Medical Billing
Services
Organized Billing. More Time for Patient Care.
Managing claim preparation, insurance verification, filing, payment posting and follow-up on underpaid or rejected claims are all part of medical billing. Outstanding accounts and administrative backlogs can add to the workload for healthcare providers when these duties become challenging to handle.
For healthcare firms looking to streamline their billing processes, Next Edge Surgical LLC offers medical billing help. Our services can be tailored to your practice’s needs, assisting your staff in keeping an eye on claim activity and identifying accounts that require attention.
Denial Review Workflow • ✓ Organized Claim Workflows • ✓ Clear Billing Reports
Medical Billing
Services
Organized Billing. More Time for Patient Care.
Managing claim preparation, insurance verification, filing, payment posting and follow-up on underpaid or rejected claims are all part of medical billing. Outstanding accounts and administrative backlogs can add to the workload for healthcare providers when these duties become challenging to handle.
For healthcare firms looking to streamline their billing processes, Next Edge Surgical LLC offers medical billing help. Our services can be tailored to your practice’s needs, assisting your staff in keeping an eye on claim activity and identifying accounts that require attention.Â
Denial Review Workflow • ✓ Organized Claim Workflows • ✓ Clear Billing Reports
RELIABLE & EFFICIENT
Complete Medical Billing Solutions
Medical billing is essentially a link between the care that is provided by a healthcare provider and claims and payments that are made afterwards. The chain is in sequence. The claim is sent to the payer, and the payer responds with a payment or denial, which then posts the payment to the practice’s records. When a break occurs at any link, money doesn’t get resolved. Common causes are missing details, eligibility gaps, etc. and other wrong codes and late follow-up.Â
These steps are managed throughout the revenue cycle. The scope will vary with what your team wants to pass off and your current process.
- Medical Billing & Coding: Charge review, code review and claim preparation
- Claim Submission & Follow-Up: Filing and status checks with payers (electronic)
- Denial Management: Examining denial reasons, correcting claims, resubmitting or appealing claims
- Pre-Visit Insurance Verification: Verifying coverage and benefits before the visit
- Patient Statements & Collections: Statements and follow-up of patient balances
- Detailed Reporting & Analytics: Summaries of claims, payments, denials and open balances.
Medical Billing & Coding
Check Procedure codes (CPT, HCPCS) and diagnosis codes (ICD-10-CM) with documentation before the claim is submitted.
Revenue Cycle Management
Revenue Cycle Management is the entire journey of a patient registering at a clinic till the final payment is made. It is supported throughout the eligibility process, payment posting and receivables follow-up.
Credentialing & Enrollment
Support with provider credentialing and provider enrollment documentation (if stated in contract).
Continuous Support
Continual checking of claim activity and open accounts and contact for billing questions.
WHY CHOOSE US
Why Practices Choose Our Billing Support
A good billing partner makes clear what he or she does and provides you with a breakdown of all the claims. Our team has experience in the medical & healthcare billing industry. Clear communication, consistent follow-up, and reports that your staff can read without a glossary—we do three things.
In-house billing creates a need for coordination of staff, documentation, payer rules and follow-up. Delegating specific tasks can help relieve the strain, particularly if you’re looking for more administrative assistance.
- It is advisable to review claims for submission
- Follow up on denied and rejected claims
- The tracking of accounts receivable by age and status
- News about claims, payments and denials
- Services that are designed for the workflow that you are using
- A record of how to address the job
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Complete Patient Information
Claims must include full patient information, proper codes and matching documentation. A structured review identifies gaps ahead of the payer.
Timely Follow-Up
Payers determine their filing and appeal deadlines. All unpaid claims are reviewed regularly to prevent them from "aging out."
Revenue Visibility
Any revenue balances are tracked by age and status. Your staff gets to see which accounts to take action on first.
Dedicated Assistance
Our work is divided with the agreement. You are aware of the things that we deal with and what we need from your office.
SPECIALTIES
Specialized Billing for Multiple Medical Specialties
The type of care, the services reported and the payer affect billing needs. A dental claim is not a surgical claim. A lab claim is not an imaging claim. We do not use a template because we develop the workflow around your specialty.
Primary Care
Evaluation and management (E/M) visits, preventive services, eligibility checks and follow-up on open claims.
Surgical Practices
Procedure coding review, documentation review, claim tracking and denial follow-up for surgical cases.
Dental Practices
Dental claims will be submitted on a dental claim form, not one of the medical claim forms. We manage insurance claims, payment tracking and patient balance follow-up.
Orthopedics
Insurance and billing of office visits and musculoskeletal procedures, including documentation.
Cardiology
Claim tracking and denial review for office visits and diagnostic tests/procedures.
And More
Tell us your specialty. We will discuss the way that we would manage its billing.
OUR PROCESS
A Simple and Transparent Billing Process
There are 6 steps to our medical billing process. These are all clearly owned, so you know where any claim is at all times. We agree with each client on the details according to the services provided and according to the procedures in place at the practice.
1. Review Billing Requirements
We learn your specialty, payer mix, current workflow and pain points. This sets the scope and the tasks we take on.
2. Verify Information & Prepare Claims
We double-check patient, insurance and service details. If they are included in your scope, eligibility and coding review will apply.
3. Submit & Track Claims
Claims are submitted directly to the payers, typically via a clearinghouse. Claims are monitored according to the agreed workflow, and items requiring additional information or follow-up are identified for review.
4. Review Payments & Denials
We read the remittance advice from the payer and post payments. Underpaid or denied claims are re-evaluated. Next, it will depend on the reason code provided by the payer.
5. Report on Billing Activity
Claim status, payments, denial patterns and open balances. Periodic review brings repeat issues to light to be addressed at source.
6. Following enrollment
A contact person is assigned to handle queries. Both parties agree on the information that is sent to us and when we will report back to you.
DETAILED REPORTING
Stay Informed with Clear Billing Reports
Billing reports show which claims are paid, which are pending and which need action. Total payments alone hide that. A practice also needs to know where denials happen and which accounts are getting older.
- Accounts Receivable Reports: Open balances by age (older balances are attended to first)
- Periods Reported Payments: Payments made by period, with items to be reconciled
- Denial Analysis: Repeat denial reasons by payer, code or service, which refer to workflow fixes
- Customized Reports Based on Your Needs: Claim status and workflow trends in a format your team can use
Note line: The type, frequency, and detail of the report are confirmed at service planning.
Physician Billing Services
Physician billing simply refers to the doctor claiming patient visits. Practices manage appointments, documentation, charges, and patient balances concurrently. If one piece slips, charges are not met and subsequent runs are delayed.
We offer physician practice revenue cycle management services, such as overdue account recovery, backlog resolution, missed charges, appointment tracking, fee schedule and claims monitoring. We also perform E/M coding review with visit documentation. All visits are billed and all claims are tracked until they are resolved.
Laboratory Billing Services
Laboratory billing applies to claims for tests, not visits. There are different codes for each test and different rules for each test type. Older receivables and repeat payment issues may require additional reviews.
We assist with aging of accounts, credentialing, coding issues, insurance verification and patient billing. The workflow is in line with the services offered by the laboratory and the needs associated with the claims.
Specialized Laboratory Billing Domains
Pathology • Toxicology • Molecular • Clinical
Pathology
Claim preparation, coding review and follow-up for pathology services.
Toxicology
Coding review and denial follow-up for toxicology testing—Policies may differ between payers.
Molecular
Billing support for molecular tests, which have varying coverage and documentation requirements.
Clinical
Claim submission, payment posting and follow-up for routine clinical laboratory services.
Imaging Center Billing Services
Imaging billing often splits one scan into two parts. The professional component covers the radiologist’s interpretation. The technical component covers the equipment, staff and facility. Modifiers on the claim show which part is being billed. Wrong or missing modifiers delay payment.
We provide billing and coding support for radiology, diagnostic imaging and mobile imaging services. That includes professional and technical components, modifiers, and claim submission and denial follow-up. We confirm the specifics against your services during planning.
Dental Billing Services
There are rules for dental billing. The workflow is different from medical claims as they are based on a dental CDT code and dental plans. When the front office takes on the entire day, insurance claims, patient balances and payments add up quickly.
We offer support to independent and multi-location dental practices with dental insurance verification, claim management, payment posting and follow-up. Â
FREQUENTLY ASKED QUESTIONS
Medical Billing FAQs
The medical billing services process and submit claims, monitor payer responses, post payments and follow up on unpaid claims. Many providers also include eligibility checks, coding reviews, denial management and reporting. The extent of the involvement will vary depending on the agreement.
They can include eligibility verification, charge entry, claim submission, payment posting, denial follow-up, patient billing and accounts receivable management. The final list of tasks is determined by your needs and by your agreement.
It begins with an analysis of your requirements and processes. Then both sides agree upon accountability, what information will be sent, how claims will be dealt with, how follow-up works, and which reports are provided.
First, we will examine the denial reason and the details of the claim. Possible next steps involve fixing information, documentation, resubmission, or appeal (if applicable). Timing is important, as payers have their own deadlines.
Medical coding translates a diagnosis and services into a standard code (ICD-10-CM and CPT). Those codes are used in medical billing to assemble claims, submit them to payers and then receive payments. The two steps go hand in hand.
Yes. Billing of laboratory and imaging services is included in our service list. The rules vary by test and procedure/payer, so we verify the scope with you before we begin.
The fees vary according to the volume of claims, specialty, the range of services and the work that is delegated. Let our group know what you need and we will provide you with our price for your practice.
Reach out to our team and share with us your practice, your specialty and your current billing process. We will discuss your requirements and pinpoint which services fit.
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