EXPERIENCE
With over 36 years of combined experience, Hometown Billing is a trusted leader in medical billing. Our expertise spans multiple specialties including mental health, chemical dependency, adult foster care, ambulance payment recovery and more. We provide real-time access to detailed financial reports and claim status updates, offering transparency into your revenue cycle with no surprises.
REVENUE RECUPERATION
Our end-to-end revenue cycle management ensures no revenue is left on the table—from insurance verification and pre-authorization to billing, payment collection, and denials management. Our dedicated team works relentlessly to resolve claim denials within 30 days, ensuring quicker turnaround times for payment collection and improving your practice’s cash flow.
DEDICATED SUPPORT
With Hometown Billing, you’ll have direct access to a dedicated account manager who understands your practice thoroughly, rather than relying on an AI billing system that can introduce errors in its findings. This personalized approach ensures that questions are answered promptly, issues are resolved efficiently, and you always have a clear understanding of your billing process. Our hands-on support means you’re never left wondering about the status of your claims or payments.
SPECIALTIES
We specialize in the complexities of behavioral health billing, including mental health, substance abuse, ambulance payment recovery, and addiction treatment centers, ensuring accurate coding, compliance, and optimized reimbursement.
TECHNOLOGY
We use cutting-edge billing software that automates claim submissions, reduces human error, and speeds up reimbursement times, ensuring a more efficient and transparent process.
KNOWLEDGE
With an in-depth understanding of private insurance providers and government programs (Medicare/Medicaid), we navigate the evolving landscape of regulations and payer requirements to maximize reimbursements and ensure full compliance.
Understanding Medical Billing: A Step-by-Step Guide
At Hometown Billing, we understand that your revenue cycle impacts every part of your practice—from financial success to patient care and provider satisfaction. Each step of the billing process is crucial, and even small mistakes can increase your workload or cause revenue loss.
To help you understand how claims move through the system, here’s an easy-to-follow guide on the Lifecycle of a Claim:
- Eligibility and Demographics
It all starts with collecting accurate patient information. Each visit, your front office staff gathers the patient’s details and reason for the visit. Verifying insurance coverage at this stage is key, as mistakes here are one of the main causes of claim denials.
Before services are provided, it’s also important to check if preauthorization is needed for certain procedures. If preauthorization isn’t obtained, payment could be denied by the insurance company.
- Charge Capture and Coding
After the patient visit, the next step is recording what services were provided. This is called charge capture. The details of the visit are turned into specific medical codes using different code sets such as ICD-10 (for diagnosis) and CPT (for procedures). These codes form the basis of the claim sent to the insurance company.
- Claims Creation and Scrubbing
Once the services are coded, the claim is created. Claims scrubbing, which checks for errors, happens before the claim is submitted. This step helps catch and correct mistakes, such as missing information or incorrect codes. Clean claims get processed faster and reduce the chance of denials.
- Claims Submission
When a claim is ready, it’s sent to the payer (the insurance company). Timely filing is critical—insurance companies have deadlines for when claims must be submitted, so submitting on time prevents your practice from losing money. Claims are usually sent through a clearinghouse, which acts as an intermediary to review the claim before it reaches the insurance company.
- Clearinghouse Edits
Before a claim is passed on to the insurance payer, the clearinghouse does a final review. This is the last chance to catch any issues before submission. If the claim has errors, the clearinghouse will reject it, giving your practice an opportunity to fix it before it becomes a denial from the payer.
- Adjudication
Once the claim reaches the insurance company, it goes through a review process known as adjudication. The payer decides whether the claim is valid and how much should be paid. If there are any problems with the claim, such as missing information or discrepancies, it might be denied.
- Payment and Remittance
If the claim is approved, payment is sent to your practice. This is called remittance. Payments are often deposited directly into your practice’s account via electronic funds transfer (EFT). At this stage, you’ll also receive an explanation of benefits (EOB) or an electronic remittance advice (ERA), which explains how much was paid and why any adjustments were made. If there’s an outstanding patient balance, the practice may need to follow up with the patient for payment.
- Denials and Appeals
If a claim is denied, it’s important to follow up quickly. The denial will include a reason code explaining why the claim was rejected. This allows you to correct the issue and resubmit the claim. There are strict deadlines for resubmitting denied claims, so staying on top of denials ensures you collect the revenue you’re owed.
- Reporting and Analytics
Finally, to ensure your practice’s financial health, it’s important to monitor the performance of your billing process. Regular reporting can help you track claims, measure revenue, and identify areas for improvement. With the right data, you can streamline your workflow, improve cash flow, and enhance patient care.
Key Reports:
Timely and accurate reporting is essential to understanding the full scope of your revenue cycle. Our detailed reports give you a comprehensive view of your practice’s financial health, helping you improve processes, track KPIs, and address any issues that may impact revenue collection. Here are some of the key reports we provide:
- Monthly Changes in Accounts Receivable (AR):
This report provides a clear snapshot of your aging totals, including beginning balances, charges, payments, adjustments, and ending totals. It’s vital for tracking overall AR movement. - Insurance Aging (Less Credits):
Displays all open insurance balances without overpayments, organized by financial class such as Medicare, Medicaid, Blue Cross Blue Shield, UnitedHealthcare, Cigna, or other commercial payers. - Patient Aging (Less Credits):
A breakdown of open patient balances, with overpayments removed, giving a clear view of outstanding amounts owed by patients. - Bad Debt AR:
Identifies outstanding patient balances that have been referred to collections, helping you keep track of difficult-to-collect payments. - Receivables Analysis:
A categorized look at accounts receivables, segmented into insurance, patient, and credit categories for easy tracking. - Charges by Financial Class:
A detailed report that shows the amount of charges sent to different payers (e.g., Medicare, Medicaid, commercial insurance), so you know exactly where charges are being processed. - Payments by Financial Class and Date of Service:
This report reveals how quickly you receive payments from different payers after services have been rendered, helping you assess payment timelines and payer efficiency. - Service Item Summary:
Organized by CPT code, this report summarizes services billed, providing insights into which services are driving revenue. - Denials by Reason Code:
A critical report that breaks down claim denials by payer and reason, so you can pinpoint common issues and take corrective action to reduce denials in the future. - Standard Monthly Reports:
Customizable monthly reports to meet the needs of your board, practice management, clinical management, or other departments for ongoing review and performance tracking.
