Medical Billing Audit

Kentucky’s healthcare sector is facing challenges with medical claim denials, with the average denial rate around 18%. With about 135 hospitals and many healthcare facilities, the state’s billing processes could greatly benefit from specialized audit services to improve accuracy and efficiency. Medsit Nexus offers medical billing audit services to support Kentucky healthcare providers in reducing claim denials, maintaining compliance, and improving revenue cycles. By identifying errors, enhancing accuracy, and helping to accelerate reimbursements, we aim to contribute to greater financial efficiency.

Medical Credentialing

Credentialing involves extensive paperwork, constant follow-ups with payers, and strict compliance requirements, draining valuable resources away from patient care. Since 2018, Kentucky has lost 12.5% of its physicians, and 43 counties are already facing primary care shortages, according to Kentucky Health News. MedsIT Nexus helps ease this burden by providing streamlined, accurate, and timely medical credentialing services. We handle the complexities, assisting providers to streamline their enrollment and approval processes, so they can focus on growing their practice.

Medical Coding

Healthcare providers in Kentucky lose up to 30% of potential revenue due to claim denials, coding errors, and administrative inefficiencies (MGMA, 2023). With increasing payer scrutiny and Medicaid redetermination issues, expert billing and coding services are essential. MedsIT Nexus’s certified team provides expert medical coding services to ensure accurate claim submissions, reduce denials, and speed up reimbursements, helping healthcare facilities recover lost revenue and maintain compliance.

Medical Denial Management Services

In 2022, Kentucky hospitals faced a negative 2% operating margin, resulting in losses over $250 million, with 38% of hospitals at risk of closure. On top of that, insurers like Humana and UnitedHealthcare report denial rates as high as 43%, which further impacts their revenue. MedsIT Nexus’s billing management team, with a focus on denial management services, is equipped to tackle these challenges head-on. By streamlining revenue cycle processes, reducing claim denials, and ensuring faster reimbursements, we help Kentucky healthcare facilities recover lost revenue, improve cash flow, and secure long-term financial stability.

Accounts Receivable Management

Unresolved aging claims can significantly impact revenue cycles and undermine operational stability. In Kentucky, healthcare providers lose up to 30% of their revenue due to inefficiencies in accounts receivable (AR) management and delayed follow-ups, with claim denial rates exceeding 20%. Medsit Nexus offers specialized AR management services to address these challenges. By reducing denial rates, expediting collections, and enhancing cash flow, we help healthcare facilities recover lost revenue and maintain long-term financial stability.

Medical Insurance Verification Services

In Kentucky, health insurance coverage is divided among various public and private programs, creating significant challenges for healthcare providers. Approximately 45% of births are covered by Medicare, while Medicaid covers 15.6%. Employer-sponsored insurance (ESI) covers 46.1% of the population, and 3.5% have individual market insurance. However, 5.6% of Kentuckians remain uninsured, and 1.3% have military insurance. The wide range of insurance plans and coverage types complicates the verification process, often leading to costly errors and delays in claims. These inefficiencies disrupt revenue cycles and slow reimbursements. Medsit Nexus offers top-notch Medical Insurance Verification services that are designed to eliminate these complexities. We ensure accurate coverage checks, reduce errors, and streamline the reimbursement process, helping Kentucky healthcare providers maintain financial stability and avoid delays.