How the ModMed® BOOST™ RCM Services Team Handles a Claim

Follow the life of a claim with the ModMed BOOST team to learn how our skilled professionals help resolve issues before they occur.

Here is a Full Transcript of the Video: 

ModMed BOOST RCM Services is a team of skilled professionals who can help verify claim accuracy and resolve issues before they happen. Let’s follow the life of a claim with ModMed BOOST to see how they do it! The revenue cycle process begins as soon as the patient schedules an appointment. Once scheduled, our Practice Management system automatically checks insurance. Two days prior to appointments, the BOOST team double-checks reports, reconciles mismatches and adds notes to help your staff collect patient payments or missing info for a smooth check-in.

Your staff then verifies eligibility details while checking in the patient and updates any insurance shown as inactive or unknown. Your staff uploads a physical copy of the patient’s insurance card and confirms the insurance is still active. As you see the patient, EMA EHR auto-suggests CPT and ICD-10 codes based on your documentation. After the visit note is finalized by your provider, a charge entry seamlessly flows into Practice Management for the BOOST team to work on. Accuracy is the name of the game. The BOOST team examines claims and works with you to make adjustments to get clean claims out the door.

The BOOST team flags incomplete claims that require your timely attention, such as missing information, incorrect insurance or non-contracted payers, so the BOOST team can submit as soon as possible on your behalf. Next, the BOOST team submits claims to Trizetto Provider Solutions, our integrated clearinghouse, which works as a communication hub connecting the practice management system to the payer's adjudication system. When a denial happens, the BOOST team springs into action. Using an extensive database of payer resources, the team contacts the payer on your behalf and crafts a targeted appeal. In the event a first-level appeal is unsuccessful, your staff is consulted to help develop a second appeal.

As payments from insurers come in, the BOOST team checks for missing EOBs and confirms that EFT/ACH deposits are logged for clients who choose to participate in the deposit confirmation process. For practices using ModMed Pay, the BOOST team posts patient credit card payments into the Practice Management system. Finally, the BOOST team handles any incoming patient calls specifically regarding balances, insurance updates, claims processing and payment collection, so you don’t have to. 

And that’s how ModMed BOOST RCM Services handles a claim from start to finish. Get the ModMed BOOST RCM team on your side today!