Medical Billing Companies & Consultants in New Castle, PA

Headquartered in New Castle, Pennsylvania, L&M Medical Billing Solutions, LLC is a revenue cycle firm that manages the business and reimbursement functions of independent physicians and medical offices. Practices of every size and discipline can turn this paperwork-heavy work over to the firm, which frees doctors and reception personnel to focus on patient care. The firm's central argument to prospective clients is economic. It contends that paying an outside specialist is the more affordable route for a practice, compared with building its own payroll of billers from scratch.

Services

Its work spans each stage of reimbursement, beginning with confirming coverage when a patient checks in and extending through the pursuit of rejected claims. Principal services include:

• Confirming patients' insurance coverage and assisting with office organization
• Submitting claims to insurers through electronic channels or by mail
• Recording payments from explanations of benefits and reviewing electronic remittance advice to make sure adjustments are accurate
• Handling rejections, filing appeals and persistently pursuing outstanding claims
• Producing statements for patients and fielding their questions about bills
• Auditing encounter forms and clinical notes to ensure diagnosis and procedure codes are up to date
• Verifying medical necessity prior to submission
• Thorough monthly reporting on the financial condition of the practice

Every claim is monitored until the insurer either approves or rejects it. Roughly every month to month and a half, the firm generates aging and accounts receivable reports designed to surface unresolved denials and amounts still owed by patients. Newly onboarded practices can also get assistance recovering insurer and patient receivables going back up to twelve months before the start of the engagement. Whenever coding or documentation requirements are updated, L&M provides instruction to doctors and office personnel.

Specialties Served

According to the firm, its client history includes practices in cardiology, chiropractic care, dermatology, emergency and urgent care, family medicine, internal medicine, behavioral health, ophthalmology, ambulatory surgery, physical therapy, pediatrics and urology. Practices outside these fields are welcome as well.

Background and Credentials

The company reports a combined total of over a decade of experience across billing, coding, documentation auditing and the analysis of fraud, waste and abuse. Drawing on that range, it evaluates each claim from several vantage points: those of the treating provider, the coder, the biller, the insurer and an auditor. Credentials cited include AHIMA's Certified Coding Specialist designation, earned in 2018; completion of an Advanced Billing Specialist course in 2023; and a 2012 certificate in medical coding and billing from Everest Institute Pittsburgh. Client testimonials note that the principal previously worked in an insurer's fraud investigation unit and later at a medical billing company, where she assisted with the transition to a new EDI clearinghouse.

How It Works With Clients

Practices considering the service may ask for a complimentary review of their operations. This assessment examines denied and unresolved claims, the denial codes that appear most frequently, outstanding patient balances and the portion of revenue sitting in receivables. L&M then walks through the results with the practice during an individual consultation and supplies a customized price estimate. Through a partnership with a comprehensive revenue cycle management platform designed for independent practices, the firm can offer that software at a reduced price to clients moving to a new system. The company identifies accuracy, consistency and efficiency as its guiding principles, symbolized by the three interlocking gears in its logo. It also states that it adheres to compliance guidance from CMS and the OIG, maintains HIPAA compliance, and ensures that patients calling with billing questions reach a live staff member rather than an automated menu.