Your Partner in Seamless Medical Billing
Prospect Healthcare Solutions is a full-service medical billing company that assists with the financial management of your business. Our experienced staff provides many different types of billing to clinics, hospitals, and physicians throughout the United States.
By providing a comprehensive range of Medical Billing Services and Other Medical Revenue Cycle Management (RCM) Services, we allow healthcare providers to achieve maximum income while reducing the number of mistakes and simplifying their administrative tasks.
Helping you focus more on your Patients Through an Efficient Process That Provides Accurate and Timely Payments.
Turning Your Claims into Care – Efficient, Accurate, Reliable.
Service Offered by Prospect Healthcare Solutions
Prospect Health Solutions offers a comprehensive suite of medical billing services, designed to help healthcare professionals streamline their billing and payment processes. Our goal is to provide accurate and expedient support for all aspects of medical billing.
Our Medical Billing Services Process encompasses the entire Revenue Cycle, providing Healthcare Providers timely & accurate reimbursements. We manage every step in the Billing Lifecycle from Initial Credentialing Services through the Final Payment Posting & Denial Management. We begin the process by enrolling Providers with Insurance Payers, processing charge entry accurately along with submitting claims. We review claims after submission to uncover any potential errors, delays, and rejections during the claim Process. All denied or underpaid claims are analyzed and corrected as soon as possible to reduce revenue loss.
At the time of the initial contact with the patient as well as throughout their intake process, we will capture the patient's demographic information, insurance information, and all necessary documentation. We ensure that the patient's entire medical record is complete, accurate, and has been brought into compliance with both payer and regulatory standards. We oversee the authorizations, referrals, and supporting documentation to ensure that all claims submitted are correct and are processed without delay. Properly registering the patient at their intake is an excellent way to help reduce claim denials because of inaccurate or incomplete information, as well as increase the overall efficiency of the practice.
Prior to providing any service, we verify that the patient has current and up-to-date insurance information, including coverage limits, co-pays, deductibles, and authorization requirements. This proactive verification allows our Providers to understand what types of services can be provided under a patient's policy and the financial responsibility of the patient. By identifying any potential insurance coverage issues ahead of time, we are able to minimize claim denials, delayed payment on claims and disputes between patients and their Providers regarding billing. With a high level of accuracy in verification, we are able to improve the transparency of healthcare costs to Patients, by providing them with accurate information about costs before services are rendered.
With the following principles of coding: CPT, ICD-10, and HCPCS, our certified coders will assign accurate coding that appropriately describes the services rendered. Accurate coding will help reduce or eliminate the number of rejected claims, underpaid claims, and non-compliance issues. Our coders are up-to-date on changing coding rules and payer-specific requirements, ensuring that all claims submitted to insurers (payers) are compliant with the general coding industry standards. By accurately interpreting all documentation, we minimize coding errors, reduce audit exposure, and expedite the rapid approval of claims.
Timely payment posting and denial management are essential to maintaining your organization's cash flow. Our team will post all payments made by both the patient and insurance companies correctly and accurately track the payment transactions for each patient.
Also, our team will analyze each EOB (Explanation of Benefits) statement to make sure there were no issues with the claim such as underpayment, IOU adjustments, or denials. If any claims were denied for any reason, we will find out the reason for denial (i.e. coding, eligibility issues, or lack of documentation) and will take the necessary steps to correct any errors and file an appeal for those denied claims.
We provide AR Recovery as part of our medical billing service. It allows Practices to recover unpaid & overdue Claims more effectively than any other provider. AR Recovery uses our knowledge & experience from both Consulting & providing Professional Medical Billing and Medical Billing Management Services. We assist with tracking "bad debts", determining what caused Claim non-collections and contacting Payers so that Practitioners can receive their payments in a timely manner. AR Recovery is a very useful service for both medical billing for doctors and medical billing for clinics because it helps with reimbursements (Cash Flow) and prevents Revenue Losses.
With Revenue Cycle Management (RCM) services, we provide a 100% complete Revenue Cycle Management (RCM) for healthcare professionals. Our services include all facets of healthcare billing – from patient registration to insurance verification and from claim submission to payment posting – within an integrated system. By using RCM Services, practices will obtain the benefits of a highly structured and automated process, allowing for the best accuracy, speed in receipt of money, and complete improvement of financial performance through increased efficiency from outsourcing.
Medical practices both large and small benefit from using our Virtual Medical Assistants for all of their Administrative duties. Along with other services offered through our Medical Billing Service, VMAs will assist in scheduling patients, verifying insurance coverage and entering data which will ultimately reduce the number of clerical errors that occur within any practice. Professional Medical Billing Support provided by our VMAs can be integrated easily into your current processes. It will simplify your Medical Billing Management processes and save you money when it comes to Medical Billing for both doctors and clinics.
With our Free Practice Audit, you will receive a thorough assessment of your current medical billing practices and procedures without any obligation on your part. Our Free Practice Audit will identify any issues with your current billing system (e.g., inaccuracies, inefficiencies, lost revenue) regardless of how large or small your practice is. We will provide you with a complete list of recommended actions that will allow your practice to effectively manage its medical bills so that you get the highest possible reimbursement while maintaining the financial well-being of your business.
We offer Comprehensive Medical Scribe Services To Assist You With Your Medical Billing And Ensure That You Have Accurate, Real-Time Documentation Of Patient Encounters To Help You Manage Your Practice. By Reducing Administrative Workload For Your Physicians And Staff, The Medical Scribe Provides A Faster And More Accurate Processing Of Medical Claims For Your Clinics And Both Your Physicians And Staff For Their Patients' Health Information. Medical Scribes Support Medical Billing Solutions in the following ways: Increased Efficiency, Improved Compliance And Increased Revenue Cycle Performance.
Medical Billing Services Process
Our Medical Billing Services Process encompasses the entire Revenue Cycle, providing Healthcare Providers timely & accurate reimbursements. We manage every step in the Billing Lifecycle from Initial Credentialing Services through the Final Payment Posting & Denial Management. We begin the process by enrolling Providers with Insurance Payers, processing charge entry accurately, along with submitting claims. We review claims after submission to uncover any potential errors, delays, and rejections during the claim Process. All denied or underpaid claims are analyzed and corrected as soon as possible to reduce revenue loss.
Patient Registration and VA Services
At the time of the initial contact with the patient as well as throughout their intake process, we will capture the patient's demographic information, insurance information, and all necessary documentation. We ensure that the patient's entire medical record is complete, accurate, and has been brought into compliance with both payer and regulatory standards. We oversee the authorizations, referrals, and supporting documentation to ensure that all claims submitted are correct and are processed without delay. Properly registering the patient at their intake is an excellent way to help reduce claim denials because of inaccurate or incomplete information, as well as increase the overall efficiency of the practice.
Insurance Eligibility and Benefits Verification
Prior to providing any service, we verify that the patient has current and up-to-date insurance information, including coverage limits, co-pays, deductibles, and authorization requirements. This proactive verification allows our Providers to understand what types of services can be provided under a patient's policy and the financial responsibility of the patient. By identifying any potential insurance coverage issues ahead of time, we are able to minimize claim denials, delayed payment on claims and disputes between patients and their Providers regarding billing. With a high level of accuracy in verification, we are able to improve the transparency of healthcare costs to Patients, by providing them with accurate information about costs before services are rendered.
Medical Coding Services
With the following principles of coding: CPT, ICD-10, and HCPCS, our certified coders will assign accurate coding that appropriately describes the services rendered. Accurate coding will help reduce or eliminate the number of rejected claims, underpaid claims, and non-compliance issues. Our coders are up-to-date on changing coding rules and payer-specific requirements, ensuring that all claims submitted to insurers (payers) are compliant with the general coding industry standards. By accurately interpreting all documentation, we minimize coding errors, reduce audit exposure, and expedite the rapid approval of claims.
Payment Posting and Denials Management
Timely payment posting and denial management are essential to maintaining your organization's cash flow. Our team will post all payments made by both the patient and insurance companies correctly and accurately track the payment transactions for each patient. Also, our team will analyze each EOB (Explanation of Benefits) statement to make sure there were no issues with the claim such as underpayment, IOU adjustments, or denials. If any claims were denied for any reason, we will find out the reason for denial (i.e. coding, eligibility issues, or lack of documentation) and will take the necessary steps to correct any errors and file an appeal for those denied claims.
Accounts Receivable Recovery
We provide AR Recovery as part of our medical billing service. It allows Practices to recover unpaid & overdue Claims more effectively than any other provider. AR Recovery uses our knowledge & experience from both Consulting & providing Professional Medical Billing and Medical Billing Management Services. We assist with tracking "bad debts", determining what caused Claim non-collections and contacting Payers so that Practitioners can receive their payments in a timely manner. AR Recovery is a very useful service for both medical billing for doctors and medical billing for clinics because it helps with reimbursements (Cash Flow) and prevents Revenue Losses.
Revenue Cycle Management (RCM) Services
With Revenue Cycle Management (RCM) services, we provide a 100% complete Revenue Cycle Management (RCM) for healthcare professionals. Our services include all facets of healthcare billing – from patient registration to insurance verification and from claim submission to payment posting – within an integrated system. By using RCM Services, practices will obtain the benefits of a highly structured and automated process, allowing for the best accuracy, speed in receipt of money, and complete improvement of financial performance through increased efficiency from outsourcing.
Virtual Medical Assistant
Medical practices both large and small benefit from using our Virtual Medical Assistants for all of their Administrative duties. Along with other services offered through our Medical Billing Service, VMAs will assist in scheduling patients, verifying insurance coverage and entering data which will ultimately reduce the number of clerical errors that occur within any practice. Professional Medical Billing Support provided by our VMAs can be integrated easily into your current processes. It will simplify your Medical Billing Management processes and save you money when it comes to Medical Billing for both doctors and clinics.
Free Practice Audit
With our Free Practice Audit, you will receive a thorough assessment of your current medical billing practices and procedures without any obligation on your part. Our Free Practice Audit will identify any issues with your current billing system (e.g., inaccuracies, inefficiencies, lost revenue) regardless of how large or small your practice is. We will provide you with a complete list of recommended actions that will allow your practice to effectively manage its medical bills so that you get the highest possible reimbursement while maintaining the financial well-being of your business.
Medical Scribe
We offer Comprehensive Medical Scribe Services To Assist You With Your Medical Billing And Ensure That You Have Accurate, Real-Time Documentation Of Patient Encounters To Help You Manage Your Practice. By Reducing Administrative Workload For Your Physicians And Staff, The Medical Scribe Provides A Faster And More Accurate Processing Of Medical Claims For Your Clinics And Both Your Physicians And Staff For Their Patients' Health Information. Medical Scribes Support Medical Billing Solutions in the following ways: Increased Efficiency, Improved Compliance And Increased Revenue Cycle Performance.
Serving a Wide Range of Medical Specialties
Our company specializes in providing healthcare organizations with customized billing and revenue cycle solutions that are developed based on the specific needs of each specialty (including but not limited to: emergency room, psychiatry, and specialty clinics). This enables us to develop billing systems that support efficient operations as well as sustainable financial performance.
We also provide medical billing for behavioral health and medical billing for DME for Durable Medical Equipment providers. We have dedicated medical billing for hospice, geared towards hospice care teams, to ensure prompt payment as well as compliance with all regulations. Our comprehensive approach enables small practices to concentrate on providing excellent patient care while we take care of all the complexities associated with billing and managing revenue.
Why Our Approach Delivers Results
Time-saving accuracy
Save time and eliminate errors
Productivity-focused workflows
With procedures that are detailed to help keep clerical errors to a minimum while improving overall productivity
Faster payment collection
Increase the speed of collecting payments through enhanced claims processing
Improved financial performance
Enable companies to achieve better financial results using strategies that encourage continuous revenue opportunities
Regulatory compliance assurance
Stay compliant with federal, state, and other regulatory bodies
Custom billing solutions
Provide custom monthly billing solutions specifically designed for your practice
Round-the-clock support
Provide you with support 24/7
Seamless system integration
Have an easy integration process with your system
Our Expertise to Enhance RCM in Medical Billing
Our RCM services ensure that your practice thrives financially while maintaining compliance with industry standards. Whether you are looking for medical billing services USA, medical billing company in USA, or medical billing services California, we are the experts you can trust.
Outsourcing medical billing services can be even more beneficial for small and independent provider companies. For healthcare providers, Prospect Healthcare Solutions is one of the best medical billing companies in the USA, providing reliable, professional, and affordable billed services that take the billing process to a whole new level. Our reimbursements are handled through third-party firms, such as the ones that are offering billing services.
As a leading medical billing and coding company, we handle all the operations efficiently to reduce mistakes and increase RCM in medical billing practice. Similarly, we adopt quality assurance measures to cut down on billing errors and guarantee that healthcare providers receive accurate reimbursement. If healthcare providers choose to engage with us, our team of certified billing experts handles the accounting side of the business. So, it allows physicians to dedicate all their funding principles as well as time to deliver high-quality medical services without concern about money matters.
Medical Billing Process Optimization
Optimizing medical billing processes includes reducing errors in the collection of revenue, shortening payment times, and increasing reimbursement amounts through the improvement of the entire revenue cycle. Our structured and data-driven optimization process begins with obtaining complete and accurate patient information, continues through the various steps of the revenue cycle until the complete payment reconciliation process has taken place. By identifying, documenting, and automating various workflow gaps and repetitive steps, we are able to reduce both claim rejection and resubmission occurrences via application of payer-specific guidelines.
Credentialing Services
We will handle everything related to the Credentialing process. Application Submission; Document Verification; and follow-up with all insurance companies. Having your credentialing service provider accurately credentialed for all of your insurance payers is critical to avoid denials on claims and/or payment delays associated with incomplete and/or outdated provider information. Additionally, we will re-credential providers periodically to keep them compliant with Payer requirements. By managing the providers and their credentialing, we can help your Practice bill for services much sooner and avoid unnecessary interruptions due to having incorrect information on Providers.
Claim Creation and Submission
One of the most important aspects of obtaining payment in a timely manner is to create and submit a claim. We will prepare and submit claims that include only valid patient data, accurately verified insurance information, and the appropriate medical codes. The claims will meet both the established payer-specific guidelines as well as all of the required regulatory requirements in order to reduce the volume to be rejected. In order to achieve quick reimbursement and improved cash flow, claims will be submitted in a timely manner. We will continuously monitor claim status to identify any potential issues and quickly take appropriate action if necessary.
Why Choose Prospect Healthcare Solutions?
Accurate Medical Billing
Our team is also composed of billing professionals who are familiar with healthcare billing, coding, and claim submission processes. Our goal is to make your billing process more efficient and minimize the risk of errors, leading to enhanced reimbursement levels.
Regulatory Compliance
We ensure continuous improvement towards the requirements of current healthcare regulations so that your practice remains compliant and you do not suffer from sanctions and denials. Such emphasis on compliance increases the management of risk and comfort level.
Better Cash Flow
We improve your cash flow and your financial performance by easing reimbursement times and reducing billing errors. Our optimized revenue cycle management translates into more money coming in faster and a more reliable medical revenue service.
Customized Solutions
Every healthcare provider is unique, and we understand this fact. Our billing solutions are customized to meet your needs, so your income will be optimized, and the amount of time spent on paperwork will be decreased.
Reduced Administrative Burden
Managing billing tasks within the company can be a drain on time and resources. Our outsourcing services allow your employees to concentrate on patient care, which in turn encourages a more patient-oriented practice.
Enhanced Patient Satisfaction
With greater attention to patient care, it is no surprise that the patients are happier and more satisfied with their care. Your practice can do what it does best. We deliver high-quality care while other professionals deal with billing issues.
Expert RCM Services
Ensuring Accurate & Timely Reimbursements
Prospect Healthcare Solutions is an expert at offering Medical Business Solutions for medical providers. We know the struggles every Physician, Laboratory & Medical Group face. Our goal is to provide effective options for them.
We provide a complete array of services: customizable patient & insurance billing and collection, enabling staff to get back to a patient or doctor within 24 hours of request for payment. Practice Management solutions for all types and sizes of medical practices.
Medical Billing Services for Small Practices
Prospect Healthcare Solutions is a leading provider of medical billing services for small practices. By providing these services, we help our clients increase their revenues and streamline their operations by providing them with the highest level of customer service possible.
Small healthcare providers often have different challenges than their larger counterparts, so we work closely with each client to determine their unique needs and provide them with customized solutions and services.
We provide medical billing for primary care, ensuring fast reimbursements for their submitted claims by providing accurate and timely submissions. Our medical billing for home health services and medical billing for mental health includes simplifying documentation to help home health caregivers receive cash flow more quickly.
We provide medical billing services physical therapy, medical billing for urgent care, medical billing for cardiology, and medical billing for pain management, by providing coding and claim management accurately for each specialty.
HIPAA-Certification and Achievements
As an emerging medical billing and coding company, we prioritize compliance with state regulations and industry standards. Our healthcare medical billing solutions fulfill the exact needs of the providers. We focus on 99% fast claim submission with minimal denial rates.
Ensuring Accurate & Timely Reimbursements
Prospect Healthcare Solutions is a trusted partner and the best medical billing company for medical billing services. We understand the challenges faced by physicians, labs, and other medical groups, and are committed to providing efficient solutions.
We offer a comprehensive suite of services, including customized insurance and patient billing, healthcare recovery assistance, and practice management solutions – designed to fit organizations of all sizes and needs.
Denial Management
With our denial management services, what first appeared to be a loss of revenue transformed into opportunities for growth. We attentively tackle claims that had previously been denied to reduce your future rejections. We analyze rejected claims, note patterns and take steps to reclaim full revenues.
Payment Posting
We make sure that the payments are put down on paper correctly and without delay so that your clearinghouse can keep all the records. Our team checks insurance payments and manages it all, including rates paid by patients and refunds of money to companies. It also helps to maintain your cash flow.
AR Follow Up
By keeping in contact with the payer or payee of the unpaid or denied claim, we expertly manage your Accounts Receivable (AR). Our team is available to settle off all outstanding balances, thus preventing claims from becoming late and reducing the potential damage to revenue.
Patient Eligibility
We offer eligibility verification services to confirm patient coverage information before any service is performed. By doing this, we can make sure that insurance companies do not deny claims. We work directly with insurers so your patients can first get the treatment they require.
Outsource our Healthcare Billing Services and Solutions
By partnering with Prospect Healthcare Solutions as your outsourced medical billing and revenue cycle management (RCM) provider, you will benefit from our expertise in claims submission, coding accuracy, and regulatory compliance. Our streamlined processes enable us to efficiently process your medical bills while minimizing billing errors and accelerating payment timing.
As a result of using Prospect Healthcare Solutions' services, you will be able to significantly decrease the administrative workload associated with your practice's day-to-day operations while improving your overall RCM performance. In addition to reducing your operational costs and allowing your staff to spend more time focusing on patient care, we will ensure that your practice remains in compliance with all applicable state and federal laws while providing protection from possible penalties or claim denials.
The team of specialized billing professionals at Prospect Healthcare Solutions is continuously updated on the latest changes in healthcare regulation, so we provide personalized solutions based on the unique needs and characteristics of each provider. You will optimize your ability to collect what's owed to you while ensuring timely payment and accurate reimbursements through our services.
What Our Clients Say About Our Services
"Exceptional Support for Our Urgent Care Clinic"
As an urgent care physician, our clinic faces high patient volumes and rapid turnover. Partnering with Prospect Healthcare Solutions has been a game-changer. Their expertise in handling complex billing scenarios and insurance claims ensures we get reimbursed quickly and accurately. The team is incredibly responsive, and their real-time reports allow us to focus on patient care without worrying about administrative hassles. I highly recommend their services!
"Streamlined Pediatric Billing Like Never Before"
Running a pediatric practice means dealing with a wide range of insurance plans and claims, which can often be overwhelming. Prospect Healthcare Solutions has completely transformed our billing process. Their attention to detail and thorough understanding of pediatric coding ensure every claim is maximized for reimbursement. Thanks to them, we’ve seen a 30% reduction in denied claims and a significant boost in revenue. Their team truly feels like an extension of our practice.
"Internal Medicine Practice Thrives with Their Expertise"
Managing an internal medicine practice comes with its unique set of challenges, particularly with Medicare and private insurance claims. Prospect Healthcare Solutions has been a reliable partner, helping us navigate regulatory changes effortlessly. Their proactive approach to claims management and follow-ups has significantly improved our cash flow. It’s rare to find a billing company with such a deep understanding of our field—I’m so glad we found them!
"A Trusted Partner for Specialty Practices"
As a specialist, I’ve worked with other billing services before, but none compare to Prospect Healthcare Solutions. Their team’s knowledge of specialty billing codes and regulations is unmatched. They’ve helped us resolve long-standing issues with claims and recover substantial revenue we thought was lost. Their commitment to our success is evident in every interaction, and I can’t thank them enough for their support.
"Hassle-Free Billing for Our Multi-Site Practice"
We operate multiple clinics across the state, and finding a billing partner who could handle the complexity of our operations was a challenge—until we found Prospect Healthcare Solutions. They have seamlessly coordinated billing across all locations, ensuring consistent accuracy and efficiency. Their dedication to staying ahead of industry trends has kept us compliant and profitable. We’re incredibly grateful for their partnership.