Medical billing and coding is the process of identifying medical tests, procedures, treatments and diagnoses found in the clinical documentation, then transcribing the data into CPT and ICD10 codes to bill to government and commercial insurance companies for reimbursement on the services performed.

Charge Entry
Unlike so many other medical billing companies, ANO Revenue Cycle Management actually performs all aspects of the of the billing process. ANO-RCM employs certified coders and billers to handle the charge entry step of the billing process, removing this responsibility from the providers or other non-billing staff members. ANO-RCM understands that many EMR / EPM* systems allow the providers to click through the notes and this automatically generates many of the services that were performed. However, we also understand that you can not just rely on a computer to produce all the services, modifiers and units for all services that have been performed. That is where our certified coders and billers are able to fully assist with the process.
The ANO-RCM staff is able to take on the responsibility of manually entering the CPT codes for the services performed or are able to review the information sent over to verify all services have been identified, the correct modifiers, and the correct number of units are being submitted to the insurance company. The charge entry step is based on the needs / requirements of each individual client.

*EMR – Electronic Medical Record / EMP Electronic Practice Management

Claims Processing
ANO Revenue Cycle Management reviews all charges prior to creating claims that will be submitted electronically through to a designated clearinghouse*. Once claims are submitted to the clearinghouse ANO-RCM monitors the claims to confirm the claims were accepted by the insurance carrier or to work any claims that may have been rejected. Any required corrections would be made to the claims and then resubmitted.

* Clearinghouses are electronic stations or hubs that allow healthcare practices to transmit electronic claims to insurance carriers in a secure way that protects patient health information, or protected health information.

Insurance Payments
ANO Revenue Cycle Management works with each clinic to make sure all payments have been accounted for and are posted correctly. The staff at ANO-RCM does not solely rely on the ERA* information received through the clearing house as this information is not always correct and does not represent the date the payment was received. ANO-RCM works with the client to obtain a list of EFT’s* received by the client to balance against the ERA information available through the clearing house.Utilizing both the clearing house information and the bank EFT information assists in making sure all payments are correctly represented in the EMR / EPM system, making sure no payments are missed, making sure a payment is not posted when a payment has not truly been received and making sure the posting date correctly corresponds to the date the payment was received. Why is this important?

• Making sure all payments are correctly represented – There are occasions when the data sent to the clearing house does not accurately represent the amount deposited to the clients bank account. When posting payments both amounts should balance so the amount in the EMR / EPM system is correct.


• Making sure no payments are missed – There are occasions when an EFT is received however the data is not sent through the clearing house with an ERA. Verifying the information between the clearing house and the bank information allow us to identify those payments and reach out to the insurance company to obtain the corresponding information and post the payment correctly.


• Making sure a payment is not posted when a payment has not been received – There are occasions when an ERA is sent through to the clearing house however an EFT is never processed to the client or the payment is sent as a paper check. Posting an ERA from the clearing house that has not actually been received by the client shows a paid claim when it is still open and creates a payment for the billing company when it is not valid.


• Making sure the posting date corresponds to the payment date – It is important to understand the productivity of the group / clinic or individual provider. To do this accurate reporting is a necessity and when payments are not posted according to the date they are received this represents misleading information on monthly reports.

ERA – Electronic Remit Advice
EFT – Electronic Funds Transfer

Denials
ANO Revenue Cycle Management manages all denials that come through either the clearinghouse or the insurance carrier. ANO-RCM reviews the denial to make sure it is valid. If the denial is valid ANO-RCM makes any necessary corrections to the claim or files an appeal on behalf of the patient and client to obtain full reimbursement.