Compliance Billing Specialist, LLC (CBS) is your “Personal Tailor” for Medical Billing. CBS creates an efficient, professional, and compliant office in all areas of Practice Management, Accounts Receivable Management, Collections, Training and Education.
Allow CBS to be your administrative partner, so all your hard work translates into “Big Cash” by minimizing delinquent receivables and bad debt. CBS offers services tailored to each client’s needs. By working together as a team, CBS will create the perfect medical office for its customers and allow physicians to be physicians.
CBS was built on compliance, integrity, and a commitment to excellence as priority number one when servicing all its clients. Never settling for second-rate answers, CBS is always one step ahead of today’s regulation changes for medical billing practices.
All staff at CBS is certified medical billers and collectors, each with their own distinct specialties in physician, hospital, DME, and all other outpatient services. Our staff is required to obtain on-going education to assist in the knowledge they offer to our clients and to train and educate for future billing needs.
Our unique service is like no other billing and medical management group. You will find, by choosing CBS, that you have an advocate to improve and grow your business to its highest potential. CBS is always there to assist in the accuracy of procedural and diagnosis coding as well as verifying compliance issues regarding medical documentation.
CBS has a successful history of creating policies and procedures specific to each client’s needs and developing an environment that will produce a productive office workflow as well as efficient and timely billing and collection processes, which produce high revenue and low overhead cost.
If you are truly looking for an outsource agency that possesses the insight of today’s medical billing and practice management look no further than Compliance Billing Specialist, LLC as the number one choice.
Patient Accounts ($5,000.00 and under):
CBS has the ability to service hospitals by providing billing, collections, and management of all Outpatient accounts $5,000.00 and under. CBS will work closely with Hospital Management in identifying billing, coding, and demographical errors that can cause large delays and in some cases denials for hostpials. CBS will provide the extra research and detective work collecting accurate and updated insurance addresses, contact the ordering physician for confirmation on ICD-9 codes presented on requisitions that do not support technical procedures completed by the hostpials. CBS will also identify duplication of payments and/or technical procedures that create an inaccurate A.R.
Most Outpatient Services fall within the range of $5,000.00 and under. The following departments are:
Many Physical, Occupational, and Speech Therapies are also not covered due to LCD (Local Coverage Determinations) or LMRPs (Local Medical Review Policies). This is because of Non-Supporting Diagnosis Codes presented by the patient’s ordering physician. CBS reviews these claims to assure each facility and/or physician that their reimbursement is at the highest level.
X-Ray and Radiology Services:
Radiology Services are very low dollar items unless certain invasive procedures are performed. It is very important, in this area, to make sure all proper CPT codes and Diagnosis Codes are used to justify the medical need of each and every procedure. Focusing again on the area of the Diagnosis Code supporting the procedure in order for reimbursement to be made is a focus of CBS.
In each of these areas, CBS is proud to offer Hospitals the most experienced billers, providing a 150% effort to Bill and Collect each and every procedure performed by any Hospital Facility.
In the Lab Services area, CBS has been successful in identifying whether certain panels or procedures have been bundled or unbundled. Other areas are non-covered services due to non-supporting diagnosis codes presented on requisitions by the patient’s ordering physician and ABNs (Advanced Beneficiary Notices) not being presented to the patient on true non-covered or coverage questionable procedures.
CBS identifies the following for all Out Patient Lab Services performed to ensure the technical component is reimbursed as well as the professional.
- Correct Patient information such as Name, Address, Social Security Number, Insurance I.D. number, and Date of Birth
- Whether the ICD-9 code requires a 5th digit (If so, was it provided?)
- Verification of the patient's Medical Insurance such as a start date and termination date with the carrier.
- Inaccurate CPT codes that may have been expired or terminated all together
- Verification of whether the services require an Advance Beneficiary Notice (ABN) or not
- Whether Local Coverage Determinations or LMRP policies are applicable to the procedures performed based on the diagnosis’ codes provided on the Lab Requisition
It has been CBS' experience that, in Out-Patient Lab Billing, many of these items are missed due to the high volume almost every Out-Patient Lab experiences.
Just because an ABN was not signed at the time of services does not mean that the procedure is a total loss. Looking at the ICD-9 code and sending a formal request to review the patient chart and see if any additional diagnosis codes could justify the procedure is highly successful and legal. Many physicians do not take the time to make sure that they are writing the diagnosis that supports their requested Lab procedure. Usually they use the main Diagnosis code for the main compliant the patient came in for.
Accounts Receivable & Medical Billing
The most prevalent problems in the home health industry are to understand accounts receivable and billing issues surrounding the Medicare Prospective Payment System (PPS). Once into the new payment system, many agencies realize that there are problems with collecting receivables than were anticipated. CBS has assembled a team of accounts receivable and billing professionals to assist you with all those needs.
- Accounts Receivable Evaluation
- Off-Site Billing & Collection Efforts
- Billing Department Training
Detailed Services Include:
Verification of Eligibility
Oasis Audit and Validation of Billing Requirements
Tracking of RAP Payments and Retractions
Claim Submission and Tracking
Payment Accuracy Verification for All Payors
Procedure Process Tracking and Recommendations
Follow-up on Unpaid Accounts
Claim Rejection Resolution
Form 485 Verification of Availability
Denial Tracking with Appeal Processing
PEP Tracking and Verification
Information Systems Support
Monthly Status of All Accounts