Medical Billing
Credentialing
Coding
A/R Recovery
Audit
Medical Billing
Our clients are located in all regions of the country, so we know what is required by each Medicare MACs. We have first-hand experience billing for molecular, genetics, blood and toxicology and understand the importance of proving medical necessity for each. Our deep relationships with the payers allows us to foresee where the industry is headed and in turn provide valuable guidance to our clients to start adapting proactively to the changes.
Credentialing and Contracting
We have dedicated resources in our credentialing team that have developed strong relationships with key payer personnel allowing us to obtain contracts for our clients even when panels are actually closed.
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We understand the urgency of timely completion of all complicated forms accurately to avoid delays due to deficiency letters. We know which forms are required for each payer ensuring the credentialing and contracting process is completed accurately without impact to future collections. We have completed hundreds of enrollments with Medicare, Medicaid in all states and commercial payers.
Coding
We have a dedicated team of A/R recovery professionals focused on determining issues preventing claims from being paid. Our focus is to determine the route cause of the denials and addressing them on the front end. Our team is skilled with all federal and commercial payers. We also have a team that focuses on out-of-network claims and works closely with third-party pricing entities closely to maximize reimbursements.
Accounts Receivable Recovery
We have dedicated resources not only focus on this function, but more importantly they have the right skill set to work with these types of claims. Given our relationship with he payers we are able to generate significant revenue from old unpaid balances. We are also very cognizant about what claims to correct and appeal and not to "mass-submit" all claims, leading to further issues with the payers. We are very skilled at determining claim-level issues and then determining which set of claims can be resubmitted.
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We also offer services whereby we can provide very specific reasons for claim-level denials and provide corrective actions to your team to process.
Audit
Our audit team consists of certified coders that are well-versed in laboratory coding and billing. We provide audit services that do not require access to your system, nor does your current billing team have to be involved in the audit process. It is a very confidential process allowing our team to highlight to you the main issues causing your claims from being paid. Our audit findings have helped dozens of labs recover millions of dollars.