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BILLING AND PRACTICE MANAGEMENT

Medcore understands billing has become increasingly complex in today’s changing environment and each practice or specialty has unique requirements for maximum reimbursement. MedCore’s team structure allows for exposure of each process within billing, educating staff on individual practice needs and creating accurate filing and reporting throughout the billing cycle. Accounts are entered and claims are produced within two workdays of receipt.

This structure, regarding billing requirements by practice, allows for accurate payment application and review. Payments, tracked by payor category, CPT, ICD-10, patient demographic information, insurance information and contract information are reported monthly based on practice needs. Appropriate reviews are performed for denied and underpaid services. Codes are specifically designated to identify denial reasons, providing physicians with crucial information regarding reimbursement. MedCore’s software provides the most flexible and powerful medical insurance and data management to our clients. Medcore can organize data in an unending array of formats and produce reports from virtually any of the fields in multiple sort options. For unpaid patient balances, the software streamlines the collection process.

Understanding patient satisfaction is important to you, MedCore’s professional staff focuses on providing solutions for all billing needs in a responsive, accurate manner. Our dedication to meeting your patients needs pertinent to billing allows you to be removed from any collection activity. Our growth has been based largely on referral, an endorsement of satisfaction from our clients.
                                                                                        
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ICD-10 & CPT CODING

Correct coding is the most essential and vital component in billing medical claims.  All of the coders in our organization stay current in the ever-changing world of ICD-10 and CPT coding through the many educational resources available to them and through networking with other coders in our industry.  Our office also conducts random internal coding audits to ensure proper procedures and documentation.
                                                                                                          
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CLAIM FILING

Claims are filed within 24-48 hours of receipt of your billing information in our office. Claims are submitted electronically and, in certain cases, on paper CMS-1500 forms on a daily basis to ensure the most timely processing of your payments. All claims are followed up aggressively; our office has a team of specialists who assist in calling insurance carriers and patients to deal with outstanding claims and balances. We know that we don't get paid unless you get paid! 

 
PROVIDER ENROLLMENT

Aside from caring for your patients, insurance credentialing is an essential aspect of every practice.  It requires a significant amount of time not only to complete this paperwork but to followup on the status of the submitted applications.  Some carriers take 60 to 180 days before they finalize your participation status.  MedCore can relieve you of this tedious process and ensure you are properly credentialed with the insurance carriers required for your practice including Medicare, Medicaid, and Blue Cross Blue Shield.
                                                                                                          
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CONTRACT NEGOTIATIONS

MedCore can provide the detailed information needed to help physicians successfully negotiate contracts with insurance carriers. Allison DeBoer has been instrumental in negotiating contracts for physician groups for more than 30 years. Physicians should understand the implications of the agreement for their practice, and negotiate optimal reimbursement rates for their services.
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FEE ANALYSIS

Fee schedule analysis and review, with recommendations for increases and adjustments, is performed annually or as needed.  Fee analysis can help pinpoint low fees for immediate revision.  Comparison of a medical practice’s fees to established averages could determine the appropriateness of the fees.  In addition, linking the fee schedule to RVUs can result in consistent pricing.  The result of regular fee schedule analysis can be an increase in practice revenue.
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A/R MANAGEMENT

Since each provider and/or practice is unique, we customize our  billing & coding services to meet your individual needs. This includes all or some of the following services:

  • Data entry - we obtain information from the provider and/or practice and enter this information into our database.
  • Claims - our goal is to bill for services correctly the first time. In order to increase payment turnaround, it is critical to send out "clean claims." MedCore submits claims daily. Whenever possible, we will submit your claims electronically to significantly improve collection time.
  • Payments - as we receive payments and explanations of benefits, they are posted to our database. Each EOB will be audited for correct payment and/or benefits.
  • Appeals - if a payment or denial has been made incorrectly, we challenge the insurance companies to receive the correct reimbursement for you.
  • Statements - are mailed out on behalf of your practice. Patient accounts eligible for statementing are issued monthly. The protocols for collection activity are done expressly to your specifications.
  • Fee Schedules - are updated annually or as needed. Inflation and cost of living increases on a yearly basis, so should your reimbursement.

We continue to followup until the account is satisfied. Our accounts receivable department works diligently to pursue all outstanding amounts from both carriers and patients.

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CUSTOMIZED REPORTING

Our comprehensive reports deliver results tailored to meet each physicians unique needs. Revenue & Activity Reports, Aged A/R Summary as well as Activity Summaries by Provider, Payor Type, and CPT Frequency Report codes are just the beginning of information available.  These reports are designed so you can track your monthly charges and payments as well as your outstanding accounts receivable balances. You will always know exactly how well your practice is performing.
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NEW PRACTICE SETUP

Before any physician can open the doors and see patients, numerous tasks must be completed. MedCore understands the importance of having your practice structured properly to help ensure your success. Our practice development helps prepare you to succeed in achieving your goals by providing the resources and tools necessary for implementing a smooth running practice.

Working together, we will review billing issues that effect your practice. Coding requirement changes, documentation guidelines, fee schedule review, contract negotiation and monitoring as well as auditing of claims are just some of the services MedCore offers you. MedCore works with you and your practice, providing the education, data management, and reimbursement administration necessary to compete and provide healthcare in today’s demanding environment.
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EMPLOYEE LEASING

Depending on your practice needs and structure, employee and personnel issues can be a daunting task for the healthcare professional.

MedCore offers employee leasing options that can compliment your needs or resolve your office staffing issues.

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ACCESS TO ACCOUNTING, LEGAL AND FINANCIAL PROFESSIONALS

Whether you are a solo practitioner or a large provider group, setting up a new medical practice can be a lengthy process.  It is a complex and difficult task. We can help. MedCore has worked with legal, financial and banking professionals who have years of experience working with medical practices.
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