Medical Billing Services Page

If you are considering outsourcing billing and collections, take the 20% Test. If you can answer yes to at least two questions, you are likely a good candidate to consider the services The 80/20 Group has to offer:

1. Are you spending more than 20% of your workday in practice management activities?
2. Is more than 20% of your Accounts Receivable older than thirty days?
3. Is staff turnover more than 20% annually?

Benefits

Here are some of the more obvious benefits of outsourced billing and collections services:

• Eliminate associated recruiting costs
• Eliminate training new B &C employees
• Eliminate worker’s comp claims from B & C personnel
• Eliminate management resources and time spent on B&C personnel
• Reduce the risk of embezzlement and fraud
• Eliminate ongoing training to keep up with coding changes and changes in payer procedures
• Reduce fixed operational expenses
• Increase patient load without concern for additional employee workload, space consideration or new hires

Even if it costs exactly the same out of pocket to maintain an in-house billing and collections department as it does to outsource, the benefits of outsourcing would still outweigh in-house management.

In the comparison below, assume one physician collecting $50,000.00 per month, using one biller.

The 80/20 Advantage

Data Entry

The 80/20 Group realizes that accuracy in data entry is vital to claims reimbursement. We've established a set of checks and balances to ensure that all patient and insurance information is entered correctly. Our billing software allows us to "scrub" all claims before they are submitted, minimizing the potential for human error at the data entry point. The claim scrubber verifies the technical and coding accuracy before your claims are filed by identifying potential problems that will cause claim rejection or reduction in payment.

The clinical claim scrubber provides a comprehensive set of coding and technical edits. Each individual edit may be enabled or disabled completely, for a specific claim type or for an individual payer. Some of these edits include:

• LMRP medical necessity
• Proprietary medical necessity
• RVU sequencing
• CCI/CCP
• E/M over/under coding
• Correct modifier usage
• ICD-9 validity, ultimate specificity, secondary code suitability and V-code validity
• CPT/HCPCS/ICD-9 current year validity
• CPT/patient gender suitability
• CPT/patient age compatibility
• Assistant surgeon rules
• Add-on/parent code resolution
• Medicare non-covered services
• Statutorily excluded services

Charge Entry

After the coding and data entry is performed, the software again runs a pre-billing analysis to "scrub" claims for errors. CPT, ICD-9, Modifiers, referring physicians, facilities, date of onset/injury and other important factors are checked. Forms are then submitted electronically or by paper, depending on the carrier's capabilities

Follow-up Process

Our follow-up on claims is what truly separates 80/20 from the competition. We are committed to following up on all outstanding claims, no matter the charge or reimbursement. We believe in continually following up with each insurance company until payment or processing is resolved. It is this attention to detail and commitment to our clients that provides an increased level of reimbursement and that sets us apart from our competitors.

Our follow-up methods include:

• Telephoning insurance companies regarding unpaid claims at 30 days for electronic claims and 45 days for paper claims
• Filing secondary and tertiary insurances
• Never balance billing a patient until unresolved insurance issues are completed
• Insurance Inquiries and Appeals to insurance companies for denied services that do not meet the National Correct Coding Policy that have been certified by HCFA and approved by the AMA
• Telephone and written appeals requested on denied inquiries
• Creation of patient payment plans
• Continuous billing cycles for patients