BILLING & CODING SERVICES: Our Process

CODING:

The Profit Solutions coding and billing process is proven, consistent and accurate. Our medical reimbursement specialists simply code upon actual documentation, not preconceived value.

To ensure that we exceed your expectations:

• All of our medical reimbursement specialists are up-to-date on ICD-9 coding, CPT coding, and HCPCS coding as required by carriers for maximum return.

• Our coding, ICD-9 coding, CPT coding, and HCPCS coding is proven to be consistent based on CMS guidelines.

• Medical reviews are conducted customary when a dispute with a carrier arises.

• We will conduct chart auditing services to maximize reimbursement.

• We will train physicians and ancillary staff for documentation of services.

• We conduct random coding audits that ensure proper procedures.

BILLING:

Claim Submission
Bills and claims to patients, insurers, third party payers and guarantors, as appropriate, are prepared and submitted in Client’s name and on Client’s behalf for physician services.

Secondary and tertiary claims are filed upon payment of primary insurance. Secondary claims are filed electronically, when offered by the insurance carrier.

Cycle Reporting
Provide a complete in-house collection cycle to obtain either payment in full or establish payment arrangements. This includes reminder and follow-up statements, phone calls and an additional firm collection letter before placement with outside collections.

Customer Service
Our medical reimbursement specialists value our relationships with customers, vendors, carriers, partners and everyone else we interact with.

Our medical reimbursement specialists strive to:

• Maintain a professional, ongoing association with all insurance carriers.

• Provide professional, experienced personnel to handle all inquiries from patients and carriers.

• Establish a patient inquiry telephone line for responding to inquiries.

• Handle written inquiries pertaining to accounts and statements.

• Post payments to patient accounts, and maintain files and records for audit purposes. When available, AMS takes full advantage of HIPAA mandates by importing electronic remits.

• Ensure proper payment as contracted with insurance carriers.

• Produce monthly credit balance reports to submit to Medical Practice Management Company for reimbursement.

• Write-off of accounts that are not collected through normal billing procedures, per client’s instructions.

• Issue Truth in Lending statements and coupons.

• Research returned mail for correct addresses.

• Provide all electronic filing fees, postage, forms, office supplies, office space, and phone lines.

Fee Schedule Analysis
Periodic fee schedule analysis and review, with recommendations for increases, modifications and adjustments based upon statistical analysis. Parties acknowledge and agree that the fee schedule, including and supplements thereto, is confidential. The fee schedule shall not be disclosed to any third party, with the exception of conditions required by the contract, without prior written consent of our client during the term of the Agreement.

Monthly Reports
Over 25 reports are available to keep the group completely informed of charges, collections, physician performance and contractual write-offs including:

• Procedure analysis by physician and group

• Collections by financial class

• Physician Efficiency based upon hours worked

• Charges, revenue and adjustments by financial mix

• Average Charge, Number of Patients, Total Charges

• Frequency of Procedure Codes

• Accounts Receivable Aging

Credentialing
Thorough credentialing with selected insurance carriers such as Medicare, Medicaid, Blue Cross Blue Shield, and Commercial Insurances using required applications. Initial credentialing occurs with a newly-hired provider and involves renewals throughout the provider's employment with the Client.