Powerful Healthcare Solutions
In today’s environment of intensive health care audits, you must have confidence that medical claims are properly developed and supported in the EMR documentation. Payor requirements are continually updated through changes to the CPT/HCPCS descriptions, payor medical policies, local coverage determinations, and articles only published on line. EMR documentation is the source for determining whether the billed code is supported. Auditors and the OIG look for key components in the progress notes and the orders to make decisions about whether the claim is payable, both in pre and post-pay reviews. The trend of audit and investigation will only intensify because the denial rates are significant.
MJS can help you avoid the devastating blow of large recoupments and civil or criminal investigation that often results from billing mistakes and unsupported services through our Claim DNA program!
Why is the MJS Medical Billing Different?
We get the processes started right before we submit the first claim! Our clinical and billing staff work side-by-side to make sure your billing, collections, and documentation processes are compliant and on the right track for payment!
EMR Review *
After the agreement is in place, MJS clinicians perform a record review of a small sample of unbilled claims for frequently billed CPT/HCPCS codes to identify any areas of weakness that could be a factor in future external audits. We will provide a brief educational webinar for the physician/NPP, or any staff billed “incident to” with tips on how to correct and/or improve the underlying support documents for future billing.
Credentialing Review *
Our Account Management Team performs credentialing review for all persons in the practice for whom claims will be submitted. We will confirm PECOS enrollment, NPI accuracy, licensure and credentialing status with applicable boards of review, CLIA enrollment, OIG exclusion lists, and payer enrollment as may be required. Problems will be addressed with the Practice Manager and/or physician designee.
Contracts Review *
The Contracts Review Team receives and reviews all active payor contracts to determine that enrollment documents are current and that the billing codes and fees are properly loaded into the payor files. Issues of “no pay” or “low pay” are resolved on the front end. Claim submission requirements are set to assure that all “clean claim” requirements are met!
We provide a standard contract for billing and collection services and a HIPAA compliant BBA with a term of one year with opt out provisions, but we are happy to work with your attorney on requested modifications. When the agreement is formalized, start-up activities described above will be initiated. Both of us have the 1st opt out at the end of these activities. When we are mutually in sync with each other, our Account Management Team will initiate all required enrollment documents with your payors.
MJS will be happy to be your billing and collections partner! Call today for a quote on our services