At Apex MedPro, we follow the claims till the end i.e. we make sure you are paid. From demographics to payments we take care of it all, irrespective of electronic or paper billing; even worker’s compensation is our burden to pick.

Our priority is to handle claims electronically.

Primary Claims Submission: Prescribed industry rules are followed to determine the primary insurance. Our 6 step process ensures that only clean claim is send to the payer. Once the primary pays its portion of the claim, it is then billed to the secondary insurance if the patient has it; in case of Medicare it requires electronic submission for secondary claims. If a secondary claim is submitted on paper the claim is printed onto a CMS form 1500 and a copy of the explanation of benefits (EOB) is attached.

If the patient has third insurance, tertiary payer claims are submitted if there is a balance left on a CMS form with both EOBs of primary and secondary payers.

Providing real-time eligibility verification requires fast-paced teamwork. We at Apex MedPro provide upfront eligibility confirmation by giving you eligibility and benefit details of your patient even before he/she visits the office. Without an extra charge we make your workflow faster than ever.

Prior Authorization (PA) approval is a process used by some health insurance companies to determine if they will cover a prescribed procedure, service, or medication. The process is intended to act as a safety and cost saving measure.

Realizing its importance and impact on revenues, APEXMedPro has a separate desk to handle all your authorization verification and where required we will get authorization approvals for you.

Sometimes even clean claims are denied for a variety of reasons. We at Apex MedPro review all submitted claims starting from the batch files and follow them up with insurance representatives. Our customer services department works in close collaboration with the billing department and insurances alike to get the money in your bank account.

Doing aging analysis we take care of claims by dividing them into 0-30, 31-60, 61-90, 91-120 and 120+ aging buckets; we ensure that nothing is missed.

Aging reports are shared weekly with providers and meetings are conducted at their suitable time for resolution.

Physician professional billing experiences claim denials.
The revenue cycle profitability depends upon highly efficient accounts receivable and claim denial management.

At APEXMedPro, we aim to keep denial rates below 5%.Our team possesses deep understanding of corrective action process on denials. At APEXMedPro, we aim to keep denials rates below 5%.
Our experts follow a number of process steps in accordance with insurances for a clean submission thus avoiding any rejections. Denial management or in other words working on accounts receivables is our trade mark. Our billing specialists keep the daily accounts receivables (DAR) fewer than 60 days by immediately getting to work on the denials received. Our experts not only work with medical insurances but are equally capable of resolving billing issues with clearing houses and patients alike.

Apex MedPro Contract Payment Review (CPR) system enables you to ensure that reimbursements received from payers meet negotiated and contracted reimbursement rates. Our contract payment review system immediately identifies underpayments and our team of experts coordinates with payers for the full recovery.

On a quarterly basis our specialist team interacts with all your contracted payers and updates the contract rates for procedures without any cost.
We fight for every penny you deserve.

APEXMedPro Rejections Management (RM) system helps physicians get paid faster. Once the claim is submitted electronically our clearinghouse service checks the format of the electronic file and validates the claim against various payer specified rules for any missing information/requirement.

Rejected claims are tracked down by automated tracking report for faster and more accurate identification of loop and re-submission.

Manual posting desk, in collaboration with CPR system, keeps a sharp eye on the adjustment rates. Our up to date fee scheduler does not allow physicians to fall in the category of over adjustments.

With ICD-10 changes in the old ways are inevitable and with proper education and training on the appropriate method adjustment rates can be controlled. We have more elaborate processes in place for categories such as timely filing, provider not credentialed, no authorization, professional courtesy, small balance write-offs, etc.

In a perfect world there should not be any denials for claims and on first submission all claims should get paid but this does not happen.

For professional medical billing team it is imperative to have the deep understanding and knowledge to navigate the complexities of the claims appeal process with ease and success.

At APEXMedPro, skilled appeals management team takes care of medical, surgical and specialty practices and facilities. This assures that supporting documentation for determination is provided in accordance with rules.

It is also crucial to have knowledge of current Medicare and Medicaid insurance appeals processes. When claims are denied for over-payments a “Recovery Audit Contractor” (RAC) identifies and makes determinations.

Appealing for RAC audit or denied claims is a multi-step process. There are five levels of appeal in Medicare Part A and B.

1. First Level of Appeal: Re-determination by a Medicare carrier, fiscal intermediary (FI), or Medicare Administrative Contractor (MAC)
2. Second Level of Appeal: Reconsideration by a Qualified Independent Contractor (QIC)
3. Third Level of Appeal: Hearing by an Administrative Law Judge (ALJ) in the Office of Medicare Hearings and Appeals
4. Fourth Level of Appeal: Review by the Medicare Appeals Council
5. Fifth Level of Appeal: Judicial Review in Federal District Court

Our team files Medicare Re-determinations which include the written request for reconsideration to Medicare, CMS-20027and CMS-2003, indicating clearly with documental evidence why we are requesting for re-determinations.

Current medical billing market has assumed coding to be an ultimate responsibility of the physician. But not at Apex MedPro. Our specialist coding team spots errors, recommends necessary changes and ensures bi-monthly meetings on practice related issues and coding suggestions to keep revenue cycle optimal.

With main focus on International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) is the new diagnosis coding system developed as a replacement for ICD-9-CM, Volume 1 & 2.

Apex MedPro provides complete patient management services under which patient statements are generated twice a month for amounts due. When the statement is sent to patient for balance amount, due date is set and listed on the patient statement. Patients can also call us for any billing related questions free of charge.

Patient balance is the difference between what the insurance allowable and what reimbursed by the insurance companies. Physicians’ revenues get huge setbacks due to the outstanding patient balance leaving your office agonized.
Apex  MedPro patient management service takes this worry off your hands. Our team of experts regularly follows-up on patient outstanding balances. We personally work with patients making it convenient for them to make payments.

Our team has delivered revenue increase of 23%-36% a year. A success for us and our clients.

• Is No-Show affecting your clinic/practice revenue?
• Are you getting frustrated by waiting for patients?

Apex MedPro provides solution with patient appointment confirmation calls. Under patient management services we make sure that your time is saved. Letting you focus on your job hassle free by providing confirmation for each appointment prior to its time.

This amazing service has helped “Doctors to be Doctors” while providing care to your patients so they feel engaged as prestige clients.

For optimum results we suggest the following:

• To control No-Show losses your office can place nominal charges for patients who do not show up. Your staff/appointment team should inform patients at the time of allotting appointment about No-Show charges.
• Prepay appointment: Patients can pay some amount of his/her choice prior to the next appointment.
• Reward for patients who show up on time with discounts on their bills.
• Track problematic patients and discontinue professional contract with them.
• Office can also charge for same-day cancellations, unless it’s an emergency.

There are millions of payers and it is not possible for billing company or physician office to handle them on their own.

Apex MedPro has top of the line clearing house, delivering physician clearing house integration which is efficient and cost effective to enhance revenues and profitability by 70%.

• Regularly updated rules based engine
• Rules based claim review and scrubbing
• 24/7 secure online access to all billing and claims processing information

Insurance verification service is the most important component of medical billing. Healthcare industry has implemented standards for confirming benefits and eligibility electronically. The ANSI 270/271 standard is commonly known as “Insurance Eligibility”.

Our insurance verification services are focused on reducing claim denials and ensuring reimbursement. Modifications in the patient insurance policy/term policies result in claim denials and loss of revenue. With APEXMedPro upfront and web-based eligibility verification you can avoid it.

1. Upfront Eligibility Verification Services
2. Web-based eligibility Verification Services

• Increase your cash collection and reimbursements.
• Reduce bad debt and slow cash collections.
• DME verification and reimbursement.
• Determine patient’s financial responsibility; enable your practice to collect from patients at the point of care.
• Instead of spending time on verification hassles we let your staff focus on practice output.

Do you feel that you are not getting proper attention?
Is your billing company really giving you the time you need?

At Apex  MedPro every client gets proper care and attention they deserve. For each account we have dedicated account leads who take care of all your concerns and provide complete satisfaction. The team includes specialists who will be at your disposal 24/7.

Is generating billing statements consuming too much of your time?
Do you want this load off your hands?

Apex MedPro provides complete statement management services. With our advanced technology generating and mailing statements is as easy as the click of a button. Our amazing patient management service takes away your extra load and lets you focus on professional matters.

• Helps you reduce cost and save time
• Customize statements as per your need
• Tractable and easy to use

My expenses are increasing.
My revenue is showing a downward slide.

These comments are made by physicians all the time…..! Did you ever ask yourself if you have authentic financial analysis to get to the bottom of things?

It is very difficult to find out what is affecting the medical practice and what strategic planning should be adopted to avoid losses; even when the reports are prepared by practice managers, accountants or administration.

APEXMedPro ensures physicians are provided reports that cover all aspects of medical billing and practice management functions.

These reports are available on weekly, monthly, quarterly and yearly basis to determine the financial health of a practice.

These customized reports are available to best suit your financial growth targets and strategic objectives.
Reports include (but are not limited to):

• Patients Visit Report
• Daily Visit Summary Report
• Daily Visit Summary Chart
• Visit Summary by Provider Chart
• Claim List Report
• Inventory Report
• Patient List Report
• Patient Data Measure Report
• Patient Birthday Report
• Patient Recall List
• Insurance List Report
• Insurance Authorization Report
• Referring Physician Patient List Report
• Patient Follow-up Report
• Patient Demographics
• Payment Reports
• Payments/Deposit Report
• Applied Payments Report
• Applied Payments by Accounts
• Payment Posted Report (Facilities, Offices)
• Monthly Practice Analysis Report Charges by Provider
• Monthly Procedure Code Analysis Summary
• Insurance Analysis Report
• Accounts Receivable Reports
• AR Aging Summary Report
• AR Aging Detail Report
• Collection Report
• Transaction/Patient Report
• Transaction Summary Report
• Monthly Statistics Report
• Manage Billing Statements
• Patient Account Ledger
• Accounting Reports
• Chart of Accounts
• Physician Referral Report

Are you having technical difficulties?
Do you need someone to assist you?

APEXMedPro technical expert team is available 24/7 throughout the year to assist you. Physician’s time is priceless and you cannot wait around for technical assistance. Technical hindrance can occur any time; knowing that support is there for you 24/7 takes worries off your head. Our support teams eliminate cost and time and let you pay more attention to your core work.