Billing

Along with Medical Coding, AE & Associates offers solutions for your Medical Billing needs. Led by our Medical Billing Manager, Michelle Bagaygay, our team of experienced Billers will make sure your billing is handled with the utmost skill and professionalism our company can offer. We can effectively maximize revenue for our clients while being very proficient in our billing process. Let us be the ones that will give you a financial boost by using our Billing Service.

Medical Billing Process

Claims Submission

• Claims are submitted electronically within 24 hours of receipt. Almost all unquestioned claims are paid within 30 days, and in some cases even earlier.
• Or we will process paper claims for those payers who do not have the capability of processing claims electronically.
• Provide a monthly report to include: Charges, Net Revenue, and all Pending ARs of 30+ days, 60+ days, 90+ days, and 120+ days
• Establish goals such as strategies for improving revenue for services provided

Patient Statements

• Monthly statements are mailed out for each account with a deductible or patient responsibility balance.
• Payments and Posting
• Each EOB is analyzed and appropriate payments are posted to the proper claim. At the end of each month, you will receive comprehensive reports reflecting all transactions

We Also Provide

• Follow up on unpaid insurance claims, denials, and outstanding patient balances
• We will consistently and proactively review, correct, and resubmit any unpaid claims, denials, and outstanding patient balances.
• Process Appeals to Insurance Carriers
• Phone calls and mailing letters for soft collections

Medical Practice Billing Analysis

Dynamic Medical Practice Impact Analysis

• Offers you a complete and powerful perspective on the business side of your medical practice. It gives you the information and insight to make important decisions to increase your bottom line.
• Comprehensive reports and analysis
• Practical information about your productivity
• Efficient procedures to ensure maximum reimbursement
• Establish realistic expectations for practice revenue based on services offered and actual payer reimbursement

Reimbursement Review and Analysis

• Implementing efficient processes to handle and manage reimbursements is vital to ensuring all the revenue generated in your office is captured.
• Assess current coding and billing protocols identifying opportunities to increase revenue and profitability.
• Recommendations regarding methods for coding and revenue audits to maximize reimbursement, claim submission, and payment facilitation
• Recommendations to optimize clean claims submission
• Evaluate denial rate and recommend processes to reduce those rates to maximize revenue

Payer Analysis

• Knowing which services payers pay for, how much they pay, and when they pay is essential for sound practice planning. Our payer analysis gives you this information and more.
• Analyze payer mix and profitability derived from that mix
• Establish reimbursement comparisons between payers for all services offered by the practice
• Provide realistic reimbursement expectations and timelines for all payers and services
• Analyze contracted payer fees for purposes of internal benchmarking and contract negotiations with payers
• Provide recommendations on the patient mix to maximize actual payer reimbursement
• Provide recommendations on which patient services should be offered based on actual reimbursement
• Analyze the impact of new payer contract developments on practice revenue

Additional Services

Denial Management

• Denial Management and Benchmarking are dynamic ways of enhancing your practice revenue cycle. Your denial EOB will be proactively reviewed to identify errors and missed revenue opportunities
• Identify significant denial patterns and payer payment variances.
• Reports will summarize the total dollar amount of denied claims along with the reason for denial.
• Detailed information on each denial and potential reimbursement issue.
• Provide recommendations to avoid the same denials in the future

Provider Credentialing

• Credentialing requirements and guidelines are ever-changing. They are time and labor-intensive. We provide credentialing and credentialing maintenance for both new and established providers.
• Process and file documents for
• Hospital privileges
• Government plan enrollment
• Third-party payers
• CAQH and expired licenses

Comprehensive, easy to read, monthly reports

• At the end of every month, we will provide you with essential monthly reports that give you vital information about your monthly revenue/collections
• Snapshot report summarizing your monthly collections, accounts receivables, and denials.
• Denial Report, detailing the reason for the denial
• Feedback and Recommendation report
• Access to customizable reporting feature

Monthly Feedback and Recommendations to maximize your collections

• At the end of every month we will provide you with a Feedback and Recommendations report for your internal office to use to make changes regarding patient files (ie updating insurance information), and internal office processes (ie change in codes).

Training and Education

• AE can train Physician staff in identifying and verifying Pts for proper Eligibility screening and Registration to guarantee maximum probability of payment for services rendered.
• AE can train Providers in regards to proper coding to optimize revenue based on their contracts with Payers.

Consulting

• Our team provides a variety of consulting services.
• Review contracts for clauses, accuracy, and expiration.
• Assist Client Corporations in negotiating new Contract terms at renewal
• Help identify any potential Community and/or State Programs available which are not currently being accessed and help in the application process
• Assist in the recruiting and hiring of Medical Billers, or front office staff