Our Services

Medical billing is a complex process that involves multiple steps to ensure that a physician’s practice receives the revenue it is owed. The process can be prone to errors and missed steps, which can result in lost revenue for the practice. To ensure accurate billing and maximum revenue, the process includes error-free charge entry, real-time insurance verification, claims submission and scrubbing, payment posting, patient statements, follow-up and appeals.

Revenue Cycle Management is a critical aspect of running a successful medical practice. Our approach is flexible and consultative, and we offer end-to-end services and a specialized back-office team to meet the specific needs of your medical group. We can help your practice improve profitability and eliminate administrative burdens. To increase revenue, our steps include claim preparation, claim submission, claim management, payment posting and A/R management.

A Financial Medical Audit is an important tool for ensuring compliance and identifying areas of risk in a medical practice. We offer a suite of audit solutions that will fortify your compliance program and resolve key risk areas, driving accuracy, profitability, and peace of mind. Our audit solutions include Medical Chart Review, Risk Management, Improved Documentation, Identifying Coding, Protecting against Fraudulent Billing and Preventing Outdated Procedures. This will help the practice to identify any errors or discrepancies in the billing process and make the necessary corrections.

Credentialing is a process that ensures that medical providers meet the standards and requirements of medical organizations and payers. It helps reduce risk and improve patient relations, while also increasing revenue by attracting new patients. SYSMETICS is a team of professionals that specializes in the credentialing process and helps medical practices join networks of insurance operators, by handling all responsibilities and ensuring that practices are ready for re-credentialing. Our services include data collection, CAQH enrollment, submitting applications, active communications, fully transparent access, and a dedicated customer representative.

Account receivable management is crucial for medical billing and impacting cash flow. SYSMETICS has an internal controls system in place to properly manage AR follow-up, with a goal to submit claims accurately and follow-up with insurance companies and patients to resolve outstanding claims quickly. Key steps include claim submission, tracking, managing denials, insurance follow-up, resubmission, and payment posting.

SYSMETICS offers a Denial Management Process that includes analyzing, tracking, and reporting denials, identifying unpublished rules, and providing suggested remediation methods for individual denial claims. The process also includes identifying and implementing processes for quality improvement, measuring to eliminate recurring denials and optimizing revenue. The process includes identifying the denial reason, categorizing denials, resubmitting claims, developing a tracking mechanism, building a prevention mechanism, and monitoring future claims.