Medical Billing & Collection

S&S Healthcare Services, LLC performs the complete spectrum of billing and collection functions on behalf of our clients.  While the multitude of individual tasks performed each day are significant, we have outlined below a general description of the basic processes we utilize.

Data Coordination and Review

  • We will coordinate a standard schedule for receiving charges, along with a delivery method that is convenient for the Clinic.
  • We will review each super bill / charge ticket for missing or incomplete information prior to claims submission.

Charge Entry and Claims Submission

  • Charges will be entered into the billing system and internal billing edits will be reviewed for any issues needing to be addressed before submission.
  • Claims will be submitted electronically through a clearinghouse.  Control totals will be monitored to ensure all charges submitted are received by the clearinghouse for transmission to the respective payers.  We can also submit paper claims when necessary.
  • Internal edits/reports prepared by the clearinghouse will be reviewed to identify any denials or other issues requiring further work.
  • We will coordinate with the Facility immediately to obtain or correct any missing or incorrect information identified through the clearinghouse edits and resubmit the corrected claims accordingly.

Insurance Payment Posting

  • Insurance payments will be posted from the EOB’s received and payments will be balanced to the EOB totals.
  • Each patient account will be carefully reviewed during the payment posting process, and any denials received will be pursued immediately to determine the reason for denial, and whether corrected information is needed to reprocess the respective claim.  We will coordinate with the Facility regarding any updated patient insurance information required to resubmit the claims.
  • Once the primary insurance payments have been posted, we will submit secondary claims as applicable (paper claims will be submitted as needed).

Insurance Follow-up

  • Facilitating cash flow for our clients is a major priority for S&S Healthcare Services, LLC.  Consequently, we invest the time to diligently pursue outstanding insurance balances.
  • We believe insurance follow-up is an activity for which there is no substitute for persistence and perseverance.  Accordingly, we invest the time each week to contact the respective insurance payers until we have resolution for processing the outstanding claims.
  • If we identify any patterns for payers “sitting” on claims for specific services, we will immediately coordinate with the Clinic to modify the internal processes to accommodate the payers request when possible.
  • We also establish relationships with payer representatives since this can be an important part of an efficient revenue cycle, and can serve as an avenue for overcoming certain obstacles in the claims adjudication process.
  • If the situation warrants, we will also develop relationships with supplier representatives to gain any additional insight into specific issues that may impact the processing of claims for such supplies (i.e. infusion drugs, etc.)

Patient Statements

  • We will prepare and send patient statements on a monthly basis on behalf of the Facility for all patient responsibility balances remaining after insurance, self pay patient balances, etc.
  • We will coordinate with the Facility to develop messages on the statements that communicate in a professional way the patient’s responsibility for paying their outstanding balance.
  • We will also assist with transitioning the appropriate patient balances to a collection agency as desired by the practice, and will continue to evaluate the effectiveness of the respective collection agency’s efforts.

Patient Communication

  • As an extension of the medical practice our professionals routinely take patient calls regarding questions about statements and outstanding balances.
  • Communication is a cornerstone for success.  We understand the importance of communicating effectively with patients regarding their balances, and how the collection process can directly impact patient satisfaction with the Facility.
  • Our approach is based upon common sense, responsibility and fairness to both parties.  We will be objective and professional in communicating to the patient their outstanding obligations for services rendered, and the Organization’s expectation of being paid for such services rendered.  However, we are also mindful that in some instances financial hardship may prevent patients from paying their balances due in a timely manner.  We will coordinate payment plans with patients as necessary to accommodate their financial situations.
  • In the event a payment plan is required for the patient to meet their obligations, we will follow your internal policies regarding acceptable payment plan terms to ensure consistent and fair treatment for both the patient and the practice.  We will also make recommendations if we identify opportunities to improve the collection protocols.

Reporting

  • As an extension of the medical practice we believe accurate and timely data facilitates successful decision-making.  Accordingly, we provide our clients with summary reports each month outlining key performance indicators. 
  • We understand the value of meaningful data reporting to practice administration and the medical staff.  While our practice management system can produce a variety of reports, we treat each client individually and strive to understand which reports each of our clients finds most valuable.  In addition to the basic reporting that provides a “dashboard” view of the practice’s performance, we also analyze detailed information that can provide insight into more subtle factors driving operational performance.  For example,
    • Coding patterns by provider
    • Late charges by provider
    • Denial patterns
    • Payer mix
    • Referral patterns
    • Monitoring payments received versus contracted rates
  • As a value added benefit, our team will meet with Administration and the providers to review the reports, answer questions, and discuss opportunities to improve the Organization’s performance.  Depending upon the Clinic’s preference and location, we will go on site at regularly scheduled intervals or set-up a convenient time for a conference call to cover the reporting outcomes as a team.