Why should I use Cosmos Medical Management (CMM) for medical billing and management services?

Our collection from insurance companies is 100% and A/R denial is >1%. By outsourcing billing and management services to CMM, you do not have to worry about billing staff as we are responsible for hiring, training, and supervising of employees. Our services will allow you to free up your office space and eliminate the need for billing software, thus alleviating stress, and giving your staff more time to devote to patient care and day-to-day activities. Our 20 years of experience allow us to improve your collections, no matter the size or specialty of your practice. Aside from billing services, CMM also provides complete credentialing and recredentialing services with a variety of insurance companies. We can help set up new practices and obtain NPI numbers and tax IDs if needed etc. Cosmos Medical Management is your end-to-end virtual medical billing, coding, credentialing, and management solution.

How do I make billing information available to CMM?

There are several ways to do this. We can download the patient’s demographics and superbills from your office if you give CMM remote access. Alternatively, you can email or fax the information to CMM via our secure eFax service.

How are primary and secondary insurance claims filed?

All claims are initially filed electronically or on paper if the carrier does not accept electronic claims. Claims that require medical documentation are faxed, emailed, mailed, or uploaded to the insurance website. Claims billed to secondary carriers are faxed, mailed, or billed electronically with primary insurance EOB.

How do you ensure that all claims are processed and paid by the insurance company?

We run reports regularly and use several steps to make sure all claims are paid in a timely manner. We work on each claim until it has been paid or a reasonable denial for nonpayment has been given. If a claim is not paid in a timely manner, our professional staff either calls or checks its status online and follows up rigorously until its settled. If a claim is denied and we are not satisfied, then we appeal the decision and work that claim until a satisfactory decision is rendered.

How does your company get access to EOBs and payments?

Most insurance companies make EOBs available electronically, which can be downloaded in our software through our clearing house or from the insurance carrier’s website. If your office receives EOBs and checks from insurance companies and patients, the payment will be deposited by your office staff, and EOBs and copies of the payment will be faxed to CMM.

Where do payments from insurance carriers and patients go?

All payments from insurance carriers and patients are sent directly to you by mail or through Electronic Funds Transfer (EFT). You can choose whether payments and EOBs are remitted to your post office box, bank lockbox, or physical address. If you choose to use a lockbox, EOBs are mailed to your bank where all the checks are scanned and deposited and made available through the online banking system. If you use a PO box or physical address, EOBs and checks are mailed to the payment mailing address.

How does CMM handle delinquent accounts?

CMM pursues delinquent health insurance claims and patient accounts professionally and courteously. Our procedure is to send three statements to patients with follow-up phone calls. We offer several payment plans until the account is paid in full. We also provide mutually agreed upon discounts if the patient agrees to send a full payment. Payment through credit card is offered to the patient. If the patient does not respond after three statements and phone calls, then the account is sent to a collection agency upon your approval.

How can I stay in touch with CMM to make sure my billing is done to my satisfaction?

We can meet with local physicians and selected staff upon request. For long distance clients, we can arrange a phone call or Zoom meeting to discuss any questions. We provide extensive, self-explanatory reports at the beginning of every month and can create customized reports upon request. We also provide annual comparative reports for up to the past three years of charges, collections, and outstanding balances to show the trend of your practice.

How do I make sure that patient information and data is secure?

CMM is a HIPAA-compliant billing and management company. We follow secure data protection policies, and our data is securely backed up multiple times every day.

Who answers medical billing service questions that patients might have?

The staff at CMM answers all billing-related phone calls and questions. A toll-free number will be provided on all claims and patient statements.

How do you charge for your billing and management services?

CMM does not get paid unless you get paid. Our fees are percentage-based and proportional to your receipts. The percentage charged is based on many factors, including specialty, practice size, and customized services offered. There is a one-time, nonrefundable setup fee for new and established practices. Credentialing services can be provided on an hourly basis or per project. Please contact CMM for more information.

Can I revoke or cancel my agreement with you?

Your contract with CMM is nonbinding and can be cancelled with 90 days’ prior notice and a written agreement from each party.

How do I get started?

We will send you a service contract to review and sign. We can start entering your data as soon as the agreement is signed, and the appropriate information is available. For more information please submit through our contact form or schedule a free consultation.

Fee Schedule Development And Evaluation

Fee Schedule For Healthcare Providers

Align Your Charges with You Expertise – Transparent & Competitive Fee Schedules for Maximum Reimbursement

Have you ever wondered if you are being UNDERPAID because your FEE SCHEDULE is not created according to healthcare guidelines and demographic localities?

Understanding your fee schedule is essential for maintaining a financially healthy practice. Our comprehensive fee schedule services provide custom fee schedule to each provider according to their specialty. We assist providers in setting competitive, compliant, and profitable rates, ensuring proper reimbursement from commercial insurers and government payers.

Our Fee Schedule Services Includes:

1. Custom Fee Schedule Creation

Custom Fee Schedules : We work closely with you to develop a fee schedule that reflects your practice’s unique needs, payer contracts, and industry standards. We ensure that the schedule supports both the operational goals of your practice and the reimbursement policies of your insurers.

Payer Contract Alignment : Our team ensures that your fee schedule is aligned with the terms of your payer agreements, including insurance companies, Medicaid, Medicare, and other third-party payers.

2. Fee Schedule Maintenance

Regular Updates : Healthcare reimbursement rates change frequently, and so do the requirements set by payers. We help keep your fee schedule up to date with regular reviews, ensuring it remains aligned with current regulations, market trends, and payer contracts.

Rate Adjustments : As your practice grows and evolves, we assist with necessary adjustments to your fee schedule to maintain competitive and accurate pricing for your services.

3. Compliance Assurance

Regulatory Compliance : We ensure your fee schedule complies with all federal, state, and payer-specific regulations, including those related to Medicare, Medicaid, and commercial insurers. This helps to avoid compliance issues and penalties.

Payer-Specific Guidelines : Our team updates payer policies regularly and ensures that your fee schedule complies with specific payer guidelines, reducing the chances of claim rejections or underpayments.

4. Fee Schedule Audits

Audit and Analysis : We perform regular audits of your existing fee schedule to identify potential gaps, inconsistencies, or opportunities for improvement. Our team ensures that your schedule is optimized for maximum revenue.

Optimization Recommendations : After reviewing your fee schedule, we provide actionable recommendations to optimize pricing for services, ensuring your practice is maximizing its reimbursement potential.

5. Fee Schedule Implementation

Seamless Integration : We help integrate your updated fee schedule into your practice management system (PMS) or electronic health record (EHR) to streamline billing and coding processes. This ensures accurate pricing for all services provided.

Training and Support : We provide training and ongoing support for your administrative team to ensure that they are fully equipped to manage and implement the new fee schedule effectively.

Our Process: From Discovery to Delivery

Discovery Call & Data Collection : Gather existing fee schedules, payor contracts, and service utilization reports.

Analysis & Recommendations : Deliver a detailed report outlining suggested rate changes, projected revenue impact, and implementation plan.

Implementation & Training : Coordinate with your IT/billing teams to update systems; conduct staff training sessions.

Ongoing Support & Review : Provide scheduled audits, regulatory updates, and ad-hoc consulting whenever payor agreements change.

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Why Choose CMM :

Decades of Specialized Expertise : Our team has decades of experience in fee-schedule optimization for practices of all sizes

Data-Driven Approach : We leverage leading industry tools e.g. CMS, Availity, Medicaid, BCBS for precise fee schedule development.

Customized Solutions : Whether you’re a single‐provider clinic or a multi‐specialty group, we tailor our services to your volume, specialty mix, and payor landscape.

Transparent Pricing : Our a la carte model lets you pick only the services you need – no hidden fees or long-term lock-ins.