Medical billing can be confusing, at best. Thankfully, IHMS has a comprehensive understanding of the complexities involved in billing government payers, and we are able to leverage this knowledge to benefit hospital managers in a variety of ways, including claims resolution for Medicare, Medicaid and Veterans Administration.
Our simple but effective approach on resolving such claims involves reviewing our hospital partner’s notes and account history, documenting key steps, verifying eligibility, checking the status of previously submitted claims and requests for medical records, and resubmitting claims, when appropriate.
At times, hospital payments are delayed or rejected altogether because of coding issues. As part of our accounts receivable management services, IHMS explains coding and procedural issues to hospitals, checks reimbursement rates to ensure that its partners are being paid correctly, and bills specific inpatient services to Part B after Part A benefits have been depleted. We also file appeals on inappropriately denied claims and we work with Medicare to resolve Common Working File and Medicare Secondary Payer issues.
Medicaid managed care represents another level of difficulty in that the payer has designed a system with automatic delays in processing claims. IHMS makes every effort to resolve problems with these plans, including reviewing claims issues, providing documentation to the payer of the internal problems that need to be resolved and teaming up with its hospital partners to resolve payment difficulties.