Should You Outsource Your Billing?
     Outsourcing or partnering your billing will allow you to better focus on the day-to-day operations of your practice.  Plexus' services are designed to allow you to hand over the entire Revenue Cycle process or integrate processes from front end to back which encourage a united model of communication and procedures.  For your practice this means less stress and increased revenue. Our team will collect more of your revenue, faster, and at a lower cost than if you were to hire full- time employees to do the work. This will allow you time to concentrate on patient goals not collection goals. We provide numerous reports to prove our ongoing collection efforts that will put your mind at ease. Let us handle all patient and insurance billing, claims and reimbursement concerns. Our transparent approach will put your mind at ease knowing that every possible step is being taken to manage your practice. Call us today to discuss the many ways in which we can help grow and maintain your practice goals.

 Medical Billing & Revenue Cycle Management

      Our client driven approach provides outstanding customer service, support and training for doctors, staff and patients. Our experience in multiple specialties and continuous education for our staff proves to be advantageous to clean up practices with diminished revenue and maintain high standards in customer service and paid claims. We continuously monitor and follow up on claims over 30 days old and call or appeal immediately after denial or a request for information is received. Reporting and revenue cycle meetings are provided to ensure all provider staff possess the same knowledge and has a clear understanding of their part in the revenue cycle. All staff has an impact on claim payments and creating the best practices for each department and constantly communicating effectively is a key component to running an efficient private practice, FQHC or multi-provider clinic.

       We strive to work as one with your team and provide support for questions or concerns. We are your "business office" as we manage the claim from the invoice/superbill through its completion and all steps in between (claim submission, providing requested information to insurance companies, appealing denials, reviewing chart notes for best coding practices, suggesting coding tactics to maximize charges. We have processes and policies that will integrate to your practice and work flow ,but is customizable to make our combined processes easier and more efficient. We have a practice management system that we will set up for you and facilitate full training for your staff. Most EMR products integrate with our software system for electronic transfer of claims. For larger facilities we will learn your PM system and EMR to become super users on the system and are able to meet our efficiency goals.

Some of our routine duties:

*Monitor KPI's (key performance indicators) to maximize cash flow. We typically achieve much better results compared to the industry standards.
*Review all charges to ensure proper coding
*Verify MA and MC eligibility
*Verify PT demographics
*Transfer electronic claims to each Insurance Company
*Review of insurance communications Post insurance & patient payments

*Process Claim Denials & File Appeals
*Follow-up on unpaid insurance claims and patient accounts
*Monthly auditing of accounts and fee schedule

*Generate patient statements

*Provide customer service to patients

*Prepare write-off & refund requests

*Patient collection services

FQHC Billing

We understand that FQHC and CHC billing is unique and demands attention to additional areas that other clinics do not need to monitor. That is why we take extra time to ensure the highest level of Medicaid and Medicare paid claims to maximize your cost report reimbursement and incentive payments. We possess the knowledge of how to submit Medicare claims to Part A with the correct revenue code, roll up configuration and required HCPCS codes. We monitor patient household assessments and FPL levels to ensure they receive their necessary sliding fee discount prior to being billed. We monitor Medicaid backdating and retroactive eligibility so claims can be submitted and paid months later and included in your incentive payment. We stick to the strict collection policies and guidelines required of FQHCs to ensure we are abiding by all state and federal guidelines. We completely support the mission and are honored to be involved in helping the underserved, uninsured and underinsured population.

      Our staff acknowledges that this patient base does not always receive the best care and customer service, but that empowers us to provide the absolute best support and guidance for your patients and staff. We are not only concerned about reimbursement, but pride ourselves on going above and beyond to serve the community with you.


Chart Auditing

We have certified medical auditors on staff that can perform required audits associated with your annual cost reporting or internal auditing procedures. With access to your EMR we can randomly pull  charts and perform accurate and precise reviews for any specialty or degree (physician, nurse practitioner, physician assistant, MSW, etc.). Once completed, you will receive an audit form filled out with any issues or recommendations. On-site coding help is also provided based on findings.

Physician Credentialing

Due to the challenging process demanded by the insurance companies many physicians have trouble with denials related to credentialing . We have years of credentialing contacts at the insurance company's offices and can eliminate these unnecessary denials. We provide our practices and physicians the option of full credentialing services. We have qualified credentialing specialists using the latest insurance credentialing software to submit applications for your new providers and monitor the re-credentialing of your present staff and facilities. We are familiar with CAQH, NPPES and RWHC. Reports and spreadsheets are produced to provide status updates based on your needs. These days constant monitoring of credentialing status is necessary and handing this task over to Plexus will allow you time to focus on patient care and not wondering if you will be paid by their insurance.

Comprehensive Staff Training

All of our staff is cross trained in multi-specialty billing, obtaining authorizations, verifying patient demographic and insurance information, working the A/R and answering all patient calls. With this expertise we will create manuals, cheat sheets, details step-by-step how to binders on most processes within your practice.

     Reception staff has benefited from our training by learning what questions to ask at check in, what information is needed from the insurance card and driver's license to produce a clean claim and how to ask for payment. Clinical staff has benefited from our specialty specific coding training, which included CPT, CDT, HCPCS and ICD-10. We review active cases and questionable scenarios to answer the challenging coding questions. Office managers will learn what aspects of the staff, practice and figures need to be reviewed and monitored and what trends to look for so all potential problems are averted.

      HIPAA is not a topic that has much gray area and all of your staff will benefit from our HIPAA and Red Flag Rules training. This training includes take home material and real world examples that will help your staff protect patient's PHI and access it in a secure manner.


Plexus has the knowledge of all aspects of a provider's practice and has helped physician's and practice managers get the business back on track by identifying problem areas and dangerous trends. We provide a comprehensive overview of all areas of the practice, our findings and recommendations on areas of improvements. This review has helped previous providers understand their practice's downfalls and find solutions.

        We can then provide training in these areas or partner with you to handle the billing and revenue cycle management. Our knowledge can become yours! Give us a call today for more details.