Revenue Optimization

MTServices's Revenue Optimization Team Safeguards to Intact the Supreme Stage of Success

Retained & Expended Revenue Optimization

The Revenue Optimization team at MTServices is dedicated to achieving excellence and maintaining elevated revenue levels. We prioritize maximizing employer satisfaction by meticulously reviewing modern procedures from multiple perspectives, identifying various avenues for revenue enhancement.

Our team conducts a comprehensive evaluation of the entire revenue process, aligning it with state regulations. Through a detailed analysis of demographic entry, medical record decoding, claim submission, payment posting, and denial management, we establish a robust partnership with the client's staff. Subsequently, a strategic plan is devised for implementation in both front and back offices. Successful execution of this plan results in a bolstered cash flow, ultimately optimizing revenue.

Why MTServices Optimization Program

MTServices presents its Revenue Optimization Program in contrast to the indications outlined below.

SUBOPTIMAL ACCOUNTABILITY

Robust Checks and Balances are essential for ensuring transparency and smooth operations in the practice.

ELEVATED DENIAL RATE

A denial rate exceeding 10% is a clear indicator of suboptimal performance in medical billing.

DISCREPANCY BETWEEN PAID AND CHARGED AMOUNTS

Significant disparities between invoiced and received amounts can adversely impact the reputation of the billing agency.

DELAYED SUBMISSION

Given the distinct Timely Filing Limits set by each insurance company, adherence to these limits is crucial to prevent denials resulting from delayed submissions.

CASHFLOW VOLATILITY

Sustained cash flow is essential for the successful operation of the practice. Ensuring technically proficient medical billing is imperative to maintain a seamless cash flow.

DELAYED PAYMENT POSTING

Delays in payment posting not only negatively affect the transparent reporting of practice outcomes but also pose challenges in identifying potential future denials.

INORDINATE MEDICAL DOCUMENTATION

Persistent requests from payers for supporting medical records to validate provided treatments suggest an incomplete submission process on the part of the submitting party.

LAGGED CLAIM FOLLOW-UP

Consistent occurrences of similar denials indicate ineffective follow-up procedures, potentially resulting in oversight.

Fundamentals of Optimized Revenue

MTServices has its strategies to upkeep the revenue at an optimal level. Brief Summary is here!

1. Pre-Submission Claim Review Process

The MTServices claim production team adheres to Standard Operating Procedures (SOPs) to meticulously examine claims for errors prior to submission. This thorough review encompasses various aspects, including demographic entry, pre-authorization, eligibility and benefits verification, and coding edits.

2. Precise Claims Submission Process

Upon successfully clearing the initial examination phase, the MTServices team meticulously selects the appropriate billing form (CMS-1500 / UB 04) for formatting. Claims are seamlessly submitted in Electronic Data Interchange (EDI) format. In instances where electronic submission is not feasible due to payer restrictions, certain claims are diligently submitted in paper format.

3. Claims Monitoring Process

Following the seamless transmission of claims, MTServices implements a systematic approach to track each claim at various stages. Our meticulous process ensures the availability of a primary receipt from the designated payer. We vigilantly monitor the claim's progress until payment is received. To enhance efficiency, an intelligent mechanism identifies and redirects denied claims to the Accounts Receivable (AR) Follow-up team. The AR team is entrusted with the responsibility of optimizing payments from the payer.

4. Accounts Receivable and Denial Management

Payments are meticulously recorded in the respective patient accounts. Unsettled and undercompensated claims undergo a thorough evaluation by our technical denial management team. This dedicated team rectifies and addresses issues associated with denied claims, resubmitting them for reprocessing. The Accounts Receivable (AR) team engages in discussions with insurance companies regarding undercompensated claims, initiating the submission of reconsiderations and appeals when necessary.

5. Preparatory Analysis

Within MTServices, our team of analysts plays a crucial role by providing valuable feedback on various facets within the Revenue Cycle. This feedback serves to identify weaknesses or areas that require improvement in the revenue cycle. Analysts diligently monitor each stage of the cycle, generating comprehensive reports that offer precise insights into the organization's performance.