Systems for Billing Companies
Medical billing companies generate revenue by capturing a percentage of collected provider fees, but profit margins are often eroded by manual claim scrubbing and high labor costs. Leakage occurs when unaddressed denials sit in the aging report or when provider credentialing delays prevent billing altogether.
Healthcare
How the business actually works
Provider Intake
Secure collection of NPI, tax identification, and credentialing documents via client portal.
Implementation
Setting up clearinghouse connections and establishing secure data transfer for patient encounters.
Claim Scrubbing
Automated verification of ICD-10 and CPT codes to ensure clean claim submission.
Adjudication Monitor
Tracking the status of submitted claims through the clearinghouse to identify early rejections.
Denial Management
Categorizing and appealing denied claims with automated documentation assembly.
Patient Statementing
Generating and delivering balance due notices via mail, email, or secure text.
Payment Posting
Reconciling electronic remittance advice and manual payments against open accounts receivable.
Performance Review
Distributing monthly financial reports and key performance indicators to practice stakeholders.
Where it leaks
Delays in provider enrollment lead to held claims and cash flow interruptions for the practice. Manual tracking of expiration dates often results in missed re-credentialing deadlines.
Unresolved denials frequently expire due to timely filing limits when staff cannot keep up with the volume. Without a systematic queue, small balance claims are often ignored in favor of larger ones.
Missing patient demographics or insurance information from the front office causes repeated rejections. Constant back and forth communication between the biller and the practice wastes billable hours.
Practices often feel in the dark about their actual collection rates and aging status. Manual report generation is time consuming and prone to spreadsheet errors.
High deductible plans increase the burden of collecting directly from patients, which billers are often ill-equipped to handle. Without automated follow-up, patient balances frequently turn into bad debt.
What LATTICE can build
A secure hub where practices upload daily encounter forms and view real-time collection dashboards.
Categorizes rejections by reason code and assigns them to specialists for immediate appeal action.
Sends automated SMS and email reminders with secure click-to-pay options for outstanding balances.
Monitors provider status and sends automated alerts for license renewals and board certifications.
Standardizes the collection of missing patient data from the clinic to prevent front-end rejections.
Visualizes net collection ratios, days in A/R, and top denial reasons for client meetings.
Notifies staff when claims approach timely filing limits to ensure no revenue is forfeited.
Automated requests to providers for missing clinical notes required to satisfy payer audits.
Example systems
Tell us what's slowing the business down. LATTICE can build around the way your business operates.
The system allows for custom workflows based on the specialty, ensuring that orthopedic claims follow a different scrubbing logic than mental health or cardiology. You can define specific rule sets for modifiers and CPT pairings unique to your client base.
By using automated status checks and electronic inquiries, your team can identify claim status without manual calls. This shifts the focus from discovery to resolution, increasing the number of claims a single biller can manage.
The client portal acts as a central communication hub where you can flag specific encounters for missing information. The practice staff receives an alert and can upload the necessary documents directly to the record, creating an audit trail.
While the focus is on revenue cycle, the data management tools can track the quality measures required for value-based care initiatives. This ensures your clients remain compliant while maximizing their reimbursement potential.
The platform is designed with healthcare-grade security protocols, including encrypted data transmission and strict access controls. It supports your internal compliance efforts by ensuring that all patient data is handled according to industry standards.