Cape Medical Billing Corp.

Cape Medical Billing Corp is equipped to undertake all aspects of medical billing on behalf of your practice.  Our services are flexible and can be adapted to the unique needs of any group.    

 

Charge Entry

• Audit of encounter forms for missing tickets

• Audit of coding by certified coders to ensure correct charge capture

• Charges entered on the date of service

• Daily balance of charges

 

Claims Processing and Account Follow-Up

• Claims generated and filed daily following review for accuracy

• Fifteen (15) day follow-up with insurance carriers (Do you have the claim? Is it a clean claim? When can we expect payment?)

• Continued follow-up of unpaid claims at 30 days, 60 days, 90 days, etc. 

• Research and review of claim requests

• Request additional information from patient for carrier, as needed

• Resubmit and update claims, when necessary

• Work every denial or rejection

• Prepare and send appeal letters using proprietary letter templates

• Process refunds following the client's established process

• Write off carrier-notified errors if not acted upon by carrier after 48 months 

• Explain insurance rules and regulations to patients

• Serve as a liaison between the patient and the carrier

 

Payment Posting 

• Batch posting of checks daily

• Check for payment accuracy against the client's fee schedule 

• Daily balance of payments posted

• Shift remaining account responsibility to secondary insurance or the patient

• Flag all appeals, denials, rejections and refunds for additional follow-up (see Claims Processing above) 

 

In-House Collections

• Generate and send a letter to the patient the day the balance shifts from insurance to patient responsibility

• Set up payment plans according to the client's established process

• Monitor payment plans for patient compliance with pay plan agreement and communicate promptly with patients who default on payment plans

• Turn patient balances over to the client's collection agency, according to the client's collection process, if the patient does not respond to payment requests

• Generate and send letters to contracted carriers if patients do not pay their co-insurance 

 

Reporting and Analysis

• As part of the onboarding process, provide the client with industry benchmark data

• Assist the client in determining which metrics make the most sense to track over time   

• Provide monthly reports that contain key revenue cycle metrics, which ultimately drive practice profitability

 

Practice Set-Up and Provider Maintenance

• Provider license applications

• Loading of fee schedules into practice management system

• Provider credentialing with CMS and insurance carriers 

• Credentialing maintenance

• Contract negotiation

• Negotiation of Physician Services Agreements with hospitals