Multispecialty Health Group Billing
Empowering Multispecialty Practices with Precision Billing
Multispecialty Health Group Billing
The healthcare landscape is constantly evolving, with multispecialty health groups playing a crucial role in providing comprehensive medical services under one roof. These groups bring together professionals from various specialties — such as primary care, cardiology, orthopedics, dermatology, and neurology — to offer integrated care. However, billing for multispecialty health groups is far more complex than handling claims for a single-specialty practice. This is because each specialty has its own set of rules, procedures, and coding requirements. Many multispecialty practices struggle with these challenges and risk delayed payments, compliance breaches, high denial rates, and revenue loss. This makes it essential to have a robust billing strategy in place.
A professional medical billing company like us offers the expertise, technology, and compliance oversight needed to streamline revenue cycle management. By outsourcing revenue cycle processes to us, multispecialty practices can enhance efficiency, improve cash flow, and focus on delivering high-quality patient care — without getting bogged down by administrative burdens.
Unbeatable Service, Quality & Price
ACCURACY
0
%
TURNAROUND TIME
<
0
Hours
COLLECTION
0
%
PRICE
Starting from $
1100
/Month
CHALLENGES
Challenges in Multispecialty Health Group Billing
Managing Multiple Specialties Under One Billing System: Each specialty has its own billing rules, payer policies, and documentation needs. A generalist billing approach often leads to:
- Coding errors due to failure to apply specialty-specific guidelines.
- Higher denial rates for misfiled claims.
- Revenue loss from undercoding or overcoding.
Compliance and Regulatory Risks: Multispecialty practices must comply with various regulations, including:
- HIPAA (Health Insurance Portability and Accountability Act): Ensuring patient data privacy.
- Medicare Compliance: Following strict rules on billing, coding, and documentation to avoid audits.
- Anti-Kickback Laws: Practices must ensure billing integrity to avoid compliance violations.
Revenue Cycle Fragmentation: Multispecialty groups often struggle with disjointed revenue cycle processes due to:
- Multiple Electronic Health Record (EHR) systems for different specialties.
- Inconsistent charge captures across departments.
- Lack of centralized billing oversight, leading to revenue leakage.
OUR PROCESS
Our Multispecialty Health Group Billing Process Workflow
At RCM Workshop, the multispecialty health group billing process begins with patient registration, where we collect and verify patient information and insurance details. Following this, healthcare providers order specific tests, which are entered into the laboratory information system (LIS). Samples are then collected and tested in the laboratory. In the next step, we assign appropriate diagnostic (ICD) and procedural (CPT) codes to the tests performed. We use these codes to submit claims to the patient’s insurance company. The insurance company reviews the claim, determines coverage, and processes the payment. Then it is posted to the patient’s account.
If any claims are denied, the denial management process kicks in, where we correct errors and resubmit the edited claims. After insurance payments are posted, we bill any remaining balance to the patient. The final step involves collections, where we conduct follow-ups on unpaid patient balances, and manage collections if necessary. This workflow ensures accurate and timely reimbursement for multispecialty health groups while maintaining compliance with regulations.
Scheduling & Registration
Carry out well-coordinated appointment scheduling, update insurance details, and handle inbound and outbound calls from/to patients.
Eligibility & Benefits Verification
Confirm primary and secondary insurance and benefits coverage of patients and verify their coverage, co-pays, co-insurance, and deductibles.
Prior Authorization
Initiate request for prior authorization with the payer, follow up to check its status till closure and finally update the system with Auth approval reference number.
Medical Coding
Check the accuracy of codes and modifiers according to specialty and assign corresponding and appropriate charges to the codes.
Charge Posting
Enter the charges for the services provided into the billing system including the cost of the medication and the administration fee.
Claims Edits & Submission
Audit the claims thoroughly to check for accuracy and edit if necessary and submit claims – both EDI and paper format.
Payment Posting
Carry out both auto as well as manual posting for payments received and conduct reconciliation against claims.
Denial Management
Analyze and categorize denial claim according to denial codes, $ amount and payers, and resubmit claims after correction.
AR Management
Follow-up with payers to gather status for unpaid claims, and their resolution.
Patient Collection
Sending patient statements and follow-up with patients for final and outstanding payment.
You can confidently rely on us to manage your entire billing process, or you have the flexibility to select specific DME billing services that suit your needs, ensuring a seamless operation without any interruptions.
BENEFITS
Outcomes Guaranteed
At RCM Workshop, we serve as an intermediary between payers and providers, maintaining transparency throughout our billing processes. By leveraging an analytics-driven approach and adhering to strict quality standards, we significantly enhance the financial outcomes of multispecialty health group billing operations.
WHY US?
Why partner with us
By partnering with RCM Workshop, your multispecialty health group can streamline its complex billing process, ensuring accuracy and efficiency. We have specialized expertise in handling various insurance claims, coding, and compliance with regulations, which reduces the risk of errors and denials. This partnership will allow you to focus on patient care rather than administrative tasks, leading to improved patient satisfaction and financial performance. Additionally, we can provide valuable insights and analytics to help optimize revenue cycles and identify areas for improvement, ultimately enhancing the overall operational efficiency of your health group.