Your experts in medical billing for behavioral health and substance abuse.
Improving your Revenue Stream since 1994.
Upper Cumberland Medical Consulting was established in 1994 and has been billing for 30 years.
At Upper Cumberland Medical Consulting, we go after every dime that is due to your practice.
While the medical billing cycle comprises numerous steps that can take anywhere from a few days to a few months, accurate billing and timely follow-up are our No. 1 priorities. Most states require insurance companies to pay claims within 30 or 45 days. We have reduced that payment cycle to 14 days on many carriers.
Payers do impose timely filing deadlines, but Upper Cumberland Medical Consulting prides itself in not allowing any untimely filing claims. At Upper Cumberland Medical Consulting late claims are not allowed, therefore, we transmit daily and know the outcome of that claim within 24 hours. Any rejections are fixed the same day and resent immediately.
We assist in training your front-end staff to gather correct data in order to help Upper Cumberland Medical Consulting produce a clean claim. The financial health of physician practices and provider organizations, depends on the effectiveness of front-end and back-end billing staff. We strive for optimum team work with our providers' offices.
Upper Cumberland Medical Consulting billing staff are experts with CPT, HCPCS, Revenue and ICD-10 codes. We can assist your office in coding and any billing issues
Our Services
A/R Collections
The final phase of medical billing is patient collections. We submit third party statements if the office selects that option. Our billing staff will follow-up with patients who fail to pay their patient financial responsibility after a set period.
In addition to regular communications through statements and availability to answer questions, patient follow-up can involve offering conveniences to accelerate collections and lessen bad debt.
Once payment is collected at the provider office, our (A/R) management will post patient payments and monitor patient balances. We provide the practice with the necessary reports to better manage his office and his patients.
Claim Tracking
Upper Cumberland Medical Consulting does not use a clearinghouse, we submit directly to the carrier, this gives us the advantage of direct billing and cuts out the middle man.
We avail to each carrier's dashboard to obtain access and status for all submitted claims. Once a claim makes it to the payer, adjudication begins.
Adjudication refers the processing of the claims resulting in determination and payment. Following adjudication, payers generate two types of documentation:
Electronic Remittance Advice (ERA)
Explanation of Benefits (EOB)
Upper Cumberland Medical Consulting receives both types electronically , depending on the carrier, and we post accordingly.
Payment Posting
Payments are electronically posted on all accounts on the same day we download checks from the carrier. Each payment is scanned by our billing staff for any $0 payments or rejections and worked to resolve any issues.
We post notes both in the Medisoft Software System and also on the Electronic Remittance Advice (ERA), stating what the issue may been and what corrections are needed in order to receive all monies due to the provider.
The back-end billing staff will reconcile payments against their claims billed and confirm that all claims are paid accordingly and each practice receives the full allowed amount for each claim.
At the end of the day, medical billers will balance with direct deposits received and supply reports to the provider's office.
Denial Management
Denials or reimbursement problems are worked as soon as they are received from insurers. When a payer denies a claim, the remittance advice provides billing staff with a denial code(s) and a brief explanation as to why the claim was denied. The denied claim will be reviewed by the billing staff to determine whether additional information is needed, If errors need to be corrected or if the denial should be appealed.When appealing claim denials,
Upper Cumberland Medical Consulting leaves no stone unturned. Due to 30 years of experience, we know the reps and staff of most common carriers and have access to get their assistance in resolving issues. The billing staff will then prepare the appeal letter and refile the claims or whatever is needed until payment is received.
Payment Posting
We post notes both in the Medisoft Software System and also on the Electronic Remittance Advice (ERA), stating what the issue may been and what corrections are needed in order to receive all monies due to the provider.
The back-end billing staff will reconcile payments against their claims billed and confirm that all claims are paid accordingly and each practice receives the full allowed amount for each claim.
At the end of the day, medical billers will balance with direct deposits received and supply reports to the provider's office.
Ready for Help?
If your practice is ready for an experienced, results-driven resource protector, then you’re ready for UCMC. Contact us today to see how we can serve your office.
