About us
We take care of your claims
Introduction
Doctors and medical practices face an ongoing challenge in getting paid properly and promptly by medical aids. Despite providing care and submitting claims, there is often a discrepancy between the amount charged and what the medical aid pays out. This “missing link” between claimed and paid amounts creates cashflow problems and administrative headaches for practitioners.
Medical aids have complex rules, procedures and red tape that frequently lead to denied or reduced payments. Claims may be rejected due to issues like incorrect billing codes, problems with pre-authorizations, limits on covered procedures, or delays in processing. Doctors end up spending valuable time following up on unpaid or underpaid claims, taking attention away from patient care.
There is a clear need for assistance in navigating the claims and payment process. Doctors need an experienced partner who can take on the administrative burden, ensure claims are submitted accurately and efficiently, and guarantee maximum appropriate payments are received. This is where we come in as the missing link between your practice’s claims and getting paid what you are rightfully owed by the medical aids.
Who We Are
We are a dedicated team of medical claims specialists who act as a liaison between healthcare providers and medical aid schemes. Our company was founded to help simplify the complex world of medical aid claims and ensure providers receive accurate and timely reimbursement for services rendered.
With years of experience dealing specifically with medical claims, we intimately understand the intricate details and unique pain points of the claims process. We know where things commonly go wrong and how to effectively resolve issues. Our deep knowledge equips us to thoroughly audit claims and identify any discrepancies that lead to denied or inaccurate payments.
At our core, we are driven by a desire to create simplicity from complexity. We handle the time-consuming claims process so you can devote your energy to delivering excellent care for your patients. Consider us an extension of your administrative team, relentlessly working in the background to maximize your legitimate claim reimbursements. Our goal is to provide complete peace of mind that you will be paid exactly what you are owed.
Medical Claim Processing
The medical claim process can be complex, with many steps that must be followed correctly for healthcare providers to receive proper reimbursement. Here is a brief overview of the key steps:
– Patient visit: The process starts with a patient visiting a healthcare provider for medical services. Details about the visit, including symptoms, diagnosis, and services rendered, are documented in the medical record.
– Claim submission: Once services are provided, the healthcare provider’s billing staff prepares an insurance claim containing details such as the patient’s policy information, date of service, diagnosis codes, procedure codes, and the provider’s charges. This claim is then submitted electronically or by mail to the correct payer.
– Claims processing: The payer receives the claim and processes it, which includes steps like:
– Verifying patient eligibility and benefits
– Checking claim information for accuracy and completeness
– Comparing the procedures and diagnoses to paid amounts
– Applying rules to determine approved charges
– Calculating the payer’s and patient’s responsibility amounts
– Claims adjudication: The payer makes a final determination on how much of the claim will actually be paid to the provider based on the patient’s benefits and policy terms.
– Provider payment: Finally, the payer issues an explanation of benefits to the patient and sends payment to the healthcare provider. This completes the medical claims cycle.
Problems can occur at any point in this cycle that prevent providers from getting properly reimbursed for services rendered. This is where medical claim follow up and auditing becomes crucial.
Where Things Go Wrong
The medical claims process can be complicated, with many opportunities for issues to arise that lead to claim rejections and payment delays. Here are some of the most common reasons medical claims get rejected or delayed:
– Missing information – Claims get rejected when key details are missing, like patient ID numbers, provider identifiers, or diagnosis codes. Having incomplete claim forms is one of the main reasons claims are denied.
– Inaccurate coding – Using the wrong diagnostic, procedure, or service codes on a claim frequently leads to rejections. Coding errors can occur due to typos, outdated code books, or lack of training.
– Errors in billing – Simple mistakes like billing the wrong insurance provider, duplicating claims, or mathematical errors in totals can cause claims to get rejected. Careless billing errors are a common culprit.
– Coverage issues – Sometimes a particular service, treatment, or medication isn’t covered by the patient’s policy. Lack of pre-authorization or out-of-network restrictions also lead to denials. Understanding policy limits is crucial.
– Timely filing issues – Most insurers require claims to be submitted within a certain timeframe, often within 90 days of treatment. Exceeding the timely filing limits results in automatic rejection.
– Eligibility issues – If a patient’s eligibility status changed, claims will get denied. Keeping current with eligibility updates and grace periods can prevent this.
– Medical necessity issues – Insurers will reject claims they deem “not medically necessary.” Disagreements over what constitutes medical necessity is a frequent reason for denials.
Being aware of these common pitfalls can help avoid claim rejections and speed up processing so providers get paid faster. Checking for errors, verifying coverage, and promptly submitting accurate claims is key.
How We Help
At Medrecons, we offer complete medical claims support to ensure you get paid accurately and on time. Our dedicated team reviews your claims submissions to identify any issues or discrepancies.
We look for common problems like:
– Incorrect billing codes used for procedures
– Errors in patient or practice information
– Disputes about allowable amounts or coverage
– Duplicate claims submissions
– Claims denied incorrectly
Where we find issues, we leverage our expertise to resolve them. We re-submit claims using the right codes and information. We follow up persistently with medical aids to overturn incorrect denials. Where there are disputes about payments, we negotiate firmly on your behalf.
Our goal is to get your claims paid correctly the first time. But where problems occur, we have the knowledge and experience to get them fixed. We do the legwork so you can focus on patient care.
With our support, you can trust your payments will fully reflect the services provided. We take care of the claims process so you can take care of your patients.
Working With Auditors
We understand the importance of having accurate records for your auditors. As medical claim specialists, we are well-versed in medical aid billing practices and can provide detailed reports that your auditors can rely on.
When discrepancies arise, we don’t just flag them – we take proactive steps to investigate the root cause and resolve outstanding issues. This saves your auditors significant time and effort trying to reconcile vague problems on their own.
We are happy to liaise directly with your auditors to provide any additional information they require. With direct access to us, auditors can gain a deeper understanding of the claims process, common pain points, and strategies for optimization. This enables them to provide more meaningful recommendations in their reports.
Our goal is always to strengthen the relationship between medical practices and their auditors through transparent communication and diligent recordkeeping. We want auditors to see us as collaborative partners in oversight, not obstacles or hassles. Let us know if we can ever provide your auditors with customized reports, walkthroughs, or training from our claims processing experts. We’re here to make everyone’s jobs easier.
Time Savings
Being in the medical field means dedicating most, if not all, of your time on patient care and running your practice. By outsourcing your medical claim processing to us, you save significant time and avoid unnecessary work.
Peace of Mind
We understand how stressful and time-consuming it can be dealing with medical aid claims and payments. As a healthcare provider, you want to be focused on delivering excellent care for your patients, not chasing payments and arguing with medical aids.
That’s where we come in. By taking on the burden of claim submission, auditing and follow-up, we provide complete peace of mind that you will get paid promptly and accurately for the services you provide. You can relax knowing that highly experienced claim specialists are working diligently on your behalf to get your claims paid.
We don’t just submit claims and hope for the best. We meticulously audit each claim line by line, identifying any errors or issues before submission. This prevents rejections and delays down the line. If any problems do come up, we handle all communication and follow up until everything is resolved.
With our dedicated team managing your claims from start to finish, you can devote your precious time and energy where it belongs – caring for your patients. Leave the administrative hassles to us and enjoy the peace of mind that comes with knowing your claims are in expert hands. Contact us today to learn more about our comprehensive medical claim management services.
Contact Us
We are friendly and always happy to hear from new clients, auditors, and business partners. Please feel free to reach out via phone, email, or our online contact form to learn more about how we can help you.
Our team is available during regular business hours to answer any questions you may have. We can provide references and testimonials from current clients upon request. Whether you’re looking for medical claims support, auditing assistance, or just want to learn more, we’re here to help.
We look forward to working with you! Our personalized approach ensures we understand your unique needs, so we can deliver customized solutions. Contact us today to take the first step toward simplified medical claims, accurate audits, and peace of mind.
our team Leaders
Meet our Team!
Madeleen Rabie
Meet Madeleen Rabie - Our Guiding Light at Medrecons In the heart of Medrecons, there's a story of passion, commitment, and a family-like bond, and at its helm is our cherished leader, Madeleen Rabie. For over two decades, she has been the driving force behind our journey in medical aid reconciliation, transforming Medrecons into not just a company but a tight-knit family since 1999. A Journey Defined by Care: Madeleen's journey is more than a professional one; it's a narrative of care and dedication. With a heart dedicated to precision and excellence, she founded Medrecons, infusing it with warmth and a sense of family that extends to every client, pharmacy, and doctor we work with. Family-Centric Philosophy: Madeleen's ethos centers around the belief that Medrecons is more than a business; it's a family. Her family-centric philosophy shapes every aspect of our operations, fostering an environment where relationships are cherished, and each client feels like a valued member of our extended family. Crafting Tailored Solutions: At Medrecons, Madeleen's touch is felt in the personalized solutions we offer. Her commitment to understanding the unique needs of pharmacies and doctors ensures that our services are not just efficient but are crafted with a genuine understanding of the challenges and aspirations of our family members. Innovation Born of Connection: Madeleen's approach blends innovation with a personal connection. She understands that the healthcare landscape evolves, and our family must evolve with it. This has led Medrecons to embrace the latest technologies and approaches, ensuring our family members stay ahead in an ever-changing industry. Legacy of Care and Excellence: Madeleen Rabie's legacy is one of care, excellence, and the enduring strength of a united family. Under her nurturing leadership, Medrecons is not just a company—it's a testament to the power of familial bonds, the kind where everyone is invested in each other's success. A Guiding Light: In the heart of Medrecons, Madeleen stands as our guiding light, steering our family towards new horizons. Her legacy is imprinted on the very fabric of our company, reminding us daily that Medrecons is not just a workplace but a family that cares, innovates, and thrives together. As a part of the Medrecons family, you're not just a client or a team member; you're a cherished member of a community where care, trust, and excellence define our journey together. As a part of the Medrecons family, you're not just a client or a team member; you're a cherished member of a community where care, trust, and excellence define our journey together.
Martie van Deventer
Diligent Data Capturer at Medrecons Meet Martie van Deventer, the newest asset to the Medrecons team, serving as a diligent Data Capturer. Martie's arrival in 2023 has already made waves, showcasing her exceptional efficiency and remarkable eye for precision as she collaborates seamlessly with Johann Rabie and the entire Medrecons family. Efficiency in Operation: Within the realm of data capturing, Martie is a standout performer. Her efficiency is not just a skill but a defining trait that propels the operations at Medrecons. Martie's ability to navigate through data intricacies with finesse showcases her dedication to delivering accurate and high-quality results. Precision Specialist: Martie possesses an extraordinary eye for precision, a quality that is indispensable in the world of data processing. Her meticulous approach ensures that every piece of data is handled with the utmost accuracy, contributing significantly to the overall operational excellence of Medrecons. Newest Member, Swift Impact: Despite being the most recent addition to the team, Martie has swiftly integrated into the dynamic environment at Medrecons. Her quick grasp of intricacies, coupled with her proactive approach, reflects not only her professional acumen but also her commitment to contributing meaningfully to the team. Dedication to Excellence: Martie's dedication to excellence is evident in every task she undertakes. Whether it's managing data streams or ensuring accuracy in records, she approaches her responsibilities with a commitment to upholding the high standards synonymous with Medrecons. Collaborative Spirit: As a data capturer, Martie understands the importance of collaboration. Working seamlessly within the Medrecons family, she contributes to a harmonious and productive work environment, embodying the collaborative spirit that defines the company. Future Growth at Medrecons: Martie's journey at Medrecons is poised for significant growth. Her dedication to efficiency, precision, and continuous improvement aligns seamlessly with the ethos of Medrecons. As a forward-looking data capturer, Martie is set to play an integral role in the future success of Medrecons. In the evolving landscape of data processing, Martie van Deventer stands out as a rising star, embodying the values of precision, efficiency, and dedication to excellence at Medrecons. Her journey is a testament to the commitment to fostering a team that thrives on professionalism and collaborative success.
Johann Rabie
Director of JR Data Processing at Medrecons Meet Johann Rabie, the astute and inspirational Director of JR Data Processing, a pivotal component of the dynamic two-part faction of Medrecons, alongside Rabie & Co. Since joining the Medrecons family in 2010, Johann has been at the helm of data capturing and operations, bringing wisdom, a quiet but powerful presence, and unwavering drive to the forefront. Professional Journey: With a decade-long tenure at Medrecons, Johann Rabie's professional journey is a testament to his dedication and expertise. Since 2010, he has played a pivotal role in shaping the data processing and operational facets of Medrecons. Data Capturing Maestro: As the head of data capturing and operations, Johann is the maestro behind the scenes, orchestrating the seamless flow of information within Medrecons. His meticulous approach and command over data processing contribute significantly to the efficiency of our operations. Quiet Wisdom: Johann's persona is characterized by quiet wisdom. Amid daily operations, his calm and collected demeanour serves as a guiding force. His ability to analyse situations and provide insightful solutions has earned him the reputation of being the wisest presence in the office. Driven Leadership: Johann is more than a director; he is an inspiring leader who embodies the spirit of dedication and drive. His commitment to excellence and continuous improvement motivates the team to strive for their best, creating a culture of high performance and achievement. Team Inspiration: Johann's leadership style is marked by inspiration. His ability to lead by example and instil confidence in the team has a profound impact on the work environment. Under his guidance, the team at JR Data Processing thrives on challenges and achieves milestones with unwavering determination. Integral to Medrecons Faction: Johann Rabie plays a pivotal role in the two-part faction of Medrecons, where JR Data Processing complements Rabie & Co. His strategic vision and operational acumen contribute to the overall success and cohesion of the Medrecons family. In the intricate tapestry of Medrecons, Johann Rabie stands as a symbol of wisdom, leadership, and quiet determination. His decade-long journey reflects not just professional growth but a commitment to excellence that defines Medrecons as a trailblazer in the healthcare industry.
Quick links to contact us
Enquiries
Enquiries:
madeleen@medrecons.co.za
Admin:
info@medrecons.co.za
Contact Numbers
Office:
(028) 050 1309
Cell:
083 458 2843
Request a Call
Feel free to request that we call your back
Hours
Monday - Friday
08:00am - 17:00pm
Trusted Partner
Your trusted partner.
We abide by a high standard of thoroughness and take great pride in the way we perform our work.
Subscribe Now
Don’t miss our future updates! Get Subscribed Today!