Medical Billing Audit

In 2024, clinical documentation audits and reviews in California increased by 100% compared to the previous year. More than 25% of providers failed audits across both professional and hospital care settings, emphasizing the need for improved compliance measures. MedsIT Nexus offers comprehensive medical billing audit services tailored to the unique needs of California healthcare providers, helping them navigate the complex audit landscape and maintain financial stability. Our audits identify compliance gaps, reduce denial rates, and safeguard against revenue loss.

Medical Credentialing

According to the California Department of Health Care Services (DHCS), approximately 300,000 healthcare providers are enrolled in the Medi-Cal program, which is California's Medicaid program. The high volume of providers in California means both the credentialing and recredentialing processes are even longer, posing challenges for healthcare organizations to maintain accurate provider information. MedsIT Nexus streamlines the credentialing process, ensuring compliance with state regulations, reducing administrative burdens, and facilitating timely provider onboarding. We help healthcare organizations maintain a competent workforce, ultimately enhancing patient care and operational efficiency.

Medical Coding

As per AAPC (American Academy of Professional Coders) in California, approximately 20% of medical claims are rejected due to incorrect coding, leading to revenue loss and increased administrative costs. Healthcare providers face significant challenges with billing errors, as the coding process is both complex and prone to human error. MedsIT Nexus provides precise medical coding services in California, reducing claim rejections and enhancing reimbursements. Our experts ensure compliance with state and federal regulations, improving claim accuracy and revenue recovery.

Denial Management Services

According to the American Medical Association in California, healthcare providers face a significant challenge with medical billing denials, with an average denial rate of 9-10%, leading to lost revenue and operational inefficiencies. Our Denial Management Services streamline the claims appeal process, identify root causes, and ensure timely corrections. By targeting common denial reasons—such as coding errors, eligibility issues, and payer discrepancies—we help reduce denials and recover more revenue, improving cash flow and operational efficiency.

Accounts Receivable Management

Over 30% of inpatient and outpatient claims submitted to commercial payers in California remained unpaid for more than three months in the first quarter of 2023, compared to just over 10% for Medicare claims. In addition, 52% of California hospitals operated with negative or unsustainably low profit margins, highlighting the financial pressures exacerbated by AR management issues. MedsIT Nexus offers comprehensive accounts receivable management services tailored to the unique needs of California healthcare providers. Our solutions aim to streamline the AR process, reduce days in accounts receivable, and enhance overall financial performance.

Medical Insurance Verification Services

Over 13 million residents, accounting for more than one-third of the state's population, were enrolled in Medi-Cal, California's Medicaid program. About 53.7% of the population had private health insurance coverage. Healthcare providers who remain busy in patient care often lack knowledge about the diverse payer requirements, leading to billing issues such as documentation errors, inaccurate coding, and claim rejection. MedsIT Nexus enhances revenue integrity for California healthcare providers by expertly managing billing across Medi-Cal, Medicare, and private insurers, reducing denials, accelerating reimbursements, and ensuring financial stability in the state’s complex insurance landscape.