Expert Coders – Increase Accuracy
Certified Professional Coders: Our Certified Professional Coders will review charges prior to submission. They will work with providers to recommend new or proper codes and modifiers.
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.
Electronic Claim Submission – Get Paid Faster
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 and Follow-Up – Maximize Profits
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. 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.