Higher collection rate
Two reasons why Summit-Edge will be able to improve collections:
1. Professional billing team
Even a large group practice will have just one key billing person. It is almost impossible for that one key person, no matter how talented, to achieve the same results of the combined skills and experience of the Summit-Edge billing team.
In-house billers typically have no one to call when a difficult claim issue is presented. All too often, these claims never get collected. At Summit-Edge, the Billing Team Leader is supported by a supervisor, with even greater expertise and experience. The supervisor is supported by both a Billing Consultant and a Technical Consultant. There has never been a billing problem that this team has not been able to solve.
In-house billers are typically trained by the previous biller, with not much training after that. Summit-Edge billers receive intense training upon hire, and the follow-up training never ceases. We are constantly training and learning from each other.
While in-house billers may have some good experience, it does not begin to compare to a Summit-Edge biller, who has had to work through thousands of billing issues to gain the position of "Billing Team Leader".
In-house billers typically work without review and oversight. Mistakes are easily buried. By contrast, the Billing Team Leader knows that her work will be reviewed, and that she is accountable for great results.
2. Powerful billing system
Most billing software in use today was designed by programmers with very little understanding of how to achieve robust collections. Even for a top-notch biller, it can be crippling. The Summit-Edge systems are designed top to bottom for efficiency and robust collections. It is loaded with 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 every session has been entered.
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 how many Ids are formatted, so it will warn the user about an ID that does not follow the expected format.
Within the software is a system for quickly checking patient elgibility, and validating billing information. At the same time, information is gathered on coverage, deductibles, etc.
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. Not many billing systems have this obviously important feature.
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 appear 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 stay on top of family collections.
The system flags sessions that appear to be underpaid. Adjustments are common in mental health billing. This system invites double-checking when payment for a session seems too low.
Summit-Edge controls the source code for the billing software. We are able to adapt quickly to a changing billing requirements or new billing strategies.
More eyes on the billing and collection process promotes better collections. For example, a provider may note a billing mistake and alert the billing person...before timely-filing becomes an issue. 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 is less likely 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 only 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 tend to pay the statement, rather than set it aside to figure out later.