Medical Billing Services

We handle the complete billing lifecycle to ensure maximum reimbursement for your services while minimizing administrative burdens.

• Claims Submission: Electronic claims processing to all major payers with <95% first-pass acceptance rate including CMS-1500 and UB-04 forms
• Denial Management: Comprehensive root cause analysis and systematic appeals process with denial trending reports
• Payment Posting: Accurate reconciliation of EOBs/ERAs with contractual adjustments and patient responsibility calculations
• Patient Billing: Customizable statement cycles with flexible payment options including online payment portals
• Specialty Billing: Deep expertise in physician, facility, and ancillary service billing across all specialties
• Regulatory Compliance: Continuous updates to ensure billing practices meet all CMS, OIG, and payer-specific guidelines
• ERA/EFT Enrollment: Setup and management of electronic remittance advice and funds transfer

Medical Coding Services

Our certified coders ensure accurate code assignment that reflects the complexity of services provided while maintaining compliance.

• Specialty Coding: Comprehensive ICD-10-CM, CPT, and HCPCS coding by specialty with modifier expertise
• Documentation Review: Ensure codes precisely match documentation with query process for clarifications
• Compliance Audits: Regular coding accuracy reviews with corrective action plans and provider education
• Risk Adjustment: HCC coding for Medicare Advantage with RAF score optimization
• Coding Updates: Annual code change implementation with staff training and documentation updates
• DRG Validation: Inpatient coding review to ensure accurate grouping and reimbursement
• CDI Support: Clinical documentation improvement collaboration for accurate code capture

Claims Follow-Up

• Aging Report Analysis: Systematic review of 30/60/90+ day claims with prioritized action plans
• Payer-Specific Protocols: Custom workflows for each major payer including Medicare, Medicaid, and commercial plans
• Underpayment Recovery: Automated identification and dispute of payments below contracted rates
• Denial Prevention: Trend analysis with corrective measures to reduce recurring denial reasons
• Appeals Management: Professional appeal letter drafting with supporting documentation
• Payer Portal Management: Centralized access and monitoring of all payer portals for claim status

Patient AR Management

• Self-Pay Collections: Multi-channel approach including calls, statements, and text reminders
• Payment Plans: Customizable plans with automatic payment processing
• Bad Debt Minimization: Early intervention strategies and collection agency coordination
• Financial Counseling: Patient education on insurance benefits and payment options
• Charity Care Screening: Assistance with financial assistance program applications
• Small Balance Resolution: Cost-effective strategies for resolving balances under $25

Provider Credentialing Services

Complete Credentialing Solutions

• Initial Credentialing: Comprehensive CAQH profile setup and maintenance with primary source verification
• Payer Enrollment: Complete Medicare, Medicaid, and commercial plan enrollment including group applications
• Recredentialing: Proactive management of renewal cycles with deadline tracking
• Document Management: Centralized repository for licenses, certifications, malpractice insurance with expiration alerts
• Contracting: Support with fee schedule negotiation and participation status management
• Privileging: Hospital privileging application assistance with supporting documentation
• DEA/State License: Renewal management for all required provider licenses
• Credentialing Verification: OIG, SAM, and NPDB monitoring with alert system