Medical Billing Services

Payment posting is a crucial step in the billing process, and due to its sensitivity, an accurate and efficient payment posting process is indispensable for physicians’ offices. Our Billers are known for their high efficiency and analytical skills in payment posting.

Our Billers understand that reading Explanation of Benefits (EOBs) requires skill and familiarity with the nuances of payer communication when handling payment posting accounts. They:

• Enter the allowed amount,
• Enter the paid amount and patient responsibility information,
• Calculate contractual adjustments.

This meticulous process also facilitates easier insurance follow-up.

Payment posting is evolving with the use of Electronic Remittance Advice (ERAs) from payers. Our Billers support ERA posting by verifying the posted payments. They specialize in handling advanced electronic remittance scenarios, including denials, underpayments, over-payments, multiple adjustments, automatic cross-over, secondary remittance, and reversals.

Before closing the payment posting, our Billers ensure that patient payments accepted in the front office match encounters entered in the back office.

The stepwise assessment of medical billing makes our Billers specialists for your practice.

Denials are a major threat to the financial health of most practices, and effectively managing them is crucial for achieving financial success. It is estimated that 10% of physician revenue is lost due to inadequate Denial Management Processes.

Our association’s Billers are experts in denial management analysis, which helps prevent denials and revenue losses in the first place. If you have existing denials, let our Billers and coders handle them, and you’ll see those claims getting paid promptly.

The key to successful denial management is analysis. Once the root cause of a denial is identified, correcting it and securing payment becomes straightforward. It takes a specialist to perfectly analyze a claim. Our Billers are specially trained to recover collectables from:

• Workers’ compensation
• Medicare
• Medicaid
• Attorneys

Denial claims often require appeals—requests and explanations for reconsideration of previously denied claims, outlining the conditions that now make the claim eligible for payment. Some appeals are time-sensitive. Our Billers review your most commonly denied claims, prioritizing them based on volume and dollar value, and file appeals promptly.

Considering the cost of appealing claims, both in terms of time and money, our Billers decide judiciously whether to appeal a claim. They understand that many practices lose significant income each year by not appealing denied claims, and they focus on maximizing recovery through strategic appeals.

How BillMD Medical Coding Services Works

Error-free medical coding is crucial for accelerating payments. Our medical billing and coding services help your practice achieve this efficiency. Physicians nationwide struggle to find professionals who can alleviate their administrative burdens, allowing them to focus on providing quality healthcare. Most physicians prefer specialists to manage the reimbursement process and maximize revenue, but many still seek comprehensive solutions for their revenue cycle management.

Medical Coding Services

Medical coding is a specialized function within Revenue Cycle Management, involving healthcare providers, patients, payers, and physician administrative staff. Medical coders work closely with Billers to process accurate revenue codes based on the clinical documentation provided by healthcare providers.

The expertise of a certified and experienced medical coder ensures prompt and denial-free reimbursement for providers.

The BillMD Team supports physicians and healthcare organizations by coding diagnoses, procedures, and services, which medical Billers then convert into revenue. We offer the expertise of a vast network of trained and qualified coders with extensive experience across all specialties, including small clinics, multi-specialty providers, and large hospitals. Our coders are proficient in ICD-9-CM, Evaluation and Management codes, and CPT coding systems, with specialized training in each of the specialties we serve.

With thorough training in medical terminology, disease processes, and pharmacology, our coding professionals ensure a smooth transition to the ICD-10 system and HIPAA 5010 compliant reporting.

The Value our Medical Coders bring to your Revenue Cycle

• Updates on coding changes and fee schedule analysis
• Adherence to all CCI edits and LMRP standards for coded charts
• Expertise in using appropriate modifiers and Place of Service (PoS) codes
• Code audits for unbundling, up-coding, and down-coding

This expertise and accuracy in coding have significantly reduced denial ratios and increased collections for healthcare providers. Our professional billing and coding team has streamlined operational processes and optimized Revenue Cycle Management. With a large network of AAPC-certified, highly experienced coders who are proficient with the latest billing software, healthcare IT applications, and recent changes in billing, coding, and healthcare regulations, BillMD can enhance your revenue management and save you valuable resources.

How does it all work?

Physicians nationwide often struggle to find professionals who can handle their administrative tasks, allowing them to focus on delivering quality healthcare. Most physicians prefer to rely on specialists for managing the reimbursement process and maximizing revenue, but they continue to seek comprehensive solutions for managing their entire revenue cycle.

Physician groups are increasingly opting for centralized medical billing services. These solutions enable cost-sharing and efficient resource utilization, resulting in time savings, improved patient care, and a more profitable practice.

Common challenges faced by physician groups with in-house billing systems include:

• Shortage of experienced staff and medical billing resources
• Management and retention of billing staff
• Ensuring seamless claim processing
• High costs associated with renting space for billing activities and storage
• Administrative and processing service expenses, along with managing various vendors
• Time constraints, as staff must balance day-to-day operations with revenue recovery
• Need for dedicated supervision and a team to stay updated on the latest changes
• Handling claims processing, accounts receivable (A/R), and cash flow management

The BillMD Solution

We offer proactive, end-to-end medical billing outsourcing services that address the common challenges faced by physician groups. Our services manage your entire revenue cycle, from the initial patient encounter to the reimbursement of claims. We prioritize accuracy and adhere to the latest guidelines to ensure error-free medical insurance claims. By processing claims through our experienced team and using the appropriate billing software, we ensure timely revenue flow and effective follow-up on submitted claims.

Why Physician Groups Outsource Medical Billing Services to BillMD:

• HIPAA Compliance: Managed by a specialized team
• Increased Revenue: Reduce office expenses such as administrative and operational costs
• Enhanced Patient Care: More time to provide quality care and grow your practice
• Expertise and Resources: Access to experienced staff, powerful systems, and aggregated resources
• Workload Management: Alleviate backlogs and heavy workloads
• Implementation of New Platforms: Support for changes like ICD-10
• Cost Efficiency: Lower costs associated with additional employees and office infrastructure
• Staffing Flexibility: Avoid downtime due to staff illness or vacation
• Focus on Core Functions: Greater control over your business and decreased A/R and financial delays
• Fewer Rejected Claims: Improved accuracy in claim submissions

A key benefit of outsourcing is the significant improvement in revenue collection. Physician groups have seen a 40% increase in net revenue by partnering with a reliable outsourcing service like BillMD. Outsourcing medical billing and collections can potentially boost your bottom line by approximately $254,000, or 20%.