Reimbursement and EOB Review with Billing Staff

One of our Coding and Reimbursement experts will work directly with the billing staff to assess their knowledge of proper coding and billing strategies.

During this process, an extensive analysis of selected Explanation Of Benefits (EOB) and the associated CMS 1500 claims, or electronic equivalent, will be performed. 

This analysis will include the identification of denials and how the denials were handled by the staff. Claims that should be resubmitted or corrected for clerical errors will be assessed.

A detailed review of the claims identified will assist the staff with determining what reimbursement may have been lost due to incorrect coding, improper modifier usage, or diagnosis-to-procedure rational, as well as required information on a CMS 1500 form.

An assessment of billing procedures will be performed to assist in identifying instances where claims were not submitted or not submitted properly that resulted in lost reimbursements. 
There will be specific recommendations to eliminate the problem of lost reimbursements in the future as well as identification of claims that can still be resubmitted.

An assessment of the practice’s Usual & Customary fees will also be performed to uncover lost reimbursement through underbilling with low fees.