No billing team collects 100% of allowable. Typical results range from 80% to 95%. The difference between these percentages is a huge amount of cash flow. We work with you to reach 99%.
Insurance money is hard to get...so is family money. For optimum results, the billing solution needs to be well-thought-out and robust - at every point in the billing process. Few practices reach 99% because there are so many points where slippage occurs.
Every detail of the Summit-Edge software has been designed to maximize collections. For example, the system identifies and presents problem claims to the follow-up person. Similarly, the system identifies family money that is starting to slip away. Even small little details, like a one-click warning letter, helps attain the 99% collection rate.
The support we provide also helps you get to the 99%. For example, our Billing Consultant is available to the billing person when difficult billing obstacles are encountered. We work with billing persons on a first-name basis.
Here is a sampling of some of the more powerful features:
Unauthorized sessions typically don't get paid. So, the system includes a robust system for managing authorizations. There are two kinds of warnings: 1) when an authorization is expiring, and 2) when the user is attempting to schedule an unauthorized procedure.
Makes sure sessions get entered
Sessions that don't get entered don't get paid. So, the system includes a system for comparing sessions entered with a provider's appointment schedule. Providers are encouraged to review their "Schedule Report" at the end of each week, to make sure everything is entered correctly.
4-Step accuracy validation
With all the timely-filing rules, claims need to go out right the first time. So, there is a 4-step system for validating the accuracy of session data. This includes warnings if the system doesn't like what it sees...for example, a diagnosis of marital counseling on a mental health client.
This system warns about problems that may cause the claim to be rejected. For example, the system knows what a Medicare Id usually looks like, so it will warn the user about an ID that does not follow the familiar format.
Before a batch of claims is filed, the system checks eligibility with the insurance company. Problem claims are held back for review by the billing staff.
Dynamic follow-up system
We provide a dynamic and powerful on-screen claim follow-up system. When the follow-up person clicks on "Problem claims", the system shows the claims that have been denied or are overdue for payment. The user can drill down for more information...fix the problem...and, if necessary, refile the claim. After follow-up has been done, the claim falls out of the "Problem claims" list. This is an easy, yet powerful, system for managing problem claims.
Robust family collections
We provide a robust system for billing families and following up on unpaid statements. The system tracks when statements were mailed. It's easy to identify statements that need to go out. More importantly, it is easy to identify families that are not paying timely. In fact, their names accumulate under a "Losing" button...as in "You will lose this money if you do not do something." Warning letters can be sent in a couple mouse clicks, so it is fairly easy to maximize family collections.
Professional Billing Consultant
It's common for billing software vendors to provide software support, but where does the billing person go with their everyday billing questions? Summit-Edge provides a Professional Billing Consultant, who is ready to help with any billing question. New to Railroad Medicare? She can explain how it works! The Billing Consultant has extensive behavioral health billing experience, and the calls she gets every day just adds to that experience.
The system flags claims that appear to be underpaid, so that they can be reviewed by the lead billing person.
More eyes on the billing and collection process helps collections. For example, a provider may note a billing mistake and alert the billing person...before timely-filing becomes a problem. Equally important, providers need to keep abreast of the billing when scheduling patients. Maximizing collections is a team effort...providers, managers, front office and billing staff. We want everyone to be able to do their part in the billing process. So, openness is a key concept.
If the responsible party doesn't understand the statement, he will be reluctant to pay it. We've eliminated the adjustments that are so common on medical statements. There is a summary line for each date of service, showing the key numbers - the charge, what insurance paid, what is pending and what is due from the family. As it is easy to understand, patients are more likely to pay it, rather than set it aside to figure out later.