Medical billing service comparison

Charges	ABC LLC	Others
No limitations in practice management system(PMS). We work with any clients PMS
Charge files are downloaded directly from Dropbox, Google Drive, PMS, FTP, Email and Fax
Hospital, dialysis and non office visit patients demos are added in PMS
Non office visit patient demos are directly requested to the hospitals rather than relying on the provider
Eligibility verified before the claims are created
Missing patient member ID is requested directly rather than relying on the practice
Office procedure precerts are verified before the claims are submitted
Claims are submitted with in 8 hours
Hospital patients diagnosis are checked with the hospital for high specificity and accuracy
Handwritten providers diagnosis and CPTs are analyzed and searched for accurate coding
Claims created for No-show patients and statements sent on the same day
Weekly reminders regarding missing charges and incomplete progress notes

Checking	ABC LLC	Others
Missing patient demographics in the facesheet is updated by calling, faxing, emailing and logging into hospital/facility portals
All patients insurance eligibility is verified before claim submission
Creating insurance portal access for checking eligibility and claim status
Non office patients diagnosis are confirmed/added/updated depending upon the provider specialty by logging into hospital portal
All claims are checked for erroneous by comparing hospital charge sheet/superbills before the claims are moved to claim submission team		May be
Weekly email reminders to the providers regarding Precertification/Authorization/Referral missing claims
Referral needed patients are identified before the appointment and an alert is created for the front office to obtain the referrals
Missing patients precert number is obtained by calling, faxing, emailing and logging into hospital/facility portals
Insurances are called to send the claim back to review if they processed the PA claims wrongly

Claim Submission	ABC LLC	Others
Claims are submitted within 8 hours from claims created
Everyday clearinghouse and payer rejections are fixed and resubmitted
Everyday manual claims scrubbing is done
Everyday claims submitted batch are checked for errors
All worker compensation claims are submitted with records in initial submission
Most appropriate diagnosis is picked from the progress note to match the procedure before claim submission
Medical records downloaded from hospital portal or requested through fax or phone
Missing CPT's and Dx's in a completed progress note is communicated with the provider to fix it
Weekly reminder sent to the provider to complete unsigned medical records
Insurance medical records request by letters are submitted through Insurance portal
Invoice created for Attorneys who request medical records and payment collected before sending the medical records

Payment	ABC LLC	Others
Downloading paper EOB files through Dropbox, PMS, FTP, Fax and Email
Training practice employees to upload paper EOBs and Medical records in PMS
Payments are posted the same day the money hits the bank
Missing ERA's from clearing house are traced every week by calling them
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
Sequestration and MIPS penalty are posted with the separate adjustment code to identify the total deductions
Monitoring the CPT downcoding from insurance and suggesting the correct CPT by analyzing the Medical records to the providers		May be
Continuous monitoring of payee address in ERA's/EOBs		May be
Verifying paper checks cashing detail with providers and insurance
Uncashed checks or checks sent to incorrect payee address are rectified by calling the insurances
Updating the charge fee schedule every year depending upon the changes in Medicare, Medicaid, Commercial and Self-pay fee schedule to reduce contractual adjustments
Sending Missing paper EOB reminder to the providers
Paper EOB files are posted within 16 hours
Check refund letters are analyzed and emailed to the provider to send the check		May be
Educating the providers regarding obsolete ICD, CPTs, insurance reimbursement policies etc
Reconciliation is done every month by comparing the bank statement and ERA's/EOBs		May be
Weekly charges and payments report texted to the providers
Monthly payment reports emailed to the providers		May be
Year-end reports Emailed to the practice to understand the practice production, collection and outstanding AR.		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

Denial	ABC LLC	Others
All denied claims are followed up in 8 hours		May be
Specific denied claims are researched and analyzed for the best solution		May be
Prioritizing denials and evaluating them to appeal
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
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.
All appealed claim are followed up by every day
If there is no response for the claims submitted in 30 days "No payment" appeal sent to insurance
Verbal appeals were made by calling for denied claims.
Alerts are created for the front office regarding denial such as out of state Medicaid, COB update and Medicaid yearly office visit exceeded.
Claim denial inquiry are done by live chat and secure message on insurance portal		May be
Frequent communication to the provider to avoid future denials
Educating the practice employees to obtain prior authorization for more office visits when the patient exceeds the office visit for the year.
If the insurance deny the claims for LCD and NCD guidelines for medical necessity, the provider is educated to use high specificity diagnosis.		May be
Informing the patient to update COB with the insurance.		May be
Monthly insurance reversal report Emailed to the practice.
Future denials are avoided by analyzing insurance guidelines such as LCD, NCD, CPB .. etc.		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		May be
Online Integrated credit and debit card payments option for patients to pay
Outbound call reminders to patients with high balance
Collection process is established with the practice
Immediate patient statement submission after insurance payment
Correct addresses are found for not delivered statements and return to sender patient statements		May be
Training the front office to collect the patient balance at the time of service
Handling inbound and outbound patient calls regarding statement questions
Applying the unposted patient payments before sending statements		May be
Housekeeping - Locking the fully paid/done claims
Uninsured checking for one year from the DOS
Tracking the status of the accounts submitted to collections
Weekly PT AR report

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
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

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