Medical Billing

• • You should consider outsourcing your billing when you do not have the proper personnel to efficiently handle the required tasks to accomplish a seamless billing process from start to finish. Having the right person, effectively trained, to do the right job is key in ensuring timely and accurate reimbursement.  
  • Often times, the internal team is only handling the electronic billing process, but not working rejections and denials or doing proper claims follow-up to ensure the difficult claims get paid.  When we assume the billing and collections for a practice, 95% of the time, we find that rejections are sitting and have not been worked, which represents cash that is not being collections.  Likewise, if denials are not worked, claims will likely have to be written off over time.  The follow-up process is time-intensive, but required to collect all the cash that belongs to the providers and the practice.  
  • Billing companies stay updated with changes in regulations and compliance requirements, reducing the risk of errors and potential penalties for non-compliance.  Professional billing services often result in faster processing of claims and payments, leading to improved cash flow for the practice.

• • We typically invoice for medical billing and collections services on a percentage basis. If we are strictly tasked with working accounts to improve collections, we would invoice for a percentage of those collections.  The typical range is from 4% to 8% but it depends on the size of the practice, the specialty, and whether or not we are handling all aspects of the billing process (from electronic billing to patient statements) versus just some of the tasks.  
  • Some of our services may also be billed at an hourly rate – such as initial billing process review, weekly and/or monthly reporting, regularly scheduled check-in calls – but that will be agreed upon up front with each client.

• Check out our Price Estimator Tool

Handling denials effectively is crucial for maintaining revenue flow and ensuring financial stability of a medical practice.

• 1. Identify the Reason for Denial: When a claim is denied, it’s essential to determine the specific reason for the denial. Common reasons include incorrect patient information, coding errors, lack of pre-authorization, or non-covered services.
  2. Review and Correct: Once the reason for denial is identified, take steps to correct the issue. This may involve reviewing the claim for accuracy, correcting any errors in coding or documentation, or obtaining additional information required for reimbursement.
  3. Appeal Process: Most denials can be appealed. Understand the appeals process of each insurance company and ensure appeals are filed promptly within their specified timelines. Include all necessary documentation and information to support the claim.
  4. Prioritize Denials: Prioritize denials based on their potential impact on revenue. Focus on high-dollar claims or recurring denial reasons that can have a significant financial impact on the practice.
  5. Track and Monitor: Implement a system to track and monitor denials. This helps identify trends or patterns in denials and allows the practice to address root causes proactively.
  6. Staff Training: Provide ongoing training to billing staff to stay updated on coding changes, insurance policies, and best practices for minimizing denials. This helps reduce future errors and denials.
  7. Utilize Technology: Use billing software or revenue cycle management systems that offer denial management features. These tools can streamline the appeals process, track denials, and provide analytics to improve billing efficiency.
  8. Communicate with Providers: Maintain open communication with healthcare providers or practice managers regarding common denial reasons and actions taken to prevent future denials. Collaborate on documentation improvements or coding practices to reduce denials.
  9. Monitor Metrics: Monitor key performance indicators related to denials, such as denial rate, turnaround time for appeals, and successful resolution rate. Use these metrics to evaluate the effectiveness of denial management strategies and make adjustments as needed.
  10. By implementing a structured approach to handling denials, medical practices can improve their revenue cycle management, reduce revenue leakage, and maintain financial health while ensuring timely reimbursement for services rendered.

Sending electronic claims typically speeds up the payment process significantly compared to paper claims. Here’s a general timeline of when you can expect to get paid if you send electronic claims:

1. Initial Processing Time: Insurance companies typically process electronic claims faster than paper claims.   For instance, BCBS and Medicare process a clean claim usually within 10-14 days.    Upon receipt, they begin the initial processing, which includes verifying patient eligibility, checking for errors, and determining coverage.
2. Adjudication and Approval: Once the claim passes initial processing, it undergoes adjudication. This is where the insurance company reviews the claim details, including services provided, coding accuracy, and any contractual agreements. If everything is in order, the claim is approved for payment.
3. Payment Issuance: After adjudication, the insurance company generates a payment to the healthcare provider. Payments are often issued within a few weeks of claim submission, depending on the insurance company’s payment cycle.
4. Electronic Funds Transfer (EFT): Many insurance companies offer electronic funds transfer (EFT) options for payment, which can further expedite the receipt of funds into the provider’s designated bank account.

Overall, electronic claims submission can significantly reduce the time it takes to receive payments compared to paper claims, which may take several weeks or even months. However, specific timelines can vary based on factors such as the insurance company’s processing policies, any additional reviews or audits required, and the completeness and accuracy of the claim submitted. It’s important for healthcare providers to monitor claim status and promptly follow up on any delays or denials to ensure timely reimbursement for services provided.

Our team is able to provide services from start to finish of the billing process – charge entry, working rejections, working AR, payment posting, denials, patient statements, etc. We can review your practice on the front-end and make suggestions on how to improve your current processes. 

As a medical billing and collections outsourcing provider, the services typically offered can encompass a wide range of functions aimed at managing the revenue cycle effectively for healthcare practices. Here are the primary services commonly provided:

1. Insurance Verification and Eligibility (if requested): Verification of patient insurance coverage, eligibility, and benefits prior to services being rendered to ensure proper billing and reduce claim denials.
2. Claims Submission: Preparation and submission of medical claims to insurance companies, Medicare, Medicaid, and other third-party payers electronically or via paper as necessary.
3. Payment Posting: Recording and reconciliation of payments received from insurance companies and patients against outstanding balances to maintain accurate accounts receivable records.
4. Denial Management and Appeals: Identification, analysis, and resolution of claim denials through appeals processes to maximize reimbursement and minimize revenue loss.
5. Accounts Receivable Follow-Up: Proactive follow-up on outstanding claims and aged accounts receivable to expedite payment and reduce the average days outstanding (DSO).
6. Reporting and Analytics: Provision of regular reports and analytics related to billing performance, revenue trends, claim denials, and collections metrics to support practice management decisions.
7. Patient Billing and Invoicing: Generation and distribution of patient statements for services rendered, including handling inquiries related to patient billing and payment arrangements.
8. Credentialing Services (separate scope of work but available to all clients): Assistance with provider credentialing and enrollment with insurance networks to ensure providers can bill and receive payments from various payers.
9. Compliance and Regulatory Support: Adherence to healthcare regulations (HIPAA, Medicare/Medicaid guidelines, etc.) and staying updated with industry changes to maintain compliance in billing practices.
10. Consulting and Support Servicse (usually billed at an hourly rate): Guidance and support on revenue cycle optimization, coding audits, fee schedule analysis, and process improvement initiatives to enhance overall billing efficiency and revenue generation.

Providers of medical billing and collections outsourcing tailor their services based on the needs and preferences of the healthcare practice, aiming to streamline operations, improve cash flow, and optimize revenue while allowing providers to focus on patient care.

Legacy, as a medical billing and collections outsourcing company, supports a wide range of provider specialties across the healthcare spectrum. While the specific list may vary depending on the company's capabilities and expertise, here are common provider specialties that Legacy supports:

1. Primary Care Physicians (PCPs): Family medicine, internal medicine, pediatrics, etc.
2. Specialty Care Physicians: Cardiology, dermatology, gastroenterology, neurology, oncology, etc.
3. Surgical Specialties: General surgery, orthopedic surgery, urology, etc.
4. Hospital-Based Practices: Anesthesiology, emergency medicine, radiology, pathology, etc.
5. Mental Health and Behavioral Health: Psychiatry, psychology, counseling services, etc.
6. Women's Health: Obstetrics and gynecology (OB/GYN), reproductive medicine, etc.
7. Dental and Oral Surgery: General dentistry, endodontics, periodontics, orthodontics, etc.
8. Chiropractic Care: Chiropractors and related services.
9. Physical Therapy and Rehabilitation: Physical therapy, occupational therapy, speech therapy, etc.
10. Home Health and Hospice: Home health agencies, hospice care providers, etc.
11. Home Care Services: in-home care assistance, respite, etc.

We support healthcare facilities such as hospitals, clinics, urgent care centers, imaging centers, and laboratories, among others.

Each specialty and healthcare setting has its unique billing and coding requirements, compliance considerations, and reimbursement challenges.  We tailor the services to meet the specific needs of each provider specialty, ensuring efficient revenue cycle management and compliance with healthcare regulations.

Effective communication between Legacy and the healthcare provider's office is crucial for smooth operations and accurate billing. Here are common methods and practices for communication:

1. Electronic Health Records (EHR) Integration: We can integrate directly with the provider's EHR system. This allows for seamless access to patient demographics, encounter notes, and coding information without manual transfer, ensuring accuracy and efficiency.
2. Secure Messaging Platforms: Utilizing secure messaging platforms or portals for communication ensures that sensitive patient information and billing details are transmitted securely with the provider's office.
3. Regular Meetings or Calls: Scheduled meetings or conference calls between the billing company and the provider's office can facilitate discussions on billing issues, updates on claim statuses, and addressing any concerns or questions promptly.
4. Email Communication: Email is often used for routine communications or general inquiries.
5. Phone Communication: Direct phone calls may be used for urgent matters or complex issues that require immediate attention or detailed discussion.
6. Training and Documentation: Providing training sessions or documentation to the healthcare provider's office staff on best practices, coding updates, and compliance requirements ensures clear communication and understanding of billing processes.
7. Follow-Up Protocols: Requests for additional information or actions are tracked through Excel and access to Sharepoint online, which ensures that items are responded to promptly, minimizing delays in billing and collections.

By establishing effective communication channels and practices, we can maintain a collaborative relationship, ensuring accurate billing, timely reimbursement, and overall satisfaction with billing services.