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Services

Verification

A large percentage of claim rejections are due to lack of prior insurance verification or having incorrect benefit information. Getting proper health coverage information is a prerequisite to successful claim processing and patient care. Biller’s target should be getting all claims paid with first submission. In order to do that, office and biller must have patient’s correct demographics and insurance information. A form of picture ID is a must as well. At MBS, we make medical coverage verification a priority. We verify medical coverage for patients ahead of the appointment date by confirming active coverage and referral requirements. We also work with the office staff to ensure proper information is collected at the time of the appointment and help develop effective patient processing steps.

Billing & Coding Services

MBS takes a holistic approach to billing. Successful billing takes a well organized team. We keep updated on all eye related news and updates. We also attend CME courses for billing and coding and HIPAA throughout the year. We research on any revision proposed or enacted for CPT codes and diagnosis codes. We keep doctors and staff updated on new rules and regulations as well. We study billing patterns and give regular feedback to providers. MBS helps doctors code efficiently by equipping them with latest information on the ever-changing world of billing codes. We attend all Academy meetings to stay current on billing and coding. We also have established communication with AAO coding experts for research on billing issues. We check each claim to make sure diagnosis codes support the billed CPT codes before submitting claims.

Claim Submission

Our work toward submission of claims begins as soon as the provider finalizes the exam. We review exams for supporting documentation. We check all documentation for Doctor’s notes on testing, and details or operative notes. We make sure all services provided by the doctor are billed according to individual insurance rules and regulations. Every single claim form narrates a patient’s visit to the doctor. One single form has the burden of carrying immense amount of information. The claim form tells the insurance, who was treated by the doctor, why did the patient come in to see the doctor, where did the patient see the doctor, how long was the visit, what were the special circumstances for the visit, what was done, and why was it done. Once claims clear our scrubbing process, they are then submitted to insurance and followed carefully for expedite processing.

Payment Posting

We have a dedicated team to keep current on all billing & coding changes updated, insurance guidelines current, Local Coverage Determination (LCD), and up to date laws and policies. We post EOBs every day and follow up on all non-pays the same day we receive them. We also study all EOBs carefully to make sure correct payments are reflected in processed claims. We submit detailed payment report to the provider’s office each month. We do not wait for insurance aging to happen before following up on unpaid claims. Our goal is to get payment for all claims within 30 to 60 days of filling. We have a dedicated claim denial management team and have established a strong communication path with insurances. Any claims that are not paid within 60 days are reported to the office with explanations and follow up details.

Reports & Account Receivables

We generate Earning report, Insurance Aging report, Patient Aging report, and Patient Credit report at the end of each month. These reports are health exam summary for your practice. If these reports are healthy, the practice is doing well. As we study the billing pattern each day, we take active notes and offer our suggestion for improvements. We submit these reports with suggestions and comments. Reports are provided on a monthly basis or on demand, as required by the office. Our goal is always to bring payments in within 30 to 60 days of billing. We aim for $0 A/R and report any issues to the provider’s office immediately. We also analyze practice accounts for better revenue management. We study and report on effective practice management and are open to meet with staff for discussion, planning, and training.

Credentialing & Insurance Contracts

The insurance web gets more complicated each year. There are constant changes in laws and regulations. Insurances are branching out to provide coverage for special groups and at times small groups are combining under a bigger umbrella. Even established practices have to do new credentialing for newly created insurance plans. It is of utmost importance to retain a copy of all contracts. Each contact comes with designated fee schedule for the provider. Contracts must be maintained and updated to assure proper payments of claims. We are prepared to do any credentialing needed by established providers in the practice as well as new providers. We can help with building CAQH and state licensing process. We can also work on new contracts with insurances.

Chart Audit

We do not submit claims just because they are generated in the software. Before submitting claims, we make sure proper patient information is reflected on the form and we also check for correct provider information and health information of patients. Our billing team audits all exams and billing codes to make certain all coding is done correctly and coded for the highest reimbursement. We also review all exams for appropriate level of coding. We review exam documentation to make sure it supports codes that have been billed. Our comprehensive scrubbing process is put in place to send proper information to the insurance companies and maintain highest integrity in patient health documentation. When we find conflicting information on a claim, we immediately report this to the provider and wait on provider’s written directions before submitting claims.

We are always available to answer any questions you might have about your account and follow up on any queries you might have.