WCH Service Bureau – your shield against revenue losses

Each day, our billing experts encounter hundreds of claim denials, rejections, and underpayments. At WCH Service Bureau, our account representatives identify and reprocess every claim that has not been paid appropriately. Most underpayments are completely random and are caused by nothing but mistakes done by insurance carriers and healthcare providers. However, it would be silly for us to assume that there are no patterns leading to six-figure revenue losses. For 21 years, we have witnessed insurances violating the law and deliberately not paying for some services. Recently, our account representatives Julie Markova and Nozima Kholmukhamedova have resolved a major year-long underpayment case, helping our client to get back it their well-deserved $12,000 from a major New York insurance carrier.
Are you sure that your practice is fully immune to systematic revenue losses? 
Please keep reading to discover how We Can Help you ensure that you get paid what you deserve.
From the very first days of WCH Service Bureau, helping healthcare providers has been our ultimate goal. From a small private practice to major inpatient facilities, over 500 practitioners, hospitals, and home care agencies have entrusted their insurance claims billing to us. Today, we would like to share our recent accomplishment. This February, we have helped our client to resolve a major series of denials worth over ten thousand dollars.
One of our clients is an osteopathic doctor and a primary care physician. Currently, they run a small outpatient practice in Brooklyn, NY. Each day, dozens of patients insured under Medicare, Medicaid, and commercial policies visit this doctor’s office to get rid of their back pain and improve their overall lifestyle. From early 2020 till September 2021, our client had submitted 143 claims for osteopathic manipulative treatment services (OMT, CPT 98926-98929) to FidelisCare. According to the CMS clinical policy, OMT cannot be furnished and reported without an applicable office visit procedure (CPT 99202-99215). The same policy also requires healthcare providers to append modifier 25 on office procedure codes to indicate that OMT is not incidental to a consultation. Insurance carriers are obliged to pay for both services since this modifier indicates their medical necessity. However, sometimes payers enact internal payment policies that create obstacles in processing of such claims. FidelisCare, for example, does not pay for office visit procedures reported together with OMT unless the medical records are provided. Nowhere does the payer indicate this rule. It is not specified in any official reimbursement policy of FidelisCare, let alone the CMS. Osteopathic providers will not find this rule on FidelisCare website or their enrollment contract. Moreover, FidelisCare does not notify healthcare providers about a true denial reason for the service on the Explanation of Benefits (EOB), instead simply saying that an office visit is bundling to an OMT procedure. This cannot be true, since the primary purpose of the modifier 25 is to indicate that procedures are not incidental to each other.  In the case of our client, no request for medical records has ever been made by FidelisCare for these services.  As a result, all of 143 claims had been underpaid, causing a major decline in the practice reimbursement. For several months, Julie Markova and Nozima Kholmukhamedova, our account representatives, had been struggling to find out the true denial reason of the affected procedure codes. Following the advice of the FidelisCare network representative, we gathered and submitted the medical records for each affected claim in the form of a collective appeal. The payer has swiftly upheld its original decision, stating that the records were submitted too late. All this forced Julie and Nozima to submit an appeal to the New York State Department of Financial Services. 
This January, WCH Service Bureau has won this appeal on behalf of our client, and all the affected claims have been reprocessed and paid in full. An entire outstanding amount of $12,000 illegally withheld from our client, has been paid in full. The client is satisfied, and so are we.
And this is just a single story of accomplishment!
Having resolved hundreds of cases like this, here is what we would recommend you do:
I. Check every EOB you get from insurance carriers before you notice a six-figure revenue decline
At WCH Service Bureau, we verify the status of submitted claims every day. Constant monitoring of the revenue flow helps us detect & work on underpaid claims quickly and efficiently, preventing our clients from significant gaps in revenue. However, our contribution is never enough. If you start looking through your EOBs on a regular basis, you will identify all the “weak spots” of your revenue flow, like the following:
• Most frequently denied procedure codes• Least payable services• The most unprofitable insurance• Most common denial reasons
II. Act swiftly and have no doubts – submit the requested medical records as soon as possible
Do not let your denials “pile up”! Payers often request medical records for denied claims even if a denial has nothing to do with medical necessity. In most cases, there is a timely filing limit to submit the documentation. Therefore, you should never be doubtful on whether to submit the charts or not. The time is ticking, and each delay in submission may cost you thousands of dollars. Yes, we understand that sometimes you may not be sure whether it is worth submitting the documentation because you feel it may not be compliant with the payer’s filing requirements. This is what you need our internal auditing service for!
III. Talk to your biller or account representative on a regular basis
Time is money. We know how busy you may be providing top-quality services to your patients. Identifying claim denials and underpayments may be an equally time-consuming process. We have got you covered on this one! There is no need to look through your EOBs, checks, and bank statements every day. A quick conversation with your dedicated expert is often enough to be on the same page with all the issues of your revenue flow. Our billing specialists are available to you 6 days a week. Please keep in mind that we immediately contact you should we identify a significant issue that needs your attention. Your account representative will never call you simply “to discuss the things”. Each important issue requires you to be briefed.