Our proven methodology

edgeMED’s remittance processing experts process more than just payments. We analyze payment trends, denial reasons, the quality of your clinical documentation and coding processes, and effectiveness of your front-end patient collections.

We promptly process many types of payments with efficiency:

• Electronic Remittance Advice (ERA)
  Before the advent of Electronic Remittance Advice (ERAs), medical billing departments had the arduous task of scrutinizing every individual line item on a standard paper remittance advice (SPR) and then painstakingly inputting this information into the medical billing or accounts receivable software. As you might imagine, or perhaps have personally encountered, this process is laborious and time-intensive.

  ERAs have been introduced to mitigate such challenges by streamlining the process, minimizing errors, and drastically reducing the time expended on manual data entry. Nevertheless, the advantages of ERAs extend beyond these efficiencies. When you engage with edgeMED, we take automation to the next level by automatically allocating each line item found within an ERA. This signifies that, upon a comprehensive review of the ERA, we can rapidly and systematically post payments in batches, significantly enhancing the speed and efficiency of this critical financial operation.

• Manual payment posting
  We examine payment data extracted from scanned images of Explanation of Benefit (EOB) documents, and for each line item, we accurately record and allocate it to the corresponding patient accounts. In cases where certain insurance providers do not utilize Electronic Remittance Advice (ERA), we have an efficient payment allocation system that works seamlessly with ERA uploads. Once we retrieve the ERA message from the payer's platform (typically referred to as an 835 message, which is essentially a HIPAA-compliant ERA file), we effortlessly upload this file into our practice management system, ensuring the comprehensive allocation of payments.

• Denial posting
  Our team is well-versed in ANSI denial codes, in addition to the specific remark codes employed by various payers. We handle denials by executing a range of actions, which encompass submitting bills to secondary payers, transferring outstanding balances to the patient accounts, implementing adjustments and write-offs in accordance with established policies, and routing denied claims to the relevant work queues.

• Posting patient payments
  We possesses a wealth of expertise when it comes to handling payments received from patients through various channels, which include in-office cash transactions, check payments, and credit card transactions facilitated via the patient portal. Our dedicated payment processing team diligently manages the reconciliation of patient payments, assesses the necessity of transferring outstanding balances to secondary insurance providers, and effectively addresses any credit balances. Additionally, we maintain integration with collection agencies to handle patient balances that may necessitate escalated attention, contingent on your assessment and preferences.

We’re the experts you can count on

• Employ policies for write-off and adjustments
  Collaborating closely with each client, we create and implement well-defined policies for write-offs and adjustments. These policies serve as a crucial framework for decision-making when dealing with complex financial scenarios. By establishing a clear and agreed-upon set of rules, we ensure consistency and transparency in financial operations. These policies come into play during payment transactions, especially when encountering unusual contractual adjustments. We scrutinize each transaction, compare it against the established policies, and report any deviations. This meticulous approach guarantees that financial discrepancies are promptly identified, addressed, and resolved to maintain financial stability.

• Managing denials
  Denied claims can pose significant challenges to healthcare providers, both in terms of revenue and workflow disruption. At edgeMED, we've developed a systematic process to address this issue. Denied claims are swiftly routed to our dedicated coding and denial management team, consisting of experts well-versed in the nuances of healthcare claims processing. We meticulously review the denials, identify the root causes, and take the necessary corrective actions for resubmission to payers. This expedited approach ensures that denied claims are not left in limbo but are actively and effectively managed, ultimately resulting in a higher rate of claim acceptance and faster reimbursement.

• File claims with secondary payers
  In healthcare billing, it's not uncommon to have secondary payers involved, especially in cases of coordinated insurance coverage. Our comprehensive approach involves identifying claims that necessitate submission to secondary payers. We carefully process these claims, ensuring that any remaining balances are accurately recorded and billed to the secondary payer. This meticulous handling of secondary claims streamlines the revenue cycle and maximizes the reimbursement received, leaving no financial stone unturned.

• Dashboards
  Modern healthcare operations rely heavily on data and insights to make informed decisions. Our dynamic tools provide instant access to key health indicators, offering a real-time, comprehensive view of your financial performance. These intuitive dashboards enable us to monitor operations with ease and act as a catalyst for continuous improvement by presenting valuable insights and trends that can inform strategic decisions, enhance financial efficiency, and drive performance optimization across your organization.

All these elements are integral to our approach to healthcare revenue management, ensuring not only financial stability but also operational efficiency and strategic decision-making for your medical practice.