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We are home to Certified Professional Coders (CPC) and Certified Professional Billers (CPB) who understand every aspect of charge capture to billing and claims to payment processing and follow-up. Backed by advanced billing technologies, our team leverages their expertise to make billing more streamlined, accurate, and on-time. Our expertise yielded the desired revenue results for occupational health providers specializing in pre-employment medical examinations, drug and alcohol testing, medical surveillance, ergonomic assessments, immunizations, injury management and rehabilitation, and more. Here is how we will do it for you:
- Harness digital capabilities like EDI, EHR, EMR, and PMS to digitize workflows facilitating timely and accurate electronic claims submission.
- Ensure all patient information (patient demographic details, medical records, insurance provider information, coverage details, effective date, expiration date, etc.) is accurate and up-to-date.
- Determine pre-authorization needs and process subsequent documentation summarizing the medical necessity of services, seeking the payer’s approval.
- Align with the payment guidelines and fee schedules of different insurance payers, including government agencies (Medicare & Medicaid), employer-sponsored health plans, self-insured employers, and private insurance companies like Aetna, Cigna, and Humana.
- Stay informed about the latest coding updates in ICD-10, CPT, E/M, HCPCS, modifiers, and revenue codes. Our occupational billing specialists are well-versed in the latest CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC).
- Adhere to the pertinent regulatory requirements while filing claims for occupational health billing models such as capitation billing, fee-for-service billing, episode-of-care billing, etc.
- Examine the Explanation of Benefits (EOB) statement from the insurance provider to review reimbursement discrepancies, address any issues, and assist in the appeals procedure when necessary.
- Analyze EOBs to get a clarity on premiums, coverage durations, deductibles, and co-payments for subscribers, policyholders, and additional beneficiaries.
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