Billing Management

Billing that catches the error before the claim goes out

Medical practices lose significant income every year to insurance billing and coding errors. Front end rejections, denials and incorrect information can cause a massive loss of income. It can also slow the reimbursement process significantly. In far too many cases, claims are not paid because of timely filing issues.

Wrong policy number provided by the patient? NovoClinical knows. Wrong name provided by the patient? NovoClinical knows. Wrong address? NovoClinical knows. Clerical errors that are made within the patient registration processes are one of the biggest reasons for denials from insurance payers.

Every insurance is queried to determine eligibility, co-pays, deductibles and more. The correct information is populated into the patient’s chart before the visit. Eligibility can be run for a single patient or across an entire day’s schedule in bulk, so problems surface before anyone arrives at the front desk.

EOB are electronic and require no manual posting. NovoClinical even breaks down the EOB by claim, and by patient. The system calculates the amounts paid, applies them to the patient ledger and then looks for patient secondary and tertiary insurance coverage. If present, NovoClinical automatically calculates the amounts, makes adjustments and creates the secondary and tertiary (if present) claims and sends them out. Automatically.

With a plus 90 percent pass rate for the clearing house, we call NovoClinical intuitive. Practices call NovoClinical light years ahead. We couldn’t agree more.

From charge to payment, in one system

Coding happens against the documentation that supports it, in the same screen as the note. From there the claim is created, scrubbed and sent to your clearinghouse without anything being exported or re-entered. Claim status is tracked through its life — submitted, accepted, rejected, paid — so your biller can see where a claim actually is instead of calling to find out. Pre-authorizations, claim attachments and corrected claims are handled in the same place.

When a claim doesn’t get paid

Denials are worked from a queue rather than a spreadsheet. Each one carries its reason code, its history and the actions already taken. Claims can be tagged, grouped and worked in batches where the same problem affects many at once, and every status change is recorded — so when a payer disputes the timeline, you have the history.

An AI assistant sits alongside the claim: ask it questions about that claim and its remittance data in plain language and it answers from the claim’s own record. Useful for working out why a payer paid what they paid without reading the remittance line by line.

What the patient sees

Patient balances, statements and payment plans are part of the same system as the clinical record, so nobody is reconciling two sets of numbers. Statements can be sent by mail or email, patients can pay online through the patient portal, and payments post straight back against the right claim. Refunds, adjustments and deposits are handled in the system with a record of who did what.

Knowing where you actually stand

Aging by patient and by insurance, income summaries, collections performance, coding analysis and provider productivity are reported from live data rather than assembled at month end. Because the clinical and financial sides share one record, a payment traces back to the visit that generated it — which matters when you are trying to work out not just what you were paid, but why.

If you would rather not run billing in-house at all, the same system underpins our revenue cycle management service.