Medical Edge Billing & Collection
• Receive and process practice patient demographics and super bills.
• Provide access to the MedicalEdge billing system, licenses, and billing and collection support services.
• Review and correct or return for correction CPT and ICD superbill codes according the non-billable grid prior to data entry.
• Review and correct patient demographic and insurance information prior to data entry.
• Maintain database of patient and payer demographic information.
• When practicable, verify insurance coverage not verified in the clinic.
• When practicable, verify patient/payer claims information and addresses prior to claim submission.
• Daily submission of billing statements.
• Daily submission of electronic claims.
• Daily submission of paper claims to secondary insurers.
• Daily insurance follow-up on denials, down-codes and no-response claims – includes individual case research, filing appeals and re-submissions as indicated.
• Post all billing submissions in the MedicalEdge computer system.
• Post all collections in the MedicalEdge computer system.
• Reconcile practice time of service collections and post account credits in the MedicalEdge computer system.
• Verify in-patient and nursing home patient insurance coverage.
• Comply with HCFA (CMS) 1500 requirements of Medicare, Medicaid, Champus and other regulatory requirements and Managed Care Plans and commercial payers.
• Compile and report quarterly HMO encounter reports.
• Maintain CPT and ICD databases.
• Review, update and revise practice superbills.
• Maintain current fee schedule and superbill information.
• Periodically audit CPT and ICD coding compliance.
• Provide CPT and ICD coding education.
• Maintain payer databases.
• Maintain Medicare allowable by geographic division database.
• Maintain managed care plan allowable, capped service and contract provision databases in the aggregate and by individual CPT code.
• Maintain provider number, UPIN, CLIA and license number databases.
• Maintain referral physician database.
• Maintain patient referral pre-authorization and provider/tracking number databases.
• Maintain scheduling system.
• Maintain document scanning and document management systems.
• Maintain security and log-on routines for all of the MedicalEdge practice and support center staff.
• Monitor payer contract term compliance.
• Staff and manage a billing and collection patient call center.
• Develop practice patient lists and mailing labels.
• Accounting for and posting of all practice lockbox receipts.
• Provide each practice a basic practice billing and collection report set.
• Monitor patient accounts, small balance write-offs and manage referrals to collection.
• Post collection agency receipts to patient accounts.
• Write-off final account balances as indicated.