Medical Billing

Let Outsource2Experts handle your Billing and Collections. Outsource2Experts will reduce your overhead while decreasing the claim payment turn around time. Enjoy the benefits of outsourcing Billing, Accounts Receivable Follow-up responsibilities to the experienced professionals to Outsource2Experts.

Outsource2Experts Medical Billing services embrace the entire reimbursement cycle - from claim submission to collection. Outsource2Experts achieves maximum reimbursement for billings through a custom team approach that emphasizes timely and accurate account processing and extensive follow-up.

Outsource2Experts provides a complete spectrum to cover medical billing needs, including full-service medical billing and collection, financial reporting and analysis, compliance monitoring, practice management and analysis services for numerous medical specialties.

Challenges faced by Healthcare providers are

* Increasingly complex coding
* Managed care - negotiating and enforcing contracts
* Compliance and associated risk
* Cash flows affected by declining reimbursements
* Decreasing productivity; increased administrative requirements with few resources

Medical Billing Services Offered

* CPT, ICD-9, and HCPCS Coding performed by AAPC Certified Professional Coders
* Demographics & Charge Entry, allowing the claims to be sent out clean the first time – Multiple Specialties
* Payment Posting & Reconciliation
* Denials/Rejection Analysis
* Accounts Receivable Follow-up
* Old Accounts Receivable Clean-up
* Provider Enrollment Assistance
* Managed Care Contracting

Outsource2Experts Medical Billing specialist’s brings expertise in multiple states, multiple specialties, and multiple hospital and physician management systems, Medicare, Medicaid, Managed Care, Preferred Provider Organizations and Indemnity Insurers. We know CMS 1500 and UB92 forms.
Outsource2Experts Medical Billing specialist’s brings expertise in various specialties –

Ambulance Billing, Anesthesiology & Pain Management, Cardiovascular Surgery, Cardiology, Chiropractic, Dermatology, Durable Medical Equipment, Emergency Medicine, Endocrinology, Family Practice, General Surgery, Hematology / Oncology, Internal Medicine, Neurology, Nephrology, Obstetrics/Gynecology, Orthopedic, Physical & Occupational Therapy, Pediatrics, Podiatry, Pathology, Psychiatry, Radiology, Urology etc.

Outsource2Experts Medical Billing specialist’s has experience with popular billing software applications - Medic, Medical Manager, Health Pac, Calmed, Prime Clinical, Medisoft, CpuMed, NextGen, Practice Today, IDX, SMS Signature and Lytec etc.

Medical Coding

Currently, reimbursement of hospital and physician claims for Medicare patients depends entirely on the assignment of codes to describe diagnoses, services, and procedures provided. As the basis for reimbursement, appropriate medical coding has become crucial as healthcare providers seek to assure compliance with official coding guidelines. There are many demands for accurately coded data from the medical record. In addition to their use on claims for reimbursement, codes are included on data sets used to evaluate the processes and outcomes of healthcare.
Our certified medical coders have undergone AAPC medical coding classes and have attended different medical coding seminars. Our medical coding specialists are well updated with the latest changes in CPT /HCPCS and ICD -9 codes. Our Coding training programs enforce compliance and our coders strictly follow the guidelines provided by CMS.
Outsource2Experts Medical Coders are extremely familiar with the reimbursement arena, and are current on Correct Coding Initiatives, bundling and unbundling procedure changes, payer specific requirements and any state or federal government compliance issues. Outsource2Experts medical coding experts review all dictated reports to ensure completeness and accuracy. This unique service maximizes revenue and protects against accidental fraud and abuse.
Outsource2Experts Medical coders are thoroughly trained regarding current documentation and coding guidelines and updated regularly on the latest developments on Local Medical Review Policies (LMRP) and Correct Coding Initiative (CCI).
Outsource2Experts Medical Coding provides transparency in our coding methodology and gives you access produces consistency and eliminates the risk of errors. Clients receive regular feedback on coding changes, front-office documentation practices, and periodic reports, such as utilization reviews, case-mix review, and coding-related denial analysis.
Outsource2Experts Medical Coding Specialists are well trained in evaluating and interpreting health records and reports in order to accurately code diagnoses and procedures according to recognized classification systems.

• Read and interpret medical record documentation to identify diagnoses and procedures for data capture and billing
• Accurately assign related diagnostic and procedure codes for reimbursement and statistical purposes
• Apply knowledge of official coding guidelines to correctly sequence diagnostic and procedure codes
• Abstract information from patient records to complete insurance claims
• Have knowledge of various reimbursement methodologies and fee schedules
• Linkage of diagnostic codes to the proper procedure codes to ensure accurate claims submission

Outsource2Experts Certified Coders are proficient with
* CPT, ICD-9, and HCPCS coding across various specialties
* Insurance and governmental regulatory requirements
* Payer-specific coding requirements
Outsource2Experts AAPC certified coders provide many services, including:
* CPT, ICD-9 and HCPCS Coding
* Short term coding projects
* Analysis of claim denials
* Code utilization reports
* Fee schedule developments

Patient Demographics

* Ability to work on scanned images as well as electronically submitted demographic sheets.
* Ability to accurately process insurance Information (selecting appropriate insurance details)
* Outsource2Experts Medical Billing specialist’s access the information via the Server (or directly from Software Screen as the case may be) and enter information directly into the client software
Charge Entry
* Outsource2Experts Medical Billing specialist’s process charges for all specialties with good appropriate state and specialty rules.
* Trained in regulations related to Medicare, Medicaid, Managed Care, Third Party Liability, Workers Compensation, Preferred Provider Organizations & Indemnity Insurers
* Paper and Electronic claims are sent daily. Electronic claims are submitted directly to: Medicare, Medicaid, Blue Cross/Blue Shield & most commercial insurance carriers
* Outsource2Experts performs Internal Quality Assurance at different levels to provide the high quality output.
Payment Posting
* Daily Deposits balanced accurately
* Denials are worked immediately and secondary claim reports are sent on daily basis.
* For partial payments, analysis is done and corrective action is taken

Accounts Receivable Follow-up

Outsource2Experts Accounts Receivable Specialists aim is to improve the client’s cash flow by reducing days in A/R and improving profitability, by increasing collections ratio. Outsource2Experts Accounts Receivable process mechanism helps in identifying category / payer combinations and works on resolving the mix that results in the best collections first. Using this approach, we are able to quickly achieve results and also apply early feedback across the entire category. Outsource2Experts Medical Billing timely Accounts Receivable Follow-up “accelerates revenue cycles, improves cash flow, reduces receivables, and increases collection rates”.

Outsource2Experts Accounts Receivable Specialists is trained to identify patient accounts that require follow-up and take the necessary action to collect un- paid and partially paid claims. It is essential to follow-up and document unpaid claims prior to the 60 or 90 day timely filing limits assigned by many managed care contracts. Our goal is to keep the average age of Accounts Receivable at 45 days or less.

At Outsource2Experts, it is all about prompt reimbursement. Our skilled coding and billing, effective insurance processing and follow-up, timely collection, attentive patient and client service, and sophisticated data management contribute to shortened revenue cycles and improved revenues.
Outsource2Experts Accounts Receivable follow-up protocols and procedures have been designed and time tested to assure that each and every account is followed-up on in a timely and professional manner. No more untimely filings, questionable adjustments or unnecessary waiting. Outsource2Experts Accounts Receivable Specialists are extremely familiar with the current State and Federal Insurance regulations and strive to obtain high rates of return from their Follow-up efforts.

Outsource2Experts Accounts Receivable includes:

* Receivable Analysis
* Payer Follow-up
* Denials management
* Reporting

Effective Accounts receivable begins with proper coding. The claims are checked for proper order and placement of CPT codes and modifiers. Consistent, thorough, detailed follow-up is performed by Outsource2Experts Accounts Receivable Specialists. Their involvement with the insurance carriers has enabled our specialists to develop contacts and rapport that help speed the payment process. All the claims are tracked until they are paid. Every payment is checked against the carrier's fee schedule. Our specialists are expert in the appeals process.

Additional payment is often received on appeals for:

* Downcoding.
* Nonpayment of E & M (evaluation and management) codes.
* Assistant surgeons.
* Secondary procedures considered incidental to the primary procedure.
* Incorrect allowances as compared to the published fee schedule.

Provider Enrollment Assistance

To ensure a seamless transition or startup, Outsource2Experts assumes responsibility for all the forms required by payers. With each payer demanding different forms, the paperwork is never-ending. Outsource2Experts will obtain the proper forms and make sure that they are completed and filed as quickly as possible to make sure that provider receives proper reimbursement. Outsource2Experts will also confirm that all payers have the correct information of the provider to avoid payment delays or denials.