PROMED BILLING SOLUTIONS
Specializing in Chiropractic Billing
Member of the Florida Chiropractic Association
POSTING OF PAYMENTS AND EOB RESOLUTION
All insurance payments are sent directly to your office. Once payments are received, the EOB's are either faxed or mailed to ProMed Billing Solutions where we post the payment to the patientís account. The EOBís are then reconciled to ensure that the payment received was correct. If the payment received is incorrect, we follow-up on the difference.
NOTE: Insurance companies frequently pay claims incorrectly, usually in their favor. Without the proper follow-up your practice could be losing a significant amount of money related to write-offs. Your staff may not have the time to follow-up on the short payments, however ProMed Billing Solutions makes it a priority.
We challenge every UCR discount or "procedure not covered" as to its legitimacy.
How many incorrectly paid EOB's do you have? Do you know how to evaluate if an EOB is paid correctly? Weíve seen everything from:
∑ Taking too much co-pay.
∑ Not paying for all the procedures
∑ Leaving out a code.
∑ Changing the code we filed.
∑ Stating the procedure is not covered when they paid for the same procedure on the last EOB.
∑ Stating the patient met their maximum, when they didn't.
These are just some of the reasons insurance companies pay incorrectly, which will result in lost profits.
One of our most important functions is reviewing the EOB and evaluating whether the claim was paid correctly.
DENIALS, APPEALS, and INSURANCE CONTACTS
Denials occur because of communication breakdown between an insurance company and the clientís office. Constant follow-up enables ProMed Billing Solutions to resolve problems related to denials.
A frequent explanation for denials is that care was "not medically necessary". ProMed Billing Solutions finds this explanation unacceptable. We immediately contact the insurance company and obtain information on why and who determined the procedure was denied. We then escalate the issue until we reach a satisfactory result.
We realize that establishing contacts (Analyst, Case Manager, Adjustor, etc.) in the review departments at most insurance companies is a successful way of determining where the communication breakdown occurred. Our contacts discuss the reason for denial with members of our staff, so we can determine the appropriate course of action that will lead to payment.
Our proven dispute management technique enables us to resolve denials quickly and effectively.
Last modified: 12/30/07