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Realizing net collections to their fullest – The challenging part of Medical AR recovery
Today, many physicians find their medical practice or facilities generating expected or growing monthly charges but are not realizing the same growth in their reoccurring cash flow.
Unless specific and consistent active accounts receivable follow up on the current billings is initiated, it is common to find a provider with excessive amounts in medical A/R that are greater than 180 days outstanding.
Usually the volume of outstanding claims and the time it takes to research, correct, appeal, and/or re-file the claims will take much longer than anticipated. A limited number of staff devoted to this task will not be able to accomplish the goal, which is to substantially reduce/eliminate the outstanding A/R and collect as much money as possible in a short period of time.
The medical A/R program offered by MGSI overcomes the problems that traditionally hinder collection efforts by the individual providers. MGSI pursues these accounts by assigning a full team of individuals to "blitz" them.
They perform their work in three phases:
This phase involves identification and analysis of the claims listed on the A/R Aging Report. The team will review the provider's adjustment policy from which we will identify which claims need to be adjusted off. Additional claims may be identified once the analysis of timely filing limits is conducted.
Experienced medical A/R analysts initiate this phase by identifying the various issues for claims that are marked as uncollectible or for claims where the carrier has not paid according to its contracted rate with providers.
The filing/appeal limits of the major carriers will be checked and also the "claims submission address" will be checked for the claims to reach the correct processing unit. The team also confirms that "clean claims" will be reimbursed as per the contracted fee schedule
Based on the analysis and our team's findings, the claims that are identified to be within the filing limit of the carrier are re-filed after verifying all the necessary billing information is correct such as claims processing address and other medical billing rules.
Claims that have exceeded the filing limit of the carrier as well as the claims that appear to be underpaid by the carrier are appealed with the necessary supporting documents. Appeal procedures vary widely depending on the plan, carrier and state. These procedures are collected and applied on claims that are being appealed.
We will transmit the claims electronically directly to the carriers wherever possible and for the other carriers, claims are forwarded through clearing houses and aggressively followed up with the carrier for confirmation.
After completing all the above and posting payment detail to the outstanding claims, patient bills are generated as per the client guidelines and then followed up with the patients for payments.
The ultimate success of Cash Acceleration Program is dependent upon several factors:
Certainly the completeness and accuracy of the account data provided is important. MGSI provides the protocols, expertise, and resources necessary to perform a comprehensive collection effort. However, the more successful programs also have received a high level of support and cooperation from the provider's office.
Because MGSI is already in the field of providing medical billing services, our knowledge of medical billing rules and processes greatly enhances our ability to also conduct successful Cash Recovery Programs.
For more information on this service and how it can benefit your practice call toll free at 877-896-6474 or email firstname.lastname@example.org.