Charge Entry: Charges are “scrubbed” for accurate coding and other payer required edits either while reviewing the electronic file from the provider EHR / EMR or while manually entering the charges from the provider Electronic Health Records.
Claim Submission: Claims are submitted electronically through a clearinghouse. Occasionally, claims require additional information that we will provide electronically or on paper as requested by the payer to receive reimbursement.
Payment Posting: Payments are posted into our medical billing software and digital images of the payments are retained according to the record retention policies.
Payment Follow-Up: Medical Billing Specialists will follow up on unpaid or denied claims to determine the cause. When appropriate, we correct, appeal, and re-submit the claim. We always follow up to ensure timely payment.
Payment Analysis: Our billing software checks to ensure the payer paid the correct amount per the payer contract and follow-up will be done if the claim was not paid correctly.
Patient Statements/Follow-up: Patient statements will be generated after the primary payers have adjudicated the claim. Statement reminders are sent via text, email or phone. Medical Billing Specialists escalate collection efforts according to provider policies. Patients receive two statements and a final pre-collect notice.
Collection Agency: If a response is not received from patients, the provider will determine if the patient should be sent to an outside collection agency unless there is a violation of contractual obligation. PractiSynergy will transition delinquent patient accounts to an outside collection agency or attorney.
Refund Processes: A credit report is submitted monthly to providers and refunds will be issued according to the provider processes and policies or as defined by contractual obligation.