Our technological solutions and related business services can aid physician practices to cost-effectively and successfully meet regulatory challenges a rapidly shifting healthcare industry environment. We consistently innovate to keep pace with a global healthcare environment that enables transformational change in healthcare through technology.
1. Insurance Verification
- Website:- Each and every claim before submitting to insurance company, our billing experts are checking registered websites and checking insurance verification, eligibility and collecting complete details (Effective from, Managed care availity, Deductible, Co-insuance, Co-pay, OON...etc)
- Verification Calling - Our callers used to call if any insurance must require to provide eligibility information over the phone
2. Medical Coding
3. Demographic entry / EHR checking
- Our coders have many years of expertise on both the physician and Hospital billing. We have a highly dedicated coding team of CPC, American Academy of Professional Coders (AAPC) certified coders. Since we have given access to our coders for Ingenix, CMS, AMA, AAPC and AHIMA, our coding experts ensured accurate coding services.
- Coders are given access to check EHR (Electronic Health Records) / EMR (Electronic Medical Records) to ensure clean claims bore submitting to insurance company.
- So that your claims will always paid 100% in less time frame.
- Our coding professionals had knowledge of multi speciality coding and got certificates to do coding for ICD10 (Compliance date 10/01/2015).
a) Demographic Entry:-
b) EHR checkng:-
- Our trained billing experts having knwoledge of all kind of billing softwares
- Checking USPS website and adding 4 digit zip code extension in order to avoid Medicare rejection.
- Preparing clarification log for the day
4. Charge entry
- Checking Electronic Health Record for the demographic pre created by provider/hospital
- Daily schedules / appointment checking and locations cross checking
- Patient co-payments posting
- Diagnosis checkng for payable and valid codes
- Invalid / Deleted CPTs cross checking
- Adding appropriate modifiers to CPTs
- Final output verifying.
5. Audit Process
- We used to give special training for our charge entry team in order to complete the assigned task within their assigned time frame.
- All charge entry professionals does have coding knowledge.
- Once charges are entered they used to run charge reports and tally the charge count and doing self-audit before reach the batch to audit team
- Preparing clarification Log for the day
We have separate audit team to catch the mistakes internally before submitting the claim to insurance companies.
This will make sure all the submitted claims got paid 100%.
6. Claim Submission / EDI tracking
7. ERA / EFT / 835 / Deposit Posting
- We used to submit the claims under multiple clearing house on daily basis.
- Once we ran report, generating EDI rejection / acceptance report and clearing it on regular basis.
8. Account Receivables / Routine follow up
- Our trained depositors posting paper checks on daily basis.
- Auto posting for 835s / EFTs / ERAs
- Payment posters are simultaneously capturing denials and correspondces in appropriate clinic's spreadsheet.
- Tally the reports and have tracking the tally sheets in network server.
- Preparing clarification Log for the day
9. Credit Report / Patient Statement Generating / Moving to collection
- Specially trained staff handling account receivables department.
- We used to follow-up claims on regular basis until the claim get paid.
- Our callers have tracking phone numbers in order to reach the insurance rep, Provider rep, Credentialing department and EDI department in order to get payment appropriate time.
- We are tracking provider re-validation NPI / PTAN date details and follow-up with appropriate time frames.
- Client relationship Managers used to follow up clarification logs from provider/hospitals and get it fixed within 24 hours.
Credit Report:- We used to work credit report either from patient or insurance overpayment before generating patient statements.
Patient Statement Generating:-
Moving to collections:-
- We used to generate patient statements for every month first week.
- Our experts handling patient calls effectively for their statement related queries.
10. Collection Agency Follow up
- We are not moving patient to collection if they are making partial payments or set up a payment plan until their outstanding settled.
- We also not moving patient to collection if they have professional courtesy / provider office staff / friends / relatives.
- If patient didn't pay their balances after three statements, we used to move those patients to collection agency
- Once a claim moved to collection agency, we are adjusting those balances from billing software.
11. Reporting System
- We used to follow up with collection agency regarding whoever done paymnets are they moved to collection.
- So that collection team can remove those patients from their list.
- Once collection agency got payment from patient, we used to reverse the collection adjustment and post the payments and communicate to provider / hospital.
Success Billing have multiple reporting system which includes
- Weekly report for each clinics
- Monthly report for each clinics
- Yearly report for comparision
- Aging analysis report for current position for each clinic AR
- Maintain less than 5% outstanding claims under 90+ AR bucket (including MVA / WC Claims)
- 100% payable CPT reports
- Reimbursement tracking report
- Staff production
- Total time consumption for each staff and appropriate clinics
- Revenue report for each clinics