Billing Services

The Advantage GroupThe Advantage Group's full service medical billing division has built a solid reputation, providing high quality and cost effective services. We understand the challenges faced by provider organizations and utilize a customer service approach. Our billing services division handles your accounts receivables in the most effective manner:

Your staff can concentrate on taking care of patients while knowing the account portfolio and billing functions are professionally managed. We have a commitment to value, service and results, understanding that the needs of no two providers are alike. The Advantage staff and management will customize our services to match your business needs, increasing the performance and efficiency of your practice.

Staff and Experience

All of our personnel are trained extensively on the Health Insurance Portability and Accountability Act (HIPAA) in order to meet regulatory requirements. Our medical billers are expertly trained to process each claim to yield the maximum return with zero defects, and are among the most competent in the business. Additional training is provided to our billing staff through various associations such as HFMA, MGMA, and AAHAM.

Our staff ensures that our clients are made aware of any trends or changes in coding and reimbursement issues. Clients will also be notified of any perceived deficiencies in coding, documentation, charges, denials, or reimbursements that may impact that billing process.

Third party payers are identified, and where applicable, may require special account processing to assure prompt payment, proper reimbursement, and interaction with the payer.

Claims Processing - Our data processing department performs daily system downloads of all claims that can be processed electronically to payers. Upon receipt by the payer, an electronic acceptance report is generated which identifies any rejected claim, thus allowing a correction and re-submission to the payer. The remaining non-electronic primary or secondary claims are printed on appropriate forms, checked for completeness and accuracy and submitted directly to the payer.

In the event of incomplete insurance information, our staff will make every reasonable attempt to obtain the information needed including contacting the patient and/or client.

Secondary Claims Submission - Upon payment from the primary payer, we will automatically submit a claim to the secondary payer as appropriate.

Insurance Follow-Up - Our systems provide automated and timely follow up which allows our staff the capability to determine the status of all claims. This system allows staff to take prompt action if an account is not paid timely or when the payer indicates the claim has not been received.

Our insurance follow-up generates a submitted claims report that is utilized internally and clearly reveals a detailed aging of accounts submitted to each payer mix. The information is aged, separated by payer category and indicates the number of claims submitted, the dollar amounts submitted, the amounts currently paid, and the percentages of paid accounts. A detailed list of the respective accounts can be worked from a printed list or on line by staff. Some payers allow on line access to submitted claims to check on the status of claims and for follow-up purposes.

Special lists are produced specifically highlighting payer classes such as workers compensation, Medicare, Medicaid, and commercial insurance accounts that require immediate follow-up based on predetermined aging parameters or timely payment windows.

Computer generated re-bills are scheduled and activated, as necessary, when payers fail to respond with timely payment.

Balance After Insurance/Self Pay Accounts

Self Pay Balance Accounts - We employ professional account representatives responsible for the follow up and liquidation of self-pay balance accounts.  Through the use of telephone contacts, letters, and itemized statements, your account representatives strategically and successfully resolve these accounts.

In order to assist guarantor inquiries, account representatives have immediate and direct on-line access to all account information, including services rendered, payments, payer information, account notes, documentation, transactions, and all activity.

Payment Options - Every reasonable effort is made to liquidate the account balance in a professional and timely manner. In addition to cash, checks, and certified funds, we also accepts Visa, MasterCard, and American Express credit cards.

Bad Debt Collections - We can automatically transfer self-pay delinquent accounts to our collection division, providing a comprehensive approach to fit the needs of your account portfolio.