Medical Billing Audit

Ohio hospitals generate substantial revenue, for example, The Ohio State University Wexner Medical Center reported $5.9 billion in total revenue for FY2024. However, billing errors are a significant concern. A Medicare compliance audit revealed that The Ohio State University Hospital received overpayments of at least $3.7 million due to billing inaccuracies. Medsit Nexus addresses these challenges by providing thorough medical billing audit services, identifying and correcting errors to ensure compliance and optimize revenue for Ohio healthcare providers.

Medical Credentialing

Ohio's healthcare system comprises over 8,000 licensed providers, including physicians, therapists, and medical suppliers. The Ohio Department of Medicaid (ODM) centralizes the credentialing process through its contracted Credentials Verification Organization (CVO), ensuring compliance with federal and state standards. Ohio healthcare providers face challenges such as delayed reimbursements, administrative burdens, and compliance risks due to incomplete or outdated credentialing information. Medsit Nexus provides medical credentialing services, including primary source verification, timely attestation management, and regulatory compliance, reducing administrative tasks, efficient patient care.

Medical Coding

Ohio's healthcare sector is robust, with over 320 hospitals and 15 integrated delivery networks (IDNs). The demand for medical coders is growing, with the Bureau of Labor Statistics projecting an 8% increase in medical records and health information technician positions. Despite the growing demand, Ohio healthcare providers face challenges in medical coding due to complex coding systems, frequent updates to coding standards, and the need for specialized knowledge. Medsit Nexus provides expert medical coding services, ensuring accurate code assignment, up-to-date knowledge of coding standards, and strict compliance with federal and state regulations to minimize errors and enhance reimbursements.

Denial Management Services

Medical claim denials significantly impact healthcare providers in Ohio, leading to revenue losses and administrative burdens. Nationally, nearly 15% of medical claims submitted to private payers are initially denied, with Medicaid exhibiting the highest denial rate at 16.7%. Alarmingly, approximately 65% of denied claims are never resubmitted, resulting in substantial financial losses. Medsit Nexus offers specialized denial management services in Ohio to address these challenges. By leveraging advanced analytics and automation, Medsit Nexus streamlines the appeals process, reduces denial rates, and enhances revenue recovery. Their expertise ensures that providers can focus on patient care while optimizing their financial performance.

Accounts Receivable Management

A one-day delay in ARD increases leverage by 2.20%, highlighting the financial impact of delayed collections. Ohio residents are among those affected by the national medical debt crisis, with initiatives underway to alleviate significant amounts of medical debt. Medsit Nexus enhances accounts receivable management for Ohio healthcare providers by streamlining collections, reducing AR days, and improving cash flow, ensuring financial stability and addressing billing challenges efficiently.

Medical Insurance Verification Services

Approximately 68.1% of Ohioans had private health insurance, while 38.8% were covered by public insurance programs such as Medicaid and Medicare. Specifically, about 16% of Ohio's population, or approximately 1.86 million residents, were enrolled in Medicare. The diverse payors in Ohio, Medicare, Medicaid, and private insurers, each have unique regulations, creating complexity for healthcare providers in managing billing, reimbursements, and compliance. Medsit Nexus simplifies these challenges by providing tailored billing services that ensure accurate claims and streamlined reimbursements for all payer types.