Medical billing for practices and hospitals

It is a daunting task to navigate ever changing payer and regulatory requirements. You need to have the appropriate infrastructure to maintain your billing quality and to reduce errors. The costs for these are prohibitive to physician practices. By allowing us to take care of your medical billing, you will

• Increase your revenues and improve your reimbursement collections
• Get paid quicker and improve your cash flow
• Reduce your administration overhead costs
• Achieve efficiencies offered by a 24-hour billing provider as compared to inhouse staff
• Never worry about compliance again
• Minimize billing denials

We operate as a true steward of your financial success. We are committed to track all submissions and resolve claim issues as fast as possible. Our 24-hour operation allows us to get your reimbursements faster. Our team of revenue cycle experts and certified specialty-trained coders use advanced workflow technology to successfully navigate complex reimbursement regulations.

The various tasks we perform in medical billing/revenue cycle area

Patient registration:

The very first stage of a patient's appointment should include the notation of the patient's demographic information as well as information about his/her insurance, such as the insurance payer and policy number. Any information that will be useful and/or necessary in a claim situation should be detailed at patient check-in.

Eligibility verification:

Lack of focus or process in verifying the patient’s eligibility for Insurance will leads to non-payment of claims, delayed payments, rejection of claims and frustration among patients.

What we verify with the payers:

• Effective dates
• Plan exclusions
• Benefits
• Coverage details
• Co-pays and details of Co- Insurance
• Pre- Auth Number
• Patient Details as against details on the Insurance

Data entry & demographic:

Updating charges and codes for every medical procedure is the key to a successful & clean claim. Our team will capture:

• Charge Entry
• Service Date
• Billing Provider
• Healthcare Provider
• Admission Date
• Referring Physician
• Pre-Auth Code
• CPT Code
• Diagnosis code
• Demo Entry:
  Patient Details: Patient name and ID#, Gender, Marital Status, Email, Date of Birth, Social Security Number, Contact numbers work and home and Address work and home.
• Guarantor/Account Details: Guarantor Name, Date of Birth, Work and Home Phone and Address details
• Insurance Details: Insurance Identification Number, Name and address of the Insurance company, Group name/ group number, Details of the policy and policy effective date and termination, policy number, Name of the insured, Date of Birth and the relationship of the insured to the patient.

Coding:

Professional medical coders describe a patient’s history with codes which are used for filing healthcare claims and for the accurate diagnosis and recommendation of further procedures for the patient long after the claims have been paid.

Our Medical Coding services add significant value to your coding and overall operations. A single wrong code can have a huge impact on your revenue and revenue cycle, and this is why we keep our focus on being 100% compliant with the current coding guidelines.

Our coding is headed by a Doctor who is CPC. CPC H and CPC P certified. Pre-adjudicating your claims before submitting them to the Insurance company our Turn-around time is 12-24 hours.

Claims submission:

Once the claim has been properly completed, it must be submitted to the insurance payer for payment. Medical billers need to have access to the information they need about the insurance payer since there are so many variables for each insurance payer in determining how and when to submit a claim.

Clearing house denials and front end rejections:

Clearing house rejections or Payer and Front end Rejections are billing problems which slow down your cash flow. These are process errors and can be reduced to zero. Rejections occur due to one or many errors on the claim form and are returned back to the biller by the payer because of these errors.

Payer and Front end Rejections are handled by staying updated, following due diligence, communicating adequately and aptly, and following through. We strictly audit all the important touch points to ensure that the claim is not returned for reasons of a clerical error.

Payment posting:

This step involves posting and deposit functions. At this point, the amount billed to the patient will be zero if it has been paid in full or it will reflect the amount owed by the patient. The insurance payer's responsibility should have been met by this step in the process.

Denial management:

OUR TEAM WILL INCREASE REVENUE BY 30% OR MORE, SPEED UP YOUR CASH FLOW. Denials can have an adverse effect on your cash-flow. Managing denials promptly and effectively will result in an increase in the cash flow and enhance the effectiveness of the billing process with higher first-level passes.

Denials occur due to reasons like:

• Inaccurate or Incomplete Insurance information
• No Pre-Authorization Code
• Errors and Omissions related to coding and charges
• Filing claims past the stipulated time
• Credentialing Errors or no enrollment of the provider.

AR follow up:

Accounts Receivables at a practice & hospitals was purely a departmental activity until sometime ago. New and evolving payer plans, co-insurance agreements, patient co-pays, and the increase in patients with a high deductible health plan has exceedingly complicated the nature of AR.

It demands the healthcare provider to revamp and re-strategize their revenue cycle management. The process is now complex requiring the skill of specialists and trained professionals who have diligence, analytical skills and patience.

Appeals:

Appeals are an important part of the medical billing process. Appealing on a denied claim with sensitivity to its specific timeline is critical for the healthcare provider to recoup money. Moreover, if you are able to identify a pattern in claims that are denied, and the existing practice isn’t helping much when it comes to appealing on those claims, it means the physician or the healthcare provider is not aware of compliance issues or guidelines and the current billing process is incorrect by default.

How we improve your appeal process:

Categorizing and Tracking Denials: We categorize denial by type/person. This practice helps us identify patterns in denials and enables us streamline the process.

A strong Appeal letter: Using a standard template to draft an appeal letter may not be a wise thing to do. We customize every appeal letter based on the type of denial. While we take all the necessary precaution to include important details we quote industry guidelines, CMS and CPT guidelines and the payer’s reimbursement guidelines to give the appeal a higher likelihood for clearance.

AR clean up:

Cleaning up Old AR and managing denials requires prudent and calculated efforts from a medical billing company.

Being aware of the TFL: We are a medical billing company that proactively works towards avoiding AR pile up. The Timely Filing Limit which is considered as one of the main reasons for AR pile -up varies from one payer to another. We learn the pre-determined TFL of the payer and submit claims accordingly.

Timely filing of Appeal: A denied claim needs to be carefully assessed by the account receivables professional. It is important to file an appeal within 7 days of receipt of denial notice from the payer. We watch it on time when it comes re-filing of appeals, in order to crunch down on aging AR.

Credentialing:

Credentialing refers to the process of verifying the proven skills, training and education of healthcare providers. Verification of the provider credentials are done by contacting the “Primary Source”, which has provided the license, training and education. The credentialing process is used by healthcare facilities as part of their hiring process and by insurance companies to allow the provider to participate in their network. Credentialing is also the validation of a provider in a private health plan and the approval to join the network.

Medical specialties we work with

• Cardiology
• Pathology
• Internal medicine
• General medicine
• Family practice
• Home health
• Skilled Nursing Facility
• Inpatient Rehabilitation
• FQHC
• Hospice
• Ambulatory Surgical Centers