Billing and Collections
Working in the healthcare industry can be very challenging. With a growing population, not only do we have to deal with the shortage of providers, turnover of staff, constantly changing regulations, technology and payer demands, but also need to provide access to care with fewer resource.
MMHCS Revenue Cycle services focus on optimizing processes and clinic/practice growth. To do that one must start at the source of financial gain in the medical office; claims.
MMHCS will work with your organization to ensure accurate eligibility, verification, billing and posting have taken place. MMHCS will also assist with re-billing for denials to ensure your organization is receiving the maximum reimbursements for the services rendered. Let MMHCS flawlessly realign your business needs to optimize a successful revenue cycle for your organization!
- Assessments/Audits – Providing comprehensive assessments of partial to complete revenue cycle workflow from the front desk to denial management for your Quality improvement needs.
- E.H.R. Implementation – Custom training manuals, on-site training, interim support services, policy review for state and HRSA requirements, and on-site support for your workflow or system changes and transitions.
- Full-Cycle Billing – We optimize claim processing to increase revenue. This includes all steps from accepting and submitting charges to payment posting, denial management, and month end closing.
- Reporting – Our reporting provides complete transparency of revenue status and changes.
To meet today’s challenging world of healthcare, it is crucial to understand the various regulatory requirements affecting practices and having the most modern standards in place. MMHCS can provide you with guidance and solutions you can count on.
These services include:
- HRSA SAC Application Preparation
- HRSA BPR Annual Budget Period Renewal
- Changes in Scope of Services
- HRSA Site Visit Preparation
- HRSA Annual Federal Financial Report
- HRSA Prior Approvals- Carryover requests
- New Site Licensure
- Prospective Payment System (PPS) rate setting, planning and annual reconciliation.
- Assisting in the preparation of Government required reports such as
- UDS Report preparation on Financial Tables
- OSHPD Reporting by Site
- Annual Medi-cal and Medicare cost reporting
- Financial/DHCS Audit Preparation
- System for Award Management (SAM) Registration
- Preparation of Supplemental of other grants
- Annual budget
Billing and Coding Audits
MMHCS provides both Billing and Coding Audits based on your practice’s needs.
During our Billing Audits we review the entire life cycle of the claim in the billing system based on the appropriate rules and regulations. The analysis will determine all levels of audit eligibility, charges captured, provider, location, submission, and adjudication of the claim. All types of visits will be captured including billable, non-billable, and additional enabling services that are being tracked in the billing system.
The billing Audit can be geared to focus on a specific time range as well as other criteria such as insurance based on the needs of the clinic.
We also offer Billing analysis options for Aging, Payment Posting and Denials, and more.
The Coding audit can also vary by subject and scope of work. Typically, one if not all of the following three areas are included in the Coding Audit Scope.
- Evaluation and Management Coding Audit
- CPT and HCPCS Audit
- ICD-10 Diagnostic Coding Audit
We assess the provider’s chart documentation to prove medical necessity and how this supports the level of services rendered and their linkage to the diagnosis.
Based on the audit findings we offer additional services to help your clinic with the identified gaps and areas of improvement. These services can include items such as implantation and Project Management to Provider and Staff Training.
Documentation and Coding
MMHCS’s coding for services is done by utilizing our highly trained certified coders. During this service, we would optimize the client’s revenue while reducing compliance risk, increase cash flow by reducing lag days, and improve claims submission.