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.

Insurance Credentialing

What Is Insurance Credentialing?

Insurance Credentialing is the process the healthcare facility or managed care organization/health plan uses to collect and verify the “credentials” of the applicant. This includes verification of many elements including licensure, education, training, experience, competency, and judgment.

Physicians and other healthcare providers who wish to provide care in a hospital, ambulatory care facility, or other healthcare facility must undergo an application process which includes verification of credentials. Additionally, providers that want to bill an insurance company and receive reimbursement for services as an in-network provider must undergo a process of credentialing. Healthcare facilities and health plans will verify relevant education including medical school, residency/fellowship training, board certification, licensure, professional liability insurance and claims history, and will query the National Practitioner Data Bank (NPDB). The NPDB is an electronic repository containing information on medical malpractice payments and certain adverse actions related to healthcare practitioners, entities, providers, and suppliers.

Provider Enrollment Vs Provider Credentialing

Provider credentialing is different from provider enrollment. Provider enrollment is the process of enrolling a provider with insurance payers. The provider must submit a credentialing application that details their training and qualifications to treat patients in their area of specialty. After the application is submitted and credentials are verified, the approval process will involve review and approval by the network’s medical director or credentialing committee.

Process Of Credentialing:

Our Step-by-Step Physician Credentialing Process Strategy and Information Gathering

Collect documents and provider information:

Gather personal and organizational information, including CV, license information, Tax ID, NPIs’ practice address, pay-to address, etc.
Help providers in the process of selecting insurance carriers they would want to be credentialed with.

Application Submission

Start filling out and submitting applications online or on paper for insurance companies to review and start the process.

Follow-Up

Rigorous action is taken to make sure that the application is not pending for corrections or missing document(s).
Continuous follow up with insurance carriers to get the updates on credentialing process.
Once the application has been made through the initial process, we will ensure that it transitions smoothly into the contracting phase.

Contract Negotiations and Effective Dates

When enrollment is approved, the insurance carriers will email/mail the contract for provider signature. If needed, payers’ agreements are reviewed and negotiated.
After the provider signs, these agreements are returned to the payers for loading into their system to ensure that provider is in network.
We ensure that the effective dates to start seeing patients, as well as provider IDs for the applicable payers, are received.
Finally, we provide this information to your billing/administrative department or your billing company so that you can start seeing patients and have an uninterrupted cash flow.

CAQH Registration

CAQH has an online database for storing provider information and sharing it with insurance companies. Many insurance companies require providers to use the CAQH database so that they can obtain credentials directly during enrollment.

Steps:

Create a secure Username and Password for providers.
Complete the application and submit the required documentation.
Fax/upload signed attestation to certify the accuracy of the application.
Grant insurance companies access to the online application.

Medicare Enrollment

Medicare enrollment can cost you thousands of dollars in lost revenue if done incorrectly. We specialize in all aspects of medical enrollment and will work to enroll you quickly and correctly with your local Medicare administrator. We can get you credentialed faster through PECOS (Prover Enrollment, Chain and Ownership System) because we already have an active account with PECOS.

Steps:

Start credentialing through PECOS.
Submit enrollment application for individual physician and non-physician practitioners.
Submit enrollment application for Clinics/Group Practices and Certain other Suppliers.
Submit enrollment application for Reassignment of Medicare Benefits (individual physicians and non-physicians).
Upload signed attestation and documents.
Follow up in a timely manner to ensure application is complete and all the documents are uploaded.
PTAN (Provider Transaction Access Number) is issued by MAC (Medicare Administrative Contractor) upon approval of enrollment.
Submit EFT application for the transfer of electronic funds to the provider’s account.

Medicaid Enrollment

Medicare and Medicaid are separate programs. Submitting an application to Medicare does not mean you have also submitted an application to Medicaid. Enrollment approval in Medicare does not guarantee enrollment approval in Medicaid. Therefore, a separate enrollment with Medicaid is required.

Steps:

Create a secure account and obtain User ID and Password.
Submit application online for individual practices, group practices, and organizations.
Upload required documentation.
Attest to certify the accuracy of the application.
Submit EFT application.
We will not sign off until the provider receives a decision from the insurance carriers.

PPO/HMO Enrollment

PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization) are two different programs. Both plans use a network of physicians, hospitals, and other healthcare professionals. Credentialing with PPO and HMO carriers is done separately as per the provider’s request to join the network.

Steps:

An application is obtained from the insurance carriers.
A complete application with documentation is submitted.
The provider receives a contract and guidelines for reimbursement from the insurance carriers for signature.
Upon approval of network status, an executed contract is received from insurance carrier.
Contracted rate of reimbursement can be negotiated with insurance carriers on behalf of the provider.
We will not sign off until the provider receives a decision from the insurance carriers.

Services

Specialties we credential

Physicians (MD/DO)-All Specialties

Advanced Practice Providers

Behavioral Health Providers

Psychologists (PhD/PsyD)
Licensed Clinical Social Workers (LCSW)
Licensed Professional Counselors (LPC)
Marriage & Family Therapists (LMFT)
Licensed Chemical Dependency Counselors (LCDC)
BoardCertified Behavior Analysts (BCBA)

Allied Health & Ancillary Providers

Physical Therapists (PT)
Occupational Therapists (OT)
SpeechLanguage Pathologists (SLP)
Audiologists
Dietitians
Optometrists
Podiatrists
Chiropractors

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Get credentialed with top insurers fast streamline your enrollment and grow your practice today

Insurance Credentialing

What Is Insurance Credentialing?

Provider Enrollment Vs Provider Credentialing

Process Of Credentialing:

Collect documents and provider information:

Application Submission

Follow-Up

Contract Negotiations and Effective Dates

CAQH Registration

Steps:

Medicare Enrollment

Steps:

Medicaid Enrollment

Steps:

PPO/HMO Enrollment

Steps:

Services

Specialties we credential

Advanced Practice Providers

Behavioral Health Providers

Allied Health & Ancillary Providers

Get in Touch

Cosmos Medical Management LLC (CMM)

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