound patient calls regarding
statement questions

Best in Medical billing

Best in Medical billing

Applying the unposted patient payments before sending statements

Best in Medical billing

May be

Housekeeping - Locking the fully paid/done claims

Best in Medical billing

Best in Medical billing

Uninsured checking for one year from the DOS

Best in Medical billing

Best in Medical billing

Tracking the status of the accounts submitted to collections

Best in Medical billing

Best in Medical billing

Weekly PT AR report

Best in Medical billing

Best in Medical billing

Enrollment ABC LLC Others

Credentialing the providers with Medicare and Medicaid

Credentialing the providers with commercial insurance

May be

Provider profile creation and data maintenance with CAQH

Maintaing the list of in-network and out of network insurances

PMS setup will be done in 24 hours

Switching check payments into direct deposit within two weeks
from the date of first check received

EDI enrollments for claims and ERA will be done with 24-48 hours

Provider demographics update with the insurance

Hospital provider credentialing

Provider Re-validation with CMS

Provider Re-validation with state Medicaid program

New NPI application for the group practice and individual
providers within 2 hours if needed

Best in Medical billing

Adding additional service locations with the insurance

Enrolling the providers with state Medicaid CMO plans

May be

Notification to the providers with the expirable
documents and professional certificates

ADDRESS

  • 5 Concourse Pkwy Suite 3000 Atlanta, GA. 30328
  • Phone: 833 368 7772
  • Fax: 404 600 1099
  • Email: info@applebcredentialing.com
  • www.applebcredentialing.com

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