Back-end services
Claim submission and payment posting: Each claim is coded with accurate charges and procedures, then undergoes an additional round of validation through claim scrubbing before submission to the insurance providers. We track and report all incoming payments and assign account receivable follow ups for claims requiring patient co pay in case of partial denials.
Credit balance and refund processing: Credit balances occur when duplicate charges are generated due to overpayments by patients or payers for medical services. These overpayments can create compliance risks and expose providers to financial scrutiny. Our team carefully tracks and reimburses any duplicate payments to the appropriate party, ensuring accuracy and peace of mind.
AR follow-up and denial management: Hospitals, physicians, and practices often face challenges such as staff shortages, ineffective write off policies, and unresolved claims, leading to millions of dollars stuck in aging receivables. Our specialist teams use a proven process to reduce aging accounts and recover outstanding balances. For denial management, we conduct in depth root cause analysis, identify recurring issues, and implement proactive measures to prevent future denials.
Patient Collections and Reporting:
When patients receive services not covered by insurance, our administrative team initiates timely follow ups and ensures consistent communication until the balance is collected. We also deliver customized reports with data driven insights, outlining services provided, goals achieved, and clear recommendations to guide next steps.