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MEDICAL BILLING PROCESS

Since its founding, Zen Medical Services has been one of the most trusted names in the industry. Hire us for this service and learn how we cater to the needs of each client, ensuring the results you need and deserve.

MEDICAL BILLING PROCESS: Services

AUTHORIZATION

  • Eligibility Check

  • Benefits Check

  • ICD-10 check

  • Get Auth

Authorization Goals

  • Every required services should have an auth in place.

PAYMENT POSTING

  • Download ERAs, EOBs

  • Post the ERA, EOBs

  • Reconciliation of files downloaded and posted

  • Check ERA/EOB posting for accuracy

  • Bill Secondary Insurance, if secondary Insurance Medi-Cal Write off Balance

  • Flip balance to patient

  • Denial Separation and Work Denials

Patient Statement:

  • Check patient balance for accuracy

  • Apply Unapplied Credits

  • Separate Patients with 3 statement sent &email box link office

Patient Calls

  • Patient Calls: Calls to be returned in 24 hours. If patient not reached, leave a VM and follow up next day.

Payment Posting Goals:

  • Claims posted Accurately less than 2% patient calls for posting errors

  • All Claims billed to secondary (if any) 0 claims sitting in 90+ A/R to be billed secondary

  • All Denials to be worked routinely

CHARGE ENTRY

  • Download Superbills

  • Eligibility Check

  • CPT/ICD/Modifier Check

  • Place of Service

  • Insurance Check(P/S)

  • Referring Physician Check

  • Reconciliation of Charges & Submission

  • Clearing House Rejection Log Review

  • Send Daily Charge Entry Report

  • Missing Info send to provider weekly. Put info on Box

  • Response to client (Daily)

  • Complete the Provider Dashboard Weekly

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Charge Entry Goals:

  • Claims Filed on Time 0% TFL Denials

  • Claims with valid eligibility < 2% Denials for Eligilbity

  • Charge Entry Accuracy CPT/ICD/Modifier/Place of Service – < 2% Denials for any of these

ACCOUNT RECEIVABLES:

I: Denials/RA Analysis:

  • Make required calls for Daily Denials

II: A/R Work ( 30 +)

  • First Focus 120+

  • Second Focus 60 to 90

  • Goal: 40 Claims/Day

III: Rolling A/R

  • Reduce Payment Cycle

  • Review claim status for claims submitted 30 days before In Process, Denial, Not on File. Provides insight into expected payment

A/R Goals:

  • 60-90 – 25-30%

  • 90-120 – 3 to 5%

  • 120+ < 10%

MEDICAL BILLING PROCESS: List
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