How our service works

Appointment Scheduling

All patients contact your office to schedule appointments.  Staff collect basic demographic information, register the patient and schedule appointments. The front office also does

• Insurance eligibility verification                                                                                                     
• Appointment reminders by email and telephone
• Provide details on outstanding patient balances at the time of scheduling.

 

Patient Check-in

When the patient arrives for appointment, patient information is verified.  Copies of insurance cards & driver’s licenses are taken.

• Any outstanding patient balances are brought to attention.
• Insurance eligibility verification is done
• Print paper charge slips, or populate online charge slips (encounter forms)
• Pre-collect copays and deductibles.

 

Charge Capture

Capturing the diagnostic and procedure codes, creating Superbills, and transmitting them for billing can be done many ways.

Paper: patient encounter forms may be sent to us in a number of ways including scanning (most popular), faxing, mail or courier.

Software: You can continue to use your current Practice Management System or our state-of-the-art Web-based Practice Management System with integrated EHR/EMR. 

In the case of online Superbills or EMR, data is automatically transferred electronically to our systems for billing purposes

We will work with your office to setup transmitting the Superbills to us.

After the patient visit is complete, and the Superbill generated, the billing team goes into overdrive to ensure you are paid all the money you are owed, on time.

Claim Generation

Our reimbursement specialists compile and review the data provided by your practice, enter the information into the system, and generate a claim.  Advanced ‘claim scrubbing’ tools and highly skilled certified coders validate claims against ever-changing government and insurance reimbursement rules to identify errors that can be corrected to ensure a higher percentage of first pass clean claims (>97%)

Claims Submission

After checking the claims against payer reimbursement rules, we will securely transmit primary and secondary electronic claims to government payers and commercial health insurance companies for reimbursement through our integrated clearinghouse.  Use of the integrated clearing house allows us to catch and fix errors in minutes rather than days or weeks, resulting in significantly higher claim success --fewer rejected claims.

Claims that are not eligible for electronic submission are sent on HCFA 1500 paper forms,.

Payment Posting & Processing

All payments are sent to your office or directly to your bank account or lockbox.  After our team receives the information on payments and EOBs, we

• Post payments using data from electronic remittance reports
• Use Explanation of Benefits (EOB) reports to post insurance payments
• Post patient payments collected during the check-in or check-out process

 

Payments are reviewed; line-item posted in the system, compared against fee schedules, and then balanced. Information on any claim that needs to be appealed is compiled and the claim transferred to the AR team to have the denials and rejections resolved efficiently.

Secondary claims

Once the primary insurance carrier pays their share of the claim it is then submitted to the secondary insurance company if the patient has one. When submitted electronically all the information from the EOB (explanation of benefits) is entered into the claim information and submitted to the secondary insurance carrier.

Secondary and tertiary claims can sometimes seem like a pain to get paid - especially because they can be for a very small amount of money. We believe it is still important to file and follow-up on these claims to keep your receivables under control. It may not seem like a lot of money but it adds up.

Patient Billing

When there are balances due from the patient, our procedure is to send three statements to patients with follow-up phone calls. Patients are provided with a toll-free number to call with any questions about their bill. These calls come to EnrichMD where they are answered as your billing office.  If, after the third statement there is no response, we send a ten day notification letter. At that point, it is up to you to decide how to pursue collecting the balance due, perhaps using an outside collection agency or a bad debt write-off.

Better reports that meet your need

EnrichMD provides you with advanced financial and practice analysis tools, specifically designed to give enhanced visibility of your practice operations and claims status.
You can analyze payments by carrier, provider, location, procedure, diagnosis, timeframe, and much, much more. You can also monitor how well we are doing our billing and reimbursement functions.  There are currently several hundred standard reports to choose from, as well as reports that can be customized to your needs.

EnrichMD systems automatically track and analyze critical indicators that determine the profitability of your revenue cycle. Alerts are triggered to adverse changes, such as a decrease in cash collections month to date, an increase in A/R days or A/R greater than 90 days.

Most of the reports can be automatically delivered to your email.

More information

Contact the EnrichMD Team at info@enrichmd.com to learn how we can help improve the financial and operational health of your organization.