Services

 Initial Claim Filing

 CPT & ICD-9 Coding (Procedure and Diagnosis Codes)

 Develop Reasonable and Customary (R&C) Charges

 Routine follow up on outstanding claims

 Appeal both denials and claims reimbursed below R&C levels

 Patient Statements and delinquent account collections

 Consulting Services to grow your business

 Internet access to account information 24/7

Initial Claim Filing

We have a toll free fax line that our clients can use to expedite patient demographics (usually the hospital face sheet) to begin the claim process.  Data will be entered into our business program and the claim will be submitted electronically whenever the insurance company can accommodate this filing method, otherwise a paper claim is generated.

CPT & ICD-9 Coding

We have two levels of service available to our clients (chosen at the time of enrollment).  The client can decide to obtain codes from the surgeon’s office prior to submitting claim information to our office or elect to have our office obtain these codes on behalf of the client.  We first attempt to obtain this information form the surgeon’s office for continuity of claims information but if we are unable to obtain this information within a reasonable time, we will determine proper codes based on the operative report.

Reasonable and Customary Charges

It is our belief and recommendation that the assistant fees should reflect reasonable and customary charges for the procedure and area in which the services were rendered.  Too often providers submit charges that reflect negotiated fees with participating provider networks thereby negatively impacting the establishment of future R&C levels.

Routine Claim Follow Up

Unfortunately, not all claims submitted are paid on a timely basis.  Sometimes claims get “lost” in the insurance company system.  Without routine follow up these claims (and your revenue) can be lost forever.  Claims are also “pended” while waiting for additional information.  Regular follow up on open claims greatly improves your receivables and cash flow.

Appeal of claims denied or paid below R&C

We have found that many payers are unfamiliar with the independent surgical assistant as an eligible provider and therefore claims can and do get denied.  We are very proud of our record of recovery with commercial insurers.  Many insurance companies reverse their decision based on information provided them by HMS.  With the increasingly tough economy insurance companies are getting more aggressive in reducing reimbursement levels to both participating and non-participating providers alike.  We work hard to obtain maximum reimbursement and routinely appeal any claim that we believe has fallen short of reasonable compensation for our clients.

Patient Statements & Collections

Although we strongly discourage providers from billing patients for charges disallowed by an insurance company that does not mean legitimate coinsurance amounts should not be billed to the patient.  This is the part of a claim that is expected to be bourn by the patient and is built into their insurance contract.  We send out patient statement the first of each month and if payment is not made in a reasonable period of time (usually two months) we would advise our client of the status along with a recommendation to either turn over to collection or close out the account.

Practice Management and Consulting

We understand that many of our clients are extremely skilled in the Operating Room but may feel at a loss when it comes to the business side of their practice.  Being an independent practitioner means you have to market and manage your business outside of the OR.  HMS has extensive knowledge in business practices and development and is always available to discuss ways to expand your practice.

Account Access 24/7

The business software that HMS uses in its claim operation is web based.  What that means to our clients is access to patient information 24 hours a day, seven days a week.  All clients are instructed on how to download the basic program onto their computer then assigned a user name and password.  After that you will be able to check the status of each case.  But that’s not all, you will also have the ability to maintain your surgical schedule, tract income, do year end planning – the possibilities are nearly endless.