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Essential Medical Billing | Operational Efficiency | Healthcare Collection Services


Revenue Cycle Management

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Essential Medical Billing | Operational Efficiency | Healthcare Collection Services


Revenue Cycle Management

 
 

edgeMED's Essential medical billing and collection service tracks, measures and collects more of the money you’re owed in less time than you thought possible, so you can see more patients and less paper work. Our expert U.S.-based team, located in Boca Raton, Los Angeles and New York, will not only handle your back-office workload, but we’ll help optimize your entire revenue cycle to ensure your organization is running at maximum efficiency and profitability – all without any management headaches all too commonly associated with medical billing.  Plus, with our cloud-based practice management application provided to you at no charge, we definitely take the pain out of getting paid.


proof is IN the NUMBERS

Our billing and collections approach addresses the entire revenue cycle, from functions that the practice performs, such as registration and charge capture, to those that we complete: claim submission, payment posting and accounts receivable management.

Our U.S.-based professionals leave no stone unturned with backend systems and payers. Keeping you in constant control of every aspect of your practice’s revenue cycle is paramount.  That's why with edgeMED Essential, we take it a step further and help your practice dig deeper to analyze cost and profitability, monitor contract under and over payments and investigate new revenue opportunities, resulting in mutual success and long-lasting partnerships.

Using our proven methodologies, we have been exceeding physicians' expectations since 1981.

*Collection and A/R data based upon average for clients that had their 12‐month anniversary with edgeMED Essential during 2016.  No-Show Reduction Rate and Increase in Patient Visits based upon comparison of the average fluctuation in patient visits for clients without edgeMED Essential with that for clients that had their 12‐month anniversary on Essential during the year ending 2016.



Appointment Scheduling & Verification

Efficiently commence the process & improve patient balance collection using our integrated appointment scheduling component of the edgeMED Essential RCM system.

With our entire cloud-based practice management (PM) solution provided to your practice at no cost, you can easily be alerted of any outstanding patient balances, as well as verify eligibility, at the time of scheduling so staff members can provide the patient with a friendly reminder of amounts due at the time of service.


Charge Capture

Using edgeMED’s system, your charge slip automatically populates patient and insurance information directly from the appointment scheduler, making it simple for you to mark the services and diagnosis codes provided. We populate all charges to ensure high-level accuracy that results in a 97.5% first pass payment rate and reduction in denials using our sophisticated claims engine.


Electronic Claims Submission

edgeMED’s medical billing and reimbursement experts compile and analyze the data provided by your practice, enter the information into the system, and generate HIPAA-compliant claims transactions in both CMS-1500 and UB-04 formats. Our specialists not only review and balance the data, but it is also “scrubbed” for any possible errors using our advanced technology. This process ensures that claims are clean and will significantly increase first-pass payments and reduce claim denials.


Electronic Remittance & Payment Posting

Payments can be received at either the practice location or through the use of a bank lock box. Once received, payments are reviewed, posted, automatically compared against fee schedules and then balanced. edgeMED’s dedicated RCM reimbursement specialists post, analyze, research, correct, and reprocess or appeal any denials. This is performed at the time of payment posting to help ensure correct reimbursement.


Secondary Claims

Billing is never as simple as just sending out a claim. Even when a claim is paid, patients may frequently carry a second insurance, necessitating the balance from the primary claim to be sent to a secondary payer. Even on a flawless claim, it can take multiple claims or patient bills to get you paid correctly. edgeMED Essential efficiently manages this entire process for you without disruption.


Patient Billing

edgeMED Essential performs all patient billing & follow-up activities for your practice. We realize and appreciate that your patients are to you what our clients are to us – and we treat them with courtesy and respect.

Patients are mailed a series of easy-to-understand statements. Should the patient fail to respond, a letter or call sequence is started to attain payment. edgeMED is not a collection bureau, and as a result our letters and calls promote your patients to work directly with us. This may entail creating a budget plan to ensure you not only get paid, but also retain patient loyalty. However, should a patient refuse to work with us, edgeMED will facilitate the transition of the balance to our outside collection agency for payment.


Audits and Controls

Attention! Attention! edgeMED Essential focuses on the details to ensure every patient seen has been billed, each procedure accounted for, every dollar balanced and every outstanding claim gets immediate follow-up attention. Throughout the entire revenue cycle process, edgeMED Essential integrates a series of proven internal and external checks and balances. For example, our Charge Capture Exception utility analyzes and compares the patients scheduled in the appointment scheduler (and not designated as a no-show or cancelled appointment) against claims generated for that day.


unpaid claims recovery

Unpaid Claims Recovery

It’s no secret that payers have more and more rigorous rules, systems and loopholes aimed at not paying providers. Even though a practice may submit a perfectly clean claim to an insurance payer, there is never a guarantee that it will get paid, or that it will even be acknowledged with a denial.

edgeMED Essential uses our proprietary technology that aggressively hunts and detects unpaid and underpaid claims. Designed on a rules-based, insurance-specific engine, we can determine when a claim should be brought to the attention of one of our expert reimbursement specialists for active follow-up procedures. Most practices lose significant amounts of money through the cracks without even realizing it.

Our proactive protocols eliminate this possibility and will increase your bottom line – we’ve been doing it for over 35 years and you can enjoy the peace of mind you deserve.


Accounts Receivable Follow-Up

We pride ourselves on our accounts receivable management methodology. To edgeMED, this is the most critical aspect of our Essential medical billing and collection service. We work with you to establish joint follow-up parameters, adjustment rules, and standards for account elevation. We understand which claims and payers are the most valuable to your practice, and we customize our follow-up activities accordingly using an entire team of collections specialists.


Advanced Analytics and Business Intelligence Tools

Our Essential revenue cycle management service offers custom reporting and business intelligence capabilities and the ability to analyze and package, at specific frequencies, the sophisticated revenue cycle metrics that small and large health care organizations require. With edgeMED Essential reporting, you have real-time metrics at your fingertips to make informed decisions for your organization.


Account Management

We assign an industry expert to your practice who meets regularly with you and your staff. They ensure that you understand your practice's revenue cycle performance, the drivers behind your performance, and any trends we may see. We place your entire revenue cycle under a microscope and analyze every process to ensure your ongoing success.


Physician Credentialing

In order to assist our clients in pro-actively managing the physician credentialing life cycle, edgeMED offers comprehensive physician credentialing, re-credentialing, expirables management and delegated credentialing services. edgeMED's credentialing specialists are comprised of industry experts who have experience across hospital, physician and vendor organizations. Our credentialing specialists have deep experience in all aspects related to managing the physician credentialing life cycle — enabling your staff to concentrate on your practice and your patients.


ICD-10

Unlimited updates

edgeMED is committed to maintaining compliance with government regulations so you can continue to thrive. We helped our customers get to ICD-10 with minimal disruption to their organization, while also taking advantage of other continued enhancements contained in our latest releases. All software updates are free and automatic for everyone on the network without disruption.


 
 
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Doctor Claims Editing Service | Clinical Editing Technology


Intelligent Claims Editing

Doctor Claims Editing Service | Clinical Editing Technology


Intelligent Claims Editing

Smarter Solutions... get paid more. and faster.

Sophisticated claims editing for your practice may have been out of reach - until now. By reducing denials, decreasing rejections, and accelerating the accounts receivable cycle, our unique claims editing technology helps us maximize your revenue potential. 

1st pass payment rate_edgemed

When it comes to billing, money matters. While our competitors measure first-pass rates, we measure first-pass payment rates. We achieve first-pass payment rates as high as 97.5%. Getting the money into your hands — quickly and accurately — is what our edgeMED is all about.

edgeMED's Essential revenue cycle management service will:

  • Increase your margins
  • Find new revenue by identifying missed billing opportunities
  • Accelerate your payments
  • Reduce your operating expenses

edgeMED's advanced clinical editing technology is a powerful, proven system that enables us to review claims before submission to payers in order to reduce claim denial rates, shorten accounts receivable cycles, and increase the rate of collection.

Our rules-based, front-end clinical editing technology offers a robust rules engine and some of the most sophisticated database editing functionality in the marketplace to help us reduce claim denials by pre-screening for billing and coding errors, as well as to identify missed revenue opportunities through positive edits.  


revenue

Increased Revenue

The front-end and review capability of our advanced editing technology enables us to pre-screen your claims for billing and coding errors and avoid the delays associated with incorrect coding. Our system is powered by an extensive knowledgebase with more than 80 million coding relationships, including both Medicare and commercial coding, which increases accuracy and helps you receive appropriate and timely reimbursement. 


Intelligent automation

Since our technology is integrated within the claims submission and claims management process, it helps us submit cleaner and more fully coded claims — ultimately enabling faster capture of more revenue. Plus, it helps reduce the risk of noncompliance with federal guidelines with automatic alerts that provide effective ongoing education for our staff and yours. 


claim scrubbing

Obstacles to higher reimbursement UNLOCKED

With edgeMED's advanced clinical editing technology, we can:

  • Provide superior clinical editing features, integrated into our existing claims management workflow.
  • Streamline claims editing with the power of our extensive knowledgebase of over 80 million coding relationships, including both Medicare and commercial coding.
  • Reduce days in A/R by checking for errors up-front and pre-screening claims - we can submit cleaner claims the first time and speed payment.
  • Decrease rejections and denials by catching rework at the least costly point - before it leaves our doors.
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Health Revenue Cycle Management | Get Paid Faster | Medical Billing and Reimbursement Experts


Stress Free

Health Revenue Cycle Management | Get Paid Faster | Medical Billing and Reimbursement Experts


Stress Free

Stress less. Make more. Live more.

With payer technology and healthcare regulations rapidly advancing and becoming more complex, many medical organizations are unable to keep pace. Whether you are a physician practice, Accountable Care Organization (ACO) or medical home, we are your revenue cycle management experts so you don't have to be. We'll get you paid faster and increase your bottom line - so you can stress less and make more.

Our team is U.S-based. and services our practice partners from our Florida, California and New York office locations.

edgeMED locations

hassle free medical billing

SIMPLE IS BEST

Simply put, the easiest way to ensure any job gets done right is to hire an expert. At edgeMED, we utilize our 36-plus years of expertise in medical billing and consulting to achieve maximum revenue for your practice, while allotting you the time you deserve to deliver world-class patient care. 

Using edgeMED's Essential Revenue Cycle Management service, you can rest assured knowing you have found the company and solution you can use for the rest of your career.


DEDICATED EXPERT RESOURCES

As insurance company profits increase at the expense of provider reimbursements, this poses a continual risk to all physicians. Taking on insurance companies can be a challenging task for most physician-based billing personnel.

In order to achieve success, you need a team of U.S.-based, dedicated professionals who understands the nuances of billing and collections and won’t rest until you receive the money you are rightfully owed. This is a key differentiator from edgeMED and most other billing companies; many can submit a claim, but we always go the extra mile to take on the insurance companies and fight for your money.


medical billing process

PROPER EXECUTION

edgeMED’s medical billing and reimbursement experts compile and analyze the data provided by your practice, enter the information into the system, and generate HIPAA-compliant claims transactions in both CMS-1500 and UB-04 formats. Our specialists not only review and balance the data, but it is also “scrubbed” for any possible errors using our advanced technology. This process ensures that claims are clean and will significantly increase first-pass payments and reduce claim denials.


medical billing revenue

INCREASE YOUR REVENUE

While edgeMED Essential performs many ancillary services to help streamline your office operations, our greatest asset is the direct impact our billing and collections have on increasing your company profitability. We have been around this long for a reason; our proven billing model generates clean claims, increased reimbursement rates with fewer days in A/R, diminished denials, and reduced administrative burdens on you and your staff.

With our dynamic rules intelligence that collects and updates payer rules in real time, our technology ensures we submit clean claims the first time. Our technology allows us to:

  • Provide superior clinical editing features, integrated into our existing claims management workflow.
  • Streamline claims editing with the power of edgeMED's extensive knowledgebase of nine million coding relationships, including both Medicare and commercial coding.
  • Remove compliance uncertainty of claims submission by staying current with new and changing guidelines, complying with Medicare and commercial regulations, and generating reports to provide ongoing compliance monitoring. 
  • Reduce days in A/R by checking for errors up-front and pre-screening claims — we can submit cleaner claims the first time and speed payment. 
  • Decrease rejections and denials by catching rework at the least costly point — before it leaves our doors. 

At edgeMED, we are all about full transparency. We not only provide you with extensive monthly reporting and full access to our billing software, but also assign a dedicated account representative to review the health of your practice on a monthly basis and make recommendations to further enhance your practice revenue.


ALLEVIATE STAFFING ANXIETIES

Time is money - one of the oldest sayings still rings true to this day. edgeMED Essential allows you more time to focus on seeing patients and relieves the headaches associated with managing and maintaining an internal billing staff. With your newfound peace of mind, you will no longer have to worry about your cash flow being interrupted when your biller is out on vacation, calls in sick or relinquishes her position. There will be no more wasted time and resources requried to find and train a replacement biller when the inevitable turnover occurs. Next to patient care, the most important aspect of your practice is billing. Let the experts at edgeMED show you what we can do for you.


SIMPLE TO INTEGRATE

The foundation of edgeMED’s reputation is built on our ability to deliver top-level customer support and implementation. We understand the challenges involved in outsourcing your billing and apply our extensive experience to ensure your transition is seamless and pain free. We take a great deal of pride in exceeding the expectations of our valued clients, whether you are a small start up practice or established group of any size. Our user-friendly software combined with our dedicated support teams guarantees a quicker and easier transition, resulting in an uninterrupted cash flow.


medical billing advantage

PRODUCT ADVANTAGES

edgeMED’s advanced and intuitive cloud-based Practice Management and EHR software provide a robust foundation to the operation of your practice without the costly fees associated with implementation, IT expenditures and ongoing support costs. Since our software is cloud-based, you will no longer have to worry with the constant maintenance and data backups associated with an in-house server, saving you both time and money. With ongoing software upgrades included, you can have the peace of mind knowing your system will always be up to date and on the cutting edge of technology.


medical billing return on investment

ECONOMICS

edgeMED’s Essential medical billing and collections service provides a tangible ROI. In addition to reducing staff overhead, we also alleviate numerous additional expenditures, including Clearinghouse fees, monthly software maintenance and support, and the mailing of patient statements. When factoring in these cost savings combined with our proven track record of increasing reimbursements, it’s easy to see why edgeMED is the right solution for your practice.

In addition, since our reimbursement is directly tied into the revenues we are able to collect on your behalf, you are assured of a highly motivated team of experts dedicated to you – and focused on collecting the money you rightfully earned.


medical billing

EXPANSION

edgeMED Essential is designed to meet the needs of any sized practice. Our team of US-based, expert medical billers and collectors, plus our cloud-based software, provide the opportunity to dramatically grow your practice without incurring the traditional staffing, software and hardware fees that can cripple most practices. Our solution is even ideal for start up practices, as we hold your hand through implementation and setup while utilizing our credentialing services to get you up and running in an expedited time frame.


OVERSIGHT

One of the common misconceptions about outsourcing your billing is the ensuing lack of control over your financial health. edgeMED continues to educate the healthcare community to illustrate how the right medical billing and collections vendor can expand your financial freedom, insight and control.

We provide you with complete access to our HIPAA compliant software, including up-to-date reporting that can deliver a picture of your practice’s financial health at a glance. In case that wasn’t enough, you have unlimited phone support from our knowledgeable and attentive support staff, as well as your dedicated Essential account manager to help you interpret the wealth of data at your fingertips.


DIFFERENTIATORS

Healthcare Above All™ - that has been edgeMED’s philosophy from day one. Since 1981, we have had the privilege of helping thousands of physicians achieve their financial freedom through our proven formula of expert US-based staff, intelligent software and unmatched customer service.

Our staff is based in Boca Raton, New York and Los Angeles. We're passionate about our people and providing opportunities for our communities to flourish. At edgeMED, we are proudly supporting careers made to last.


 
 
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Medical Implementation Plans | Internal Medical Processes


Financially Fit

Medical Implementation Plans | Internal Medical Processes


Financially Fit

We'll have you running like clockwork...


fast ROI

FASTER RETURN ON INVESTMENT

Getting started with edgeMED is a simple and worry-free transition, regardless of the size or location of your practice.

Each Essential implementation plan is designed to fit a practice's schedule, resources, and needs. We handle all program setup, documentation, EDI implementation, process coordination, and training, eliminating the stress too often associated with a transition. Our medical billing program ensures that your practice preferences become policy before starting the billing process. If you don’t have a policy, we will create one with you.

Your dedicated edgeMED expert will consult you on how to maximize the system capabilities and internal processes within your workflow to increase efficiency – and ROI.


PERSONALIZED ATTENTION

Upon sign-up, practices are assigned a dedicated account manager. The account manager is available via phone or email and is responsible for facilitating the implementation of the entire process.

We pride ourselves on supplying best-in-class service and support. With dedicated account managers, fast response time and an U.S.-based, expert team, our #1 goal is to ensure the success of your practice.


SUCCESS IS CONTAGIOUS

edgeMED has invested time and resources in our Essential implementation program because of its significance to a successful and long-lasting partnership. We look forward to the opportunity to exceed your expectations.