Case Studies

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Underbilling & Leaving Your Money On the Table

We brought on a therapist who was at their wits end with trying to bill BCBS and not bringing in what they thought they deserved and expected. Right away, the new billing specialist was able to identify several claims which were underbilled and not paid at the usual and customary rates. Claims were corrected, resubmitted, and a check for over $1,000 was in the providers bank account, all in less than 1 week! It turns out the provider was underbilling and missing out on over $30 dollars per visit. Now the provider is bringing in the money they deserve & are breathing easier when it comes to this single provider’s bottom line!

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40% Decrease In Claim Denials & 60% Increase In Patient Collections

As billers, we understand how important it is to verify insurance eligibility & collect estimated patient dues such as Deductibles and Copays. A multi-provider behavioral health clinic contacted us concerned that too many of their claims were being rejected by insurance companies and money wasn’t coming in from the insurance companies or patients. After implementing a new Insurance Eligibility and Patient Cost Share Estimate Protocol in the office, they were able to see a 40% decrease in claim denials and increase their patient collections by 60%!

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Coding Issues & Lost Revenue Opportunities

CPT codes and Diagnosis codes are constantly changing. Insurance Companies send never-ending policy and billing guideline updates. It’s no wonder so many providers feel lost and overwhelmed when it comes to medical billing and coding. For instance, a multi-provider group contacted us due to their piling up denials and suffering bottom line. After a quick claims audit, the billing specialist was able to identify several codes which were billed but had expired. The billing specialist worked diligently to gather the updated codes and billing guidelines. The providers’ superbills were updated & they were trained on the correct codes to bill and how to identify when extended services were billable. Previously denied claims were resubmitted to recoup lost revenue. As a result, their rejections decreased by 30% and their collections increased now that they were billing for all of their time spent rendering services correctly.

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Missing Insurance Payments

We were contacted by a provider who was distraught and missing thousands of dollars’ worth of payments from insurance companies. It turns out her previous biller had written off her concerns noting that their job was billing, and tracking down payments was not part of their job description. After hours of being transferred from insurance rep to insurance rep, the provider assumed the money was gone for good. Well, that was until she contacted us. After investigating it turned out her checks were being mailed to the wrong address & put into a locked mailbox that was no longer being checked on. Her new billing specialist not only worked with the insurance companies to update the provider’s information in their systems, but also had the provider set up with direct deposit payments to the provider. All of the lost payments were re-issued and in the provider’s bank account within 1 month’s time!