Medical Billing - Letting Doctors Be Doctors
Medical Billing 101
Many people wonder, ‘What is a medical billing service?” or “Why should I use a medical billing service?”
We believe doctors should do what doctors do best – care for their patients. Running an in-house medical billing department comes with great costs in terms of time, money, and possible conflicts with patients. Outsourcing your billing with Medical Billing & Collections Systems results in reduced claims denials, improved patient relations, and increased cash flow.
Doctors save time and money working with a third party medical billing specialist. We work with our clients to increase workflow efficiencies and ensure compliance with ever-changing federal and state regulations.
MBC Systems is a full-service medical billing and collections service. We handle all the complexities of medical billing so doctors can focus on medicine, not paperwork.
For Commercial & Private Payers: Improving Patient Experience
Our goal is to provide accurate billing and improved cash flow so our clients can focus on what they do best: provide quality care to their patients. When billing commercial and private payers, we aim to help doctors improve their patients’ experience, maintain physicians’ online reputations, and inspire patient confidence. We provide easy-to-read patient reporting with detailed explanations of what is owed and why. Our customer service is available to explain anything anytime.
We offer transparent, fast, effective full revenue cycle management and easy-to-read reports of patients’ accounts including codes, dates of billing, and notes. Our billers are in-house, highly experienced, speak English, and understand the intricacies of the industry.
Medical Bill Collections
Our customers typically see increased revenue of between 10% – 15%. Collections is a marathon, not a sprint. And we know all the tactics insurers use to delay the process. We follow through, stay on top of it, and conclude the account, going to court if necessary.
Full Revenue Cycle Management
Revenue cycle management (RCM) is the tracking of a patient’s care from registration and appointment scheduling to the final payment of their bill, including all the administrative and clinical functions that contribute to the capture, management and collection of patient service revenue.
We oversee the revenue cycle management outsourced process for small and large medical practices, including:
Patient Collection Services
- According to a 2007 healthcare payment system report, 36 percent of patients have a past due balance of at least 60 days. MGMA data has found that 60 percent of the amount owed by patients is never collected.
Accounts Receivable Clean-Up
In-house Patient Collections
Reports and Analysis
- Our billing experts apply the most current CPT, ICD-10, and HCPCS codes, avoiding any discrepancies and delays in reimbursement.
- We can review your current superbill and update from there.
Many claim denials are a result of improperly credentialing of the provider. Credentialing with a payer is required before a physician can bill for a patient using that insurance. It is a detailed process that often takes five months to complete, requiring an exhaustive submission of information regarding the physician’s education, training, residency and licenses, as well as any specialty certificates.
It is estimated that 85% of applications are incomplete, resulting in significant delays. MBC Systems can help with credentialing, usually for new practices and new doctors, to ensure complete applications and proper submission. We have an efficient and effective new practice set up protocol for new providers to help get their practices up and running–and paid–fast.
We counsel new doctors to cultivate a balanced mix of payers- ideally one third Medicare, one third PPO, and the rest depending on their specialty.
Medical Coding: the key to successful Medicare and Medicaid Billing
Medicare claims are processed by a Medicare Administrative Contractor (MAC). In a process that takes about 30 days, the MAC both evaluates and processes the claim. As with all medical billing, but especially for Medicare and Medicaid, coding must be accurate for thorough and quick payment.
Billers follow the same protocol as for private, third-party payers when billing for traditional Medicare, Parts A and B. The patient information, NPI numbers, procedure codes, diagnosis codes, price, and Place of Service codes used are the same. However, the forms used are different, UB-04 for Part A, and CMS-1500 for Part B.
When a MAC processes a Part A claim, Medicare pays the provider directly. However, for a Part B claim, if the provider accepts the assignment of the claim, Medicare will pay the provider 80%, while 20% is billed to the patient.
Part of the complexity of billing Medicare claims is that although co-pays, deductibles, premiums, and coinsurance rates are at standard rates, set by the Centers for Medicare and Medicaid Services, they vary between procedures and patients. Figuring out the correct number for a patient is our specialty.
When your practice gets to a certain size getting expert medical coding help is a smart business decision. MBC Systems offers that team and the peace of mind that having expert medical coding help comes with. Call us at (949) 863-0022 to schedule an appointment or use our handy contact form.
PQRS & MIPS
We have assisted many physicians with their PQRS (Physician Quality Reassurance) medicare reporting, and are now helping navigate the CMS’s new Merit-based Incentive Payment System (MIPS). Essentially, these programs evaluate how efficiently physicians are getting their patients healthy.
Under MIPS, clinicians are included if they are an eligible clinician type and meet the low volume threshold, which is based on allowed charges for covered professional services under the Medicare Physician Fee Schedule (PFS) and the number of Medicare Part B patients who are furnished covered professional services under the Medicare Physician Fee Schedule.
Performance is measured through the data clinicians report in four areas - Quality, Improvement Activities, Advancing Care Information, and Cost.
We have found that physicians can be penalized 3-6% off of reimbursement if they do not report off the MIPS. We can help by compiling all the necessary data in the form required by the program. We pride ourselves in getting physicians paid in full, and fast.
Our 25 years of experience in the medical billing and collections industry has allowed us to construct a proprietary process that brings together industry-leading metrics and unparalleled efficiency. We will bill within 24 hours electronically, 48 hours on paper.
We use a carmaker production line model. We have a billing department, a collections department, a payment department, and a hearings department - with highly experienced experts in every module.
Ours is a cost neutral service. In over 25 years of medical billing we have never had a practice that didn’t see single if not double-digit improvements in their bottom line.
Call us today at (949) 863-0022 to find out how we can improve your cash flow, fast.