Account Management Services
Looking for professional and cost-effective solutions? Look no further! Our team specializes in providing top-notch Medical Billing Services, ensuring that your billing needs are expertly managed. Say goodbye to the stress of handling billing tasks yourself and let us handle it with precision and efficiency. We take pride in delivering exceptional services that exceed expectations. Trust us to streamline your billing processes and maximize your revenue. Get in touch today and discover why our unparalleled services distinguish us from the competition. Let’s work together towards your success!
Medical Coding
Ensuring the accuracy of procedure codes is a pivotal aspect of claims filing, directly impacting reimbursement accuracy. The American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) routinely revise procedure codes to align with evolving healthcare practices. These updates, typically implemented quarterly, with the most substantial changes taking effect on January 1st each year, encompass additions, deletions, and revisions to Current Procedural Terminology (CPT) and Healthcare Common Procedure Code System (HCPCS) codes.
Our adept coding team plays a crucial role in this process. We meticulously convert provider procedure descriptions into CPT and ICD codes or develop superbill templates, empowering doctors to accurately document services rendered to their patients. With our expertise, you can rest assured that your coding accurately reflects the care provided, facilitating seamless claims processing and optimal reimbursement.
Medical Billing
While most insurance companies adhere to standardized billing guidelines, some payers may have unique requirements. It’s crucial to understand that certain aspects of medical billing can vary depending on the payer. Therefore, it’s essential to verify and adhere to each payer’s specific guidelines to ensure accurate claims submission.
Our skilled billers are well-versed in navigating the intricacies of various payer requirements. They meticulously craft clean claims and submit them in accordance with each insurance company’s guidelines, aiming to maximize reimbursement for our clients. By staying abreast of payer-specific nuances, we ensure that your claims are processed smoothly and accurately, ultimately optimizing your revenue potential.
Aging Management
Our billing team operates under the belief that claim accuracy and efficient payment retrieval are paramount to optimizing revenue collections. Our primary goal is to enhance our clients’ cash flow by minimizing days in accounts receivable and bolstering profitability through increased collection ratios. To achieve this, our billers employ a strategic approach. They analyze category/payer combinations to determine the most effective collection methods. Prioritizing claims based on both dollar value and date of service, they organize accounts receivable by timeline (30 to 45 days, 45 to 60 days, and beyond 60 days), tackling critical claims first to expedite payment.
Our expert accounts receivable specialists meticulously audit data entered by billers, aligning it with each insurance guideline before submission. They diligently follow up with insurance companies on aging accounts, adeptly managing denials and rejections to maximize reimbursement. With our comprehensive approach, we strive to streamline the billing process, optimize revenue cycles, and ultimately, drive financial success for our clients.
Payment Posting
Our billers understand that payment posting is not just about data entry—it’s a skill that requires a keen understanding of payer communications and nuances. When handling payment posting accounts, they meticulously interpret Explanation of Benefits (EOBs), ensuring accurate entry of crucial information:
- Entering the allowed amount, paid amount, and patient responsibility details.
- Calculating contractual adjustments, facilitating easier insurance follow-up.
As payment posting evolves with Electronic Remittance Advice (ERAs), our billers adeptly support ERA posting by verifying payments. They specialize in handling advanced electronic remittance scenarios, including denials, underpayments, overpayments, multiple adjustments, automatic cross-over, secondary remittance, reversals, and more. Before finalizing payment posting, our billers meticulously match patient payments accepted at the front office with encounters entered in the back office.
Credentialing
Our experienced EDI/credentialing/enrollment specialists play a pivotal role in ensuring providers are enrolled with insurance companies and maintain up-to-date credentials. They meticulously handle CAQH re-attestation and ensure timely re-enrollment, guaranteeing uninterrupted participation in insurance networks.
With extensive experience in billing, our specialists possess the expertise to introduce physicians to new networks and payers efficiently. Some are even capable of expediting credentialing processes with government agencies. Leveraging their knowledge and established connections, they negotiate favorable credentialing offers, taking into account market offerings and fee schedules from various payers.
Our specialists are adept at analyzing the average fees charged by other specialists in your community and can provide valuable insights into your practice’s fee structure. They consult with you to ensure that your fees are competitive while maximizing reimbursement.
Pre-Authorization
Our proficient authorization team ensures that prior authorizations are obtained, as requested by the doctor’s office, before confirming appointments with patients. This proactive approach helps streamline the scheduling process, ensuring that all necessary authorizations are in place before the patient’s visit. By obtaining prior authorizations promptly, we aim to minimize delays and facilitate smooth patient care experiences.
Reporting
Generating medical billing reports is vital for assessing the overall health of your practice. These reports offer valuable insights into crucial revenue cycle metrics, allowing you to gauge performance effectively. They shed light on various aspects such as the timeliness of claim payments and the reimbursement rates from insurance carriers for essential procedures.
Our proficient reporting team specializes in delivering a comprehensive range of reports tailored to meet the specific needs of doctors. From Aging and DWC (Date of Service to Write-off) reports to Credentialing, Collection Forecasting, and Collection Analysis reports, we provide thorough and insightful analyses. These reports empower doctors with actionable information, enabling them to make informed decisions and optimize practice operations. With our expertise, you can gain a deeper understanding of your practice’s financial landscape and take proactive steps towards financial stability and growth.
Audit
Sunshine MBS establishes a benchmark for excellence in clinically-based hospital and provider bill auditing. Unlike re-pricing or unbundling software programs, our audits surpass mere computational scrutiny, yielding results that are both medically sound and legally defensible. Our meticulous auditing procedure encompasses a comprehensive review, identifying and rectifying potential errors across various fronts, including coding discrepancies, unbundling issues, code upgrades, and fee schedule deviations.
Furthermore, our dedicated Audit team conducts thorough reviews of coding practices and aging processes annually, furnishing detailed insights to doctors. By leveraging our expertise, healthcare providers can ensure accuracy, compliance, and optimal revenue generation while maintaining the highest standards of patient care.
