Coding

Medical Coding

Our certified medical coders have experience coding nationally, allowing us to be familiar with state and payer specific coding guidelines.

We are highly experienced in most specialties including:

Our medical coding experts ensure that our clients are properly documenting their medical records so that we can maximize their revenue and remain compliant. We also provide our clients with experts who can research and solve complex coding scenarios.

Furthermore, we utilize national and local coverage determination guidelines to evaluate your coding performance and assure coding accuracy which positively impacts reimbursement therefore lowering days in A/R.

Lastly, we provide this information in an easy to digest format that leaves providers and practice managers with valuable information to improve their operational and financial performance.

                                                                                               

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ASC

Ambulatory Surgical Centers (ASC)

Ambulatory Surgical Centers (ASC’s) are some of the fastest growing medical services today. ASC reimbursements are comprehensive, complex and ever-changing. According to the Medicare Carriers Manual, ASC’s are defined as a separate and distinct institutions, with the sole purpose of providing outpatient surgical treatment and services.

ASC’s use a combination of physician and hospital/clinical billing, employing the CPT and HCPCS level codes (alike most physicians), and some insurance carriers permit an ASC to bill using ICD-10 procedure codes.

Medicare currently requires that ALL ASC charges to be filed electronically, using the CMS-1500 form. Medicare also requires the use of the modifier SG when submitting charges to indicate that services were performed from an ASC.

Most ambulatory surgery centers lose additional revenue of 10-30 percent because they do not have the time or the required expertise to renegotiate contracts with insurance payers.

Here at Medorizon, we understand the legal regulations placed on ASC’s, including the specialized required coding, accreditation, documentation, and negotiated ASC provider insurance and managed care contracts needed for maximum reimbursement.

Medorizon has a billing Policy & Procedure Manual, which addresses regulatory compliance implications such as credit balances, coding, problem resolution, system integrity, and appeals. Additionally, this manual documents the entire revenue cycle and is reviewed annually. The financial policies of Medorizon address the process for following up on claims, correspondence, appeals, write offs, bad debt, and self-pay collections.

What we can bring to the table:

  • Evaluate and manage ASC workflow
  • Certified medical coders and billers that specialize in ASC’s distinct set of coding and reimbursement guidelines
  • Professional ASC coding services
  • Increase efficiency
  • Improve Cash Flow
  • Personal Injury expertise
  • Workers Comp billing
  • Court Appearances
  • Contracting
  • Compliance

At Medorizon, our billing specialists can manage all aspects of your ASC’s billing and revenue cycle management. We will work in conjunction with your facility to ensure you receive the appropriate reimbursement.

We take pride in keeping up to date with the latest CMS Medicare, Medicaid billing and documentation requirements, certifications and regulations. We make sure that each claim is tracked from start to finish by our trained and certified staff members. We have dedicated ASC staff members to follow up with payers and patients.

Our internal processes are laid out to expedite collections and ensure follow through for each and every claim. Out practice management consultants are highly trained and specialized to maximize ASC revenues all while maintaining accuracy and HIPPA compliancy.

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Accounts Receivable / Payment Posting

Accounts Receivable

Our Accounts Receivable team is here to ensure your facility receives payments for goods and services, and records these transactions accordingly. Each AR team member focuses on securing revenue by verifying and confirming the posting of receipts, and resolving any discrepancies regards to payments from patients and/or insurance companies. Each client receives a dedicated account representative.

Our main goals are to:

- Maintaining the billing system

- Generating invoices and account statements

- Performing account reconciliations

- Maintaining accounts receivable files and records

- Investigating and resolving any irregularities or enquiries

- Improve Net Collections Percentage

- Increase Net Receipts

- Decrease average days in AR

Successful accounts receivable management requires a full understanding of how each area or department relates to and influences the revenue cycle and the AR collection period.

Payment Posting

Payment posting in medical billing is one of the key processes that get the utmost attention from our Operations management.

All payers either send an EOB (explanation of benefits) or ERA (electronic remittance advice) towards the payment of a claim. Our payment posting team member will post these payments immediately into the respective patient accounts, against that particular claim to reconcile them. The payment posting is handled according to client-specific rules that would indicate the cut-off levels to take adjustments, write-offs, refund rules etc.

Co-pays, deductible and non-covered services that are paid in cash are applied to patient accounts in order for the need to be correctly accounted against the claim to avoid any inflated AR and proper closing of the claim.

Goals:

  • Posting Payments within 1 working day
  • Re-organizing Low Pay Claims
  • Auto-Generate Custom Appeals

Medical Billing

Medical billers and coders play a vital role in the connection between health care providers, patients and insurance companies.

Duties of Medical Billing:

  • Reading and analyzing patient records
  • Determining the correct codes for patient records
  • Using correct codes to bill insurance providers
  • Interacting with physicians and assistants to ensure accuracy
  • Keeping track of patient data over multiple visits
  • Managing detailed, specifically-coded information
  • Maintaining patient confidentiality and information security
  • Optimize Clinical Dictation

Medorizon’s management team has a diverse background including practice management experience, medical coding expertise, operations management, information systems, insurance claim processing, and compliance including the Healthcare Insurance Portability and Accountability Act (HIPAA).

Our organizational structure is a team-based structure with client and specialty assignments. Each client is assigned a Project Leader for the installation/implementation and an Account Manager to manage the day-to-day activity.

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Services

Complete revenue cycle management

Medorizon is a comprehensive medical billing outsourcing service, providing everything from revenue cycle management to legal support. With offices in Illinois, Michigan, and Texas, we operate throughout the United States. Our services are not typical of the quality offered by similar companies. Face to face interaction and close interpersonal relationships along with our premium customer service, sets us apart from our competition. You are invited to contact us today to facilitate a relationship for the future. We strive to understand your practice and offer affordable and effective service packages. These may be custom tailored to a variety of medical practices and specialties, ranging from small offices to expansive surgery centers. We appreciate your interest and look forward to all inquiries.

 

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