Medical Billing Office

Medical Billing Office

Medical billing is one of the most complex and crucial components of medical practice. We handle the end-to-end revenue cycle management process: from chart coding, charge entry, and patient and carrier billing to collecting, depositing, and posting medical payments. Our expertise lies in practice management and optimizing reimbursement for medical care, and our business experience enables us to recognize the unique aspects of your practice quickly.

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Medical Billing Office

Overview

We take care of all the billing and collections, allowing you to increase revenue as we optimize efficiency and improve your cash flow, which enables the Provider to focus on patient care. Our highly experienced team can pre-empt claims rejections and identify underpayments for more timely reimbursement.

 

The advanced functionality of EHS complete technology-enabled Billing and Revenue Cycle Management (RCM) Solutions delivers total control across the patient flow, account management, claims processing, and performance analysis.

 

Services

  • Patient Registration

    The first step in a clean claim is to make sure that the demographic information has been entered into the system correctly. This process involves collecting patient demographics from clinics and hospitals. Our team is trained to process, verify, and validate demographic information into the billing system.

  • Charge Entry (Electronic & Manual)

    Charge entry is one of the key areas in medical billing. In the medical billing charge entry process, patient accounts assigned with the appropriate dollar value as per the coding and appropriate fee schedule. The charges entered will determine the reimbursements for the physician’s service. Therefore, care should be taken to avoid any charge entry errors, which may lead to denial of the claims. Moreover, good coordination between the coding and the charge entry team will produce enhanced results.

    Charge entry process at EHS:

    • Charges entered into the client’s medical billing system based on account-specific rules.
    • The pending or held documents are sent to the client for clarification, on a pre-determined schedule.
    • The Quality team audits the final charges, and the clean claims are ready for transmission. EHS staff has excellent skill-sets in handling charge entry for different medical billing specialties. The teams do not just do pure data entry but provide value addition. If the teams find an issue with the superbill at the time of entry, the charge entry for that superbill is placed on hold, and clarification is sought from the client before entering the charges.

  • Claim Submission (EDI & Paper)

    We ensure every medical claim is submitted correctly. Our system metrics create a unique series of checks and balances, which allows for quick turnaround time. At EHS, we have a strict “no error, no delay” policy. This process reduces the number of days your medical claim is outstanding. We understand our clients’ cash flow requirements.

  • Patient Billing

    Patient statements help you reduce your costs and save time by billing your patients quickly and efficiently. With patient statements, you can create a fully electronic billing and payment experience for your patients and leverage traditional print and mail statement workflow. By automating your patient billing process, you can accelerate cash flow, lower your costs, and save precious time, while providing greater convenience to your patients.

    At EHS, payment posting in medical billing is one of the critical processes that get the utmost attention from our Operations management. The payments, instead of claims, are received from the Payer and Patients, are posted in the client’s medical billing system to reconcile the claim. EHS also does electronic payment posting into the medical billing software and handles the exceptions (fallouts) manually to make sure no payment is missed. The posted ERAs are stored either in the billing system or a Document Management system (DMS) for future reference.

    All payers either send an EOB (explanation of benefits) or ERA (electronic remittance advice) towards the payment of a claim. The medical billing staff posts these payments immediately into the respective patient accounts, against that particular claim to reconcile them. According to client-specific rules, the payment posting indicates the cut-off levels regarding adjustments, write-offs, and refund rules.

    When the client’s office delays in either depositing the Payer checks or sending the ERAs and EOBs for posting, then a negative balance prevails for that claim, which is a false representation of the actual scenario. This incorrect representation would show an inflated AR, resulting in the Physicians not knowing exactly how much revenue is due to them.

  • Payment Posting (ERA & Paper EOB’s)

    All payers either send an EOB (explanation of benefits) or ERA (electronic remittance advice) towards the payment of a claim. The medical billing staff posts these payments immediately into the respective patient accounts, against that particular claim to reconcile them. The payment posting is handled according to client-specific rules that would indicate the cut-off levels to take adjustments, write-offs, refund rules etc.

    When the client’s office delays in either depositing the Payer checks or sending the ERAs and EOBs for posting, then a negative balance prevails for that claim, which is a false representation of the actual scenario. This false representation would show an inflated AR, resulting in the Physicians not knowing exactly how much revenue is due to them.

  • Insurance Payment Posting

    There could be several reasons why the patient needs to pay a part of the expenses, including co-pays, deductible, and non-covered services. If the amount due from the patients is very minimal, the Provider can set a mandate for taking write-offs. If the amount is quite large, then it should be collected from the patients either before or after rendering the services. Patients typically pay through checks or credit cards (via patient portals), and these need to be correctly accounted against the claim to avoid any inflated AR and proper closing of the claim.

  • Patient Cash Posting

    Sterling HCS focuses on minimizing lost reimbursements and denials with highly efficient systems and services designed to meet our clients’ needs. One of the major problems faced by healthcare providers and medical billing companies is that a large proportion of rejected claims goes unattended and never get resubmitted. EHS Denial Management processes uncover and resolve the problem leading to denials and shorten the accounts receivables cycle. The denial management team establishes a trend between individual payer codes and common denial reason codes. This trend tracking helps to reveal billing, registration, and medical coding process weaknesses that are then corrected to reduce future denials, thus ensuring first submission acceptance of claims. Also, the payment patterns from various payers are analyzed for setting up a mechanism to alert when a deviation from the usual trend.

  • Denial Management

    For claims that are denied and need an appeal, letters are prepared and sent along with supporting documents, including Medical Records for processing. If the insurance permits telephonic or faxes appeals, the same process follows those channels.