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. Operating from our office locations in Florida, Wisconsin, California and New York, our expert U.S.-based team 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.
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.
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.
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
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.
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.
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.
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.