Hospital Billing Services
Facility billing, UB-04 institutional claims and high-volume workflows.
What it covers
- UB-04 / 837I institutional claim preparation
- Revenue code and HCPCS mapping
- DRG validation and case-mix review
- Charge description master (CDM) accuracy checks
- Payer-specific institutional edits
- High-volume batch submission and reconciliation
Where practices lose money here
A stale charge description master
A CDM that has drifted from the current code year produces claims that are wrong before anyone touches them.
Revenue code / HCPCS mismatches
Institutional payers reject on pairing rules that professional billing never encounters.
DRG assignment left unvalidated
An unvalidated DRG is either under-reimbursement or an audit finding. Neither is acceptable.
How Medway handles it
- We validate the CDM against the current code year and flag drift before it reaches a claim.
- Revenue code and HCPCS pairings are checked against each payer's institutional edits.
- DRG assignment is reviewed against documentation for case-mix accuracy.
- Batches are reconciled to remittance so nothing disappears at volume.
What you get
- Institutional claims built to payer edits, not generic rules
- CDM drift caught before it costs you
- DRG accuracy reviewed both ways
- Volume handled without losing individual claims
Get a free audit of your hospital billing claims. Send us a recent aging report and we will show you, in writing, where the recoverable revenue is — no cost, no commitment.
Frequently Asked Questions
You send us a recent accounts receivable aging report and, where possible, a denial export. We review them and give you a written breakdown: where recoverable revenue is sitting, which denial reasons are costing you most, what your timely-filing exposure looks like, and the fixes we would make in priority order. It is yours to keep whether or not you work with us. Please do not include patient health information — we only need claim-level financial data.
Most of the timeline is payer enrollment and EDI setup, and neither is fully in our control — that is the honest answer. Practices already enrolled with their payers typically start seeing claims go out within two to three weeks. Where new enrollments or revalidations are needed, budget longer, because the payer sets that pace. We tell you which of the two you are in after looking at your current setup.
Solo practitioners are often the strongest case for it, not the weakest. A one-person billing office has no redundancy — a vacation or a resignation stops your revenue cycle, and the cost is not the temp, it is the AR that ages and the claims that pass their filing deadline while nobody is working them.
Access to your existing EMR/PMS, your payer list and contracts, your fee schedule, and a recent AR aging report. If you are moving from another biller, we also need clarity on who works the open AR at transition — that is the single most commonly mishandled part of a billing switch.
