All charges are sent out to insurance via Advanced MD within 24 hours of when a provider locks and signs their note in their EHR or upon receipt of a signed superbill. Each client is assigned their own personal biller to handle their account, as well as a back up biller to cover absences and vacations to ensure charges go out every day.
"Missed visits" are checked regularly and if a note has not been signed and locked, we will contact the provider or their assistant to lock the note so we can bill out the charge.
Insurance will be verified as active and accurate and all charges will go through Advanced MD's claim scrubber that will check for over 3,000 errors. If the system detects any issues, it will prevent the claim from billing to insurance until we fix the claim that day. All claims that don't get caught in the claim scrubber will be reviewed by our billing supervisors for accuracy and they will approve the claims to leave the system. At that time, all claims are sent to the clearing house who transmit the electronic claim submission to the appropriate Claim Payor IDs.
When a provider uses a CPT or diagnosis code that is not payable or appears incorrect, we will contact the provider or a member of their team in a manner they prefer to inform them that it is not payable and give the opportunity for the charge to be reviewed and addressed accordingly. There will be a Provider Liaison that will help provide training to ensure all coding and billing requirements are met at no extra charge.
Each client will have a designated EDI member to complete all claim agreements through our clearing house to ensure that electronic claims can be submitted to those insurances that require a claims agreement. The EDI member will also set up Electronic Funds Transfer (EFT) so that all money is routed to the provider or group's bank account. This will enable our clients to receive their money directly and efficiently.
Each client will be assigned their very own payment posting specialist. Every day, that Poster will post all of your EOBs (payments) that come into our system electronically. They will also send out statements once a week on a monthly billing cycle at no extra charge to our providers. If the Poster receives an insurance related denial, such as CO22 or CO109, or a billing related denial, such as CO4, CO5, or CO11 they will notify the biller immediately to correct and rebill. If they receive a denial related to CPT or diagnosis codes, they will forward that to the biller to reach out to the provider for corrections. If a denial is received for CO252 (needing medical notes), CO226 (needing additional documentation), CO16 (lacking information), CO45 or COA1 (out right denial), it will be sent immediately to the client's Accounts Receivable member who will send in the appropriate documentation immediately or call the insurance to obtain further information.
For any Coordination of Benefits denials (COBs), the payment poster will send a letter to the patient to contact their insurance to update their COBs and mail it out same day with a red stamp notating which notice it is (i.e. First Notice), and a black stamp stating "Please update your coordination of benefits with your insurance company."
A payment poster can also post copays and patient payments if the client does not wish to do so and at no additional charge.
Once there have been multiple attempts to collect money from a patient, based on our clients specifications, GMS will begin the collections process. GMS partners with MCA Collection Agency in Missouri for all outstanding balances that have been unpaid and need sent to collections. Though our clients can use any collection agency of their choice, GMS highly recommends MCA for our clients as we have worked with them for many years and have had excellent service. MCA is rated A+ with the Better Business Bureau and does not charge unless they collect. There is a link to their website for additional details under the "Resources" tab.
GMS offers our clients access to Credentialing Specialists. They can assist if a client needs to: add an insurance or physician, re-validate an insurance contract, update CAQH, add or change a location, or update a pay-to address. These services are available at no extra charge.
Each year, GMS will review a selection of documentation resulting from Evaluation and Management encounters. This sample will provide insight to the provider's coding trends and documentation accuracy. Feedback and comparison charts are then provided to the client for educational purposes. If further sampling is necessary to ensure proper coding and documenting, GMS will notify the client of the findings in the event that remedial action is required.
GMS will send annual updates to our clients with new CPT codes, diagnosis codes, and changes in required documentation that the AMA and Medicare provide in October each year. We offer training with our providers to review any major changes that might impact them.
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