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Quality Medical Billing Helps Doctor Improve Patient Care and Volume

Managed Outsource Solutions (MOS) is a professional business process outsourcing company with expertise in the medical, online media, information technology and legal industries. Full cycle medical billing is just one of the company’s many specialized services and incorporates eligibility posting, payment posting, charge entry and claim follow up.

The Client is a board certified Internal Medicine MD. He provides critical care visits at Lutheran Medical Center in Brooklyn NY. Critical care is medical care for a critically ill or unstable patient. A critical illness acutely impairs one or more vital organ systems causing a high probability of imminent or life-threatening deterioration. Examples of conditions that generally qualify for critical care include central nervous system failure; circulatory failure; shock; or renal, hepatic, metabolic and/or respiratory failure. Apart from critical care services, the client provides gastric intubation, cardiac output interpretation, ventilator management, and vascular access procedures.

Challenge

The client was struggling in his attempts to handle all billing and collections himself as well as deliver quality care to his patients, because of time constraints. Although he was very familiar with medical billing and the entire revenue cycle, he had neither an office nor staff to make his task easier and wanted a solution. In addition, he sensed that his software was not suitably capturing his payments and that he could not handle the outstanding claims in an efficient manner.

Solution

We considerably reduced the doctor’s burden by managing his billing and collections for him. Regarding the problem in his current software, we found out instances where he was not billing properly. Certain claims were denied because they were billed without the proper modifiers with negative impacts on his bottom line. We thought it advisable to move him to our recommended software and gave him a demo. He was very impressed with the real time claim tracking and the detailed reporting features. We explained that these features would allow a quicker resolution to all billed claims and prevent improper claim/time issues.

We were successfully able to offer the client a more cost-effective solution by way of the new software which was more robust as it included a claim scrubber that would prevent these issues from happening in the future. We ensured there were no gaps in his billing or collections when switching to the new software. We worked on both PM systems until he was fully implemented on the new one with no issues.

The client’s superbills are uploaded to our secure FTP daily and are reviewed thoroughly. All associated modifiers are added for proper reimbursement. They are then reviewed and entered into the software within 24 hours. The claim is then followed through until final adjudication is made.

Outcome

The client has been with us for over a year. We were able to free up his time by managing every aspect of his billing and collections. Thus, he could not only concentrate on the needs of his patients but also significantly increase his patient volume. He has expressed his happiness and satisfaction with our services and the way we manage his account. All his questions and concerns are handled quickly and he has developed trust in us and feels he is in good hands.
The benefits noticed so far, after outsourcing to us are:

  • Affordable pricing
  • A considerable reduction in claim denials initially which gradually became as good as nil
  • Collections increased by 40 percent within two months.

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