How It Works

Understanding Our Billing Framework

Welcome to our streamlined approach to medical billing, coding, and revenue cycle management. At Bristol Healthcare, we prioritize clarity, efficiency, and accuracy in all our processes. Here's how we work:

• Sign up – BAA & Billing Agreement: We prioritize compliance with HIPAA and HITECH Acts by signing comprehensive business associate agreements (BAAs) and billing agreements. Our agreements include service-level agreements and standard clauses, ensuring clear terms and guaranteed productivity for our clients.
• Provider Credentialing: For new practices or providers, we guide our clients through the enrollment process with major payor networks. Our dedicated credentialing experts ensure swift and accurate processing of credentialing forms, facilitating optimal reimbursements for our clients.
• ERA / EFT Enrollments: Our experienced staff handles the essential task of enrolling providers in Electronic Remittance Advice (ERA) and Electronic Fund Transfer (EFT) with major payors. This streamlines the claim reimbursement process, leading to quicker turnaround times.
• Eligibility and Benefits Verification: We provide thorough eligibility and benefits verification services to ensure that our clients receive proper compensation for the services they provide. By collecting deductibles and co-pays upfront during patient visits, we enhance efficiency and revenue collection.
• Pre-Authorization and Referral: We meticulously verify authorization and referral requirements for all scheduled patients, eliminating the risk of claim denials and ensuring the submission of clean claims.
• Patient Registration / Patient Demographics: Our detailed patient registration process includes verification of insurance eligibility, benefits, authorization, and referral requirements. Accurate entry of patient and insurance information into the EMR/Billing software facilitates the submission of error-free claims.
• Medical Coding: AAPC™ and AHIMA™ certified coders and billers review medical records, superbills, and charge sheets to accurately link diagnoses to procedure codes, following AMA and CMS guidelines. Our expertise in multispecialty coding ensures precision, and we offer documentation improvement suggestions to providers.
• Charge Entry / Charge Capture: We meticulously capture provider information, service dates, procedure codes, modifiers, and diagnosis information on each claim, ensuring high accuracy levels and swift reimbursements.
• Electronic Claims Submission: All claims undergo thorough scrubbing to comply with payor and CCI edits before submission to insurance companies through our clearinghouses. Immediate action is taken on any EDI rejections received.
• Electronic Remittance Advisory / Manual Posting: Our payment posting specialists process ERA files into the billing system, while our manual posting team reviews and addresses low pays, no pays, and denials promptly and accurately.
• Denial Management: Our revenue management experts analyze denials in detail, categorize them, and develop solutions to resolve current issues and prevent future denials, ensuring timely resolution and payment of claims.
• Accounts Receivable: Using our proprietary workflow management software, BristolByte®, we categorize outstanding accounts receivable by payor, aging, and claim value, facilitating efficient follow-up and resolution to maintain consistent cash flow for our clients.
• Credit Balance Reporting / Resolution: We meticulously analyze and resolve credit balances resulting from double payments, overpayments, or incorrect adjustments, ensuring timely refunds and accurate balance billing to patients.

At our company, we are dedicated to optimizing revenue cycles, minimizing denials, and ensuring our clients receive maximum reimbursements while maintaining compliance and integrity in all our processes.