A/R Management

By reducing the number of days your revenue stays in A/R, we improve your cash flow and reduce claim denials. Our aggressive appeals process for denied claims helps get you paid. We also support your patient statements, track and resubmit unpaid claims and reconcile insurance and patient payments.

By shortening the "days in healthcare accounts receivable" cycle, Alpinesoft is able to help improve your cash flow and reduce claims denials, thus turning healthcare accounts receivables into cash. Alpinesoft can help with AR calling, following up pending claims, initiating collections, tracing the reasons for claims denials, tracking outstanding receivable balances by customer and by the date when payment is due, providing periodic reports and more.

Alpinesoft's AAPC-certified medical coders know the ins and outs of both diagnostic coding and procedural coding. They are experienced at handling CPT and HCPCS coding. We code for surgery, lab and other tests based on the guidelines of AMA and CMS. We also do ICD coding related to the CPT and HCPCS codes based on AMA and CMS guidelines. Read more about our medical coding services.

We will use Medicare as an example but this could apply to Medicaid or other third party insurance companies as well.
Medicare claims get denied mainly for the following reasons.

• Incorrect or missing ICD-10 diagnoses
• Incorrect or missing CPT-4 modifiers
• Duplicate claim
• Additional information needed to process the claim
• Claim billed amount incorrect
• Incorrect or missing CPT procedure code
• Physician's name and/or UPIN missing or incorrect
• Incorrect or missing place of service code
• Incorrect or missing quantity of services (Service billed without "quantity" noted, or with multiple quantities indicated in error on claim)
• Services inappropriately bundled

As you can see, some of the main reasons for claims denials are incorrect/incomplete data entry and incorrect medical coding.
Outstanding claims and delayed collections place added administrative strain on a hospital or physician's practice. On one hand, insurance companies often deny claims or refuse to pay them. On the other hand, federal regulations have become increasingly more stringent in the USA. Recently the federal Centers for Medicare & Medicaid Services announced that they would reduce the time physicians are given to file an appeal against a claim denial - from six months to 120 days. This increases the pressure on the staff at your healthcare practice to follow up on denied or appealed claims.