Our process involves five steps. Both the provider and Contact Billing have critical roles in ensuring prompt and correct payments.
Step 1: The Clinic Responsibility– the clinic is responsible for verifying benefits, obtaining necessary authorization, correctly gathering all needed demographic information, treating the patient and documenting and accepting applicable charges.
Step 2: Contact Billing Responsibility-Contact Billing is responsible for auditing claims, CCI Edits, validating ICD-10 vs CPT codes and adjusting modifiers as necessary to get ready for submission.
Step 3: Claim Submission-Contact Billing will get claims ready for submission and either electronically submit or drop claims to paper when necessary. Both will be sent to insurance carrier to acquire payment.
Step 4: Payments-All payments and EOB’s will go to the Clinic. The clinic is responsible for scanning or faxing all EOB’s to Contact Billing. Payments will be checked for accuracy and verified and submitted to secondary, corrected and rebilled as necessary or correctly made and posted to account as paid in full.
Step 5: Patient Collections-After insurance payment is made, the account is either paid in full and the patient file is closed, or, payment has to be collected at the front desk. If not, a patient statement is printed and mailed up to three times. If clinic is unable to collect balance, they write-off to bad debt, send to their desired collection agency or the patient pays in full and the file is closed.
Please refer to our handout for a complete flowchart of Our 5-Step Process