Medical Billing Companies & Consultants in Eatontown, NJ

Metropolitan Healthcare Billing, which also operates as Metropolitan Healthcare Billing Services (MHBS), is a revenue cycle management company based in Eatontown, New Jersey. Since its launch in 2010, it has served mostly independent physicians, laboratories and surgical specialists. Although its base is in New Jersey, the company accepts healthcare clients from any state.

Services

MHBS can manage a practice's entire revenue cycle, from the moment a patient registers through claim filing, denial follow-up and the posting of payments. Beyond billing itself, the firm provides certified coding, credentialing and enrollment for providers, and receivables management, which includes resolving old, backdated balances. Practices considering the firm can request a no-cost assessment of their existing billing operations.

• End-to-end revenue cycle management
• Medical coding and billing
• Appeals and billing for out-of-network care
• Independent dispute resolution (IDR) arbitration and compliance with the No Surprises Act
• Billing for pathology, including global claims and claims split into technical and professional components (TC/PC)
• Provider credentialing and enrollment with payers
• Negotiation of payer contracts
• Assistance with EHR systems and Meaningful Use

Out-of-network reimbursement is one of the company's main strengths. MHBS measures what insurers actually pay against FAIR Health benchmarks. To recover usual and customary rates, it writes tailored appeals at the first and second levels and also pursues peer-to-peer reviews. When necessary, it bargains with third-party repricing vendors and escalates disputes to state insurance regulators. For No Surprises Act requirements, the firm helps providers issue correct cost estimates and required disclosures, and it advocates for them during independent dispute resolution. MHBS reports a 93 percent success rate in its NSA arbitration cases.

Specialties

MHBS has worked across many fields of medicine. Its largest client groups are laboratories, gastroenterology practices and cardiology practices. It also bills for anatomic pathology, anesthesiology, orthopedics and other surgical fields, pediatrics, internal medicine, pulmonology, infectious disease, obstetrics and gynecology, radiology, ear, nose and throat care, pain management and dermatology. It also handles claims for registered nurse first assistants (RNFAs). Urgent care is a further area of focus. The company belongs to NERUCA, and for urgent care clients its goals are to raise first-pass claim acceptance and shrink receivables older than 90 days.

Working Model

Rather than offering fixed service packages, MHBS designs a billing plan for each practice. Every client is paired with a dedicated account representative who becomes familiar with that office's procedures and goals. Once a contract is signed, onboarding usually takes 30 to 45 days. The company's primary system is Greenway Intergy. Its team is also experienced with Compulink, Practice Fusion, eClinicalWorks and GMed. In urgent care settings, staff use tools that include Azalea Health, ModMed, Experity, STI and AdvancedMD, along with others. Payments and EOBs from insurers continue to go directly to the practice, and clients are given access to the company's systems so they can track daily progress.

More than 150 people work for MHBS. The staff includes coders certified as CPCs, as well as employees holding credentials in reimbursement and EHR systems. The firm states that its operations meet HIPAA requirements, that its systems are encrypted and that it treats patient information with attention to privacy. MHBS also shares its own performance metrics: a clean claim rate of 98 percent, a collection rate of 97 percent, and billing of claims within 24 to 48 hours. Testimonials on its behalf come from practices and laboratories in Eatontown, Manasquan and Edison, New Jersey.