Overview

  1. Screen Shot 2014-06-20 at 5.08.42 PMConduct initial review and verification of the charge. (If charge verified as clean), submit claim to the appropriate payers- electronically for those who accept, on paper for those who do not accept electronic claim submissions.
  2. Appealed claims submitted with accompanying information.
  3. Place date stamp deadline on claim for time tracking purposes. Claims status tracked online and in real-time for continued reimbursement management.
  4. If claim not valid, offer coding recommendations to practice to correct claim errors before submission.
  5. Follow up on claim if payer fails to adjudicate within specified time frame.
  6. (at same time) Research multiple data sources regarding denied claims. Update practice’s internal database to alert staff to changes in payer requirements.
  7. (Once payment is received into your financial account) Match payment to the charge and post it into your account.
  8. Post unapplied credits and take backs.
  9. Allocate payments, denials and denial codes, and determine appeals on payment that vary from negotiated contract to actual insurance payment.
  10. Claims submission dates, re-filing, and follow-up billing and collection notes recorded and monitored by PedsOne billing staff.
  11. Generate weekly patient bills and monthly statements
  12. Make past due reminder phone calls.
  13. Answer patient billing related questions.
  14. Create and manage reasonable but firm payment plans.
  15. Collaborate with practice staff to update patient demographic or coordination of benefits information.
  16. Make recommendations regarding transfers to collection agency or bad debt write offs.
  17. Conduct enrollment and credentialing for your new providers and confirm the accuracy of your NPI, CAQH and tax id numbers.
  18. Create reports to analyze and manage revenue cycle. Review with practice and strategize on improvement initiatives.
  19. Utilize fee schedule management tools provide a detailed picture of the accounts receivable.
  20. Make recommendations regarding fee schedule and payer contract negotiations.
  21. Advice and training for staff on front-end billing protocols (check in/out, patient recalls, financial policies, time of service payments, etc.)