Billing & Collections Services
Payment Application
This is the process of accounting from the perspective of insurance RCM. This includes applying payed amounts, observing allowed amounts, calculating deductibles, coinsurances, copays and out of pocket maximums. We will appeal payments that fall below acceptable minimums and address issues relating to this stage of RCM. Amounts that patients will owe are calculated here as well. This is the point where we are able to derive a large volume of payment trend data and ultimately aid in directing your marketing focus and assist in making admissions decisions.
Claims Submission
This is the process of using well developed knowledge and experience coupled with powerful software that allows ZMed Care to send a perfect claim every time. It is the culmination of proper verification of benefits, proper utilization review and appropriate coding. Often times this initial claim submission makes the difference between prompt payment and cyclical denial and reprocessing scenarios. ZMed Care makes sure that this is done correctly saving us time, and you money.
Filing Appeals
Appealing denials is the process of disputing what’s known as a “hard denial” (simply denied). Medical records are sent, benefits verifications, doctors orders and appeals letters are sent in an effort to establish the necessary environment for supporting claim payment. Denials all differ and require certain documents and wording to have them overturned in an appeal. Nobody likes to hear the word “No” or synonymously “Denied” and that includes ZMed Care. We make every effort to get every claim paid, and pursue insurers to the enth degree.
Paid To Member Collections
Insurers are notorious for making the lives of Out-of-network providers difficult.
Claim Follow-Up
All HIM Services provided by best experienced Employee.