Medical Billing Companies & Consultants in Youngstown, OH

Medsys Consulting, Inc. is a medical billing, coding and revenue cycle firm based on Boardman-Canfield Road in Boardman, Ohio, in the Youngstown area. The company says it has been working toward its goal since 1996. Its clients include hospitals, group practices and independently owned physician offices, and it handles both medical and surgical specialties. It works with providers in several states, so a practice does not need to be near Boardman to use it.

Billing and Coding Services

The firm's main offering is a fully outsourced billing department. Medsys takes care of the whole claim process, from the moment a charge is recorded until the account is paid. All of its work is described as HIPAA compliant. Its billing services include:

• Charge entry, claim scrubbing and electronic submission to payers
• Posting of insurance and patient payments, including ERA posting
• Processing of secondary insurance claims
• Patient statements sent on a 28-day cycle
• Checking insurance eligibility and benefits before visits
• Tracking denied claims, resubmitting them and filing appeals
• Monthly financial reports and custom dashboards that show A/R aging and key metrics

Coding is done by Certified Professional Coders who work across many specialties. They assign ICD-10, CPT and HCPCS codes, review E/M levels and documentation, and code telehealth visits. The team also designs superbills, audits charts and trains providers to cut down on coding errors.

Collections and Patient Support

Medsys chases unpaid balances from both insurers and patients. When payers pay late or pay too little, staff follow up and appeal if needed. They also set up payment plans, sort out credit balances and overpayments, and work with outside collection agencies when appropriate. Patients can call a dedicated toll-free line with billing questions, which means fewer of those calls reach the practice's front desk.

Credentialing and Consulting

The company also handles credentialing and payer enrollment. This covers Medicare, Medicare Advantage, Medicaid and Medicaid managed care plans, and commercial insurers such as Aetna, Cigna, UHC and Anthem. It sets up and maintains CAQH profiles, enrolls new providers, and manages re-credentialing, revalidations and demographic updates. Each case moves through five steps: a status review, filing applications, following up with payers, confirming approval, and ongoing upkeep.

Medsys also offers consulting led by Certified Physician Practice Managers. It helps practices with:

• Launching a new practice or planning a merger
• Reviewing and improving office workflow
• Compliance checks through chart and documentation audits
• Choosing, setting up and improving an EHR/EMR system
• Writing policies and procedures, benchmarking finances and reporting KPIs
• Planning growth, reviewing payer contracts, and hiring and training staff
• Seminars on coding, billing and collections

Buyers comparing vendors should note that Medsys covers billing, coding, credentialing and practice consulting under one contract. The firm says it has more than 30 years in the industry and keeps clients for the long term. It uses established HIPAA-compliant software and offers a free consultation to new clients with no obligation.

Quest AdvantEdge Corporation is a billing and management firm based in Youngstown, Ohio. It has handled healthcare billing since 1998. The company works as an outsourced financial back office for medical providers and other organizations. Its goal is to let owners and managers stop spending their time on invoicing and claims work so they can focus on patients and on growing the practice. Buyers comparing medical billing vendors in the Mahoning Valley and western Pennsylvania will find that the firm combines healthcare revenue cycle work with general business billing and management consulting.

Who They Serve

The firm's healthcare work covers several types of providers:

• Medical doctors and physician practices
• Specialists
• Behavioral health providers
• Ambulance and ambulette transport services
• Durable medical equipment (DME) suppliers

It also offers billing, bookkeeping, accounts receivable management and collections to businesses of all sizes in many non-medical industries.

Medical Billing Approach

A practice that signs on gets a dedicated team that works like an in-house billing department. The team includes coders, billers, collections staff and insurance specialists, and the company says its staff hold certifications and/or degrees. Staff key in claim data and check it by hand, and then integrated software screens it again for mistakes before submission. This two-step check is meant to cut down on rejections caused by clerical errors. When a payer denies or rejects a claim, the team keeps working the claim until it is fully resolved. The firm presents this as a way to lower denial rates and get paid faster. The company also stresses that providers keep control of their own finances. Practices still receive their charge slips and remittance statements with payments and send them to their Quest AdvantEdge team for processing. The firm also prepares custom reports so physicians and office managers can track performance. It says each office's setup is planned around that office's needs rather than a fixed template.

Related Practice Services

Beyond claims, the firm handles several administrative tasks that often slow practices down. These include reimbursement optimization, practice fee schedules, transcription, and setup for new or established practices. It also offers provider credentialing and contracting with insurance carriers. This makes the company a possible fit for groups opening a new office or adding payers, as well as for established practices that want to tighten up their revenue cycle.

Background and Leadership

Lori A. Gavalier founded Quest AdvantEdge and leads its consulting arm. She holds a degree in industrial and systems operations engineering and an MBA. Her experience spans the industrial, service, retail and healthcare fields. Through her team, clients can get help with strategic and marketing plans, project management, restructuring, and business process reengineering. On the business billing side, a Certified Public Accountant coordinates and reviews the work. For buyers, the main differences are the firm's long history, its range of provider types including ambulance and DME, and its pairing of billing with engineering-based operational consulting.