Medical Billing Workflow

  • Data or the information which includes insurance verification is detailed in a format to process the claim for the services rendered by healthcare.
  • RCM company holds a strong grip on patient’s record in order to support flawless billing.
  • The above method applies only for the new appointment. The information of the old appointments will be already saved.
  • Medical billing team verifies the patient’s insurance strictly end to end.
  • Eligibility and policy benefits are thoroughly focused.
  • It makes a clear note if the insurance claim can be obtained for the services rendered.
  • It checks the patient responsibilities such as co-pay, deductibles and out of pocket whether patient had accumulated the expenses.
  • Under certain services, prior authorization is required from insurance company, if not service is ready to be provided.
  • The staff uses software system to verify the patient’s data in order to speed up the work.
  • When patient consults healthcare provider, the details of the condition and service performed is recorded either by audio or video.
  • These particulars may be recorded in front of the patient or after the encounter.
  • It gives a clarity about the condition and medications that healthcare provider had prescribed.
  • They submit the record to the RCM company to process medical billing and claim the revenue.
  • Recorded audio or video is transferred into a medical script. The script contains complete condition of the health record.
  • The process of transferring voice-recorded or video-recorded medical reports by healthcare providers is termed as medical transcription.
  • Maintaining a formatted and edited file is important. Make sure the transcription does not hold any false or wrong data as it might put patient’s health at risk.
  • The transcripted information is converted into medical codes for easy and time-saving procedure.
  • The transformation of patient’s condition, medical services, medical prescription into medical codes is called medical coding.
  • Reading the complete medical history of the patient consumes more time. So, it’s scripted into codes.
  • Only the medical team is involved in medical coding. They ought to have experienced and skilled in particular areas of medical coding.
  • Coders rely on DX (condition of the patient), CPT (service rendered to the patient) to transcript the medical record into medical coding.
  • Transmitting the claims with accurate coding through EDI (Electronic Data Interchange) to the insurance company is called Charge transmission.
  • Only clean claims without errors will be transmitted through EDI.
  • Errors in transmission carry three levels:
  1. Scrubbing- Mandatory fields has to be filled without any mistake. Otherwise, the software would reject the claim.
  2. EDI rejection- Invalid information held in the patient’s record will cause claim rejection by EDI.
  3. Payer rejections- Rejection in claims occur according to the insurance guidelines and payer details.
  • Denials or payments are processed only after these three levels.
  • Medical billing claims follow a secured and encrypted transmission process.
  • AR caller concentrates on lower denials and increase payment flow in Revenue Cycle Management.
  • Their timely follow up with insurance company increases payment receivals.
  • AR caller’s main focus is to ensure payment posting for the services rendered by healthcare providers.
  • They hold a responsibility in sharing accurate details or information of patient and rectify if any errors found.
  • Correspondence and return mails from insurance and patient.
  • Denial management is an important key factor in Revenue Cycle Management.
  • It motivates a profitable revenue growth by reducing the denials with insurance company.
  • Addressing the denied claims on various issues and maintain constant follow-up.
  • Taking appropriate actions to decrease denials and increase revenue payments.
  • Determine the causes for denials and to reduce the risk of future denials.
  • Each denied claim is analyzed and researched by denial management team for best course of action.
  • Quicker payments for the denied claims within short period of time.
  • Prioritize denied claims based on payer, amount and others to ensure maximum reimbursements.
  • Role of payment posting team is to ensure frequent payment posting to the patients without facing denials.
  • EOB (Explanation of benefits), ERA (Electronic remittance advice) received from the insurance will be posted to concerned patient claims.
  • Denials and payments are captured by the posting team with EOB or correspondence receivables from insurance companies.
  • It’s important for the posting team to match the bulk payment receivables in order to tally with the cheque amount.
  • With the reference to the payment posted to the practice accounts including patient and insurance revenue will be calculated.

Our Services

EHR & PM SETUP
  • ELECTRONIC HEALTH RECORD
  • PRACTICE MANAGMENT SETUP
  • CLEARINGHOUSE SETUP
  • EDI/ERA ENROLLMENT
  • ELECTRONIC FUND TRANSFER

CREDENTIALING / PROVIDERENROLLMENT

  • CREDENTIALING & CONTRACTING
  • ADDING NEW DOCTORS
  • UPDATING DEMOGRAPHICS

MEDICAL BILLING SERVICE

  • ELIGIBILITY VERIFICATION
  • CODING AND BILLING COMPLIANCE
  • CLAIM PREPARATION
  • TRANSMITTING THE CLAIM
  • PAYMENT POSTING
  • DENIAL MANAGEMENT & FOLLOW UP
  • SUMMARY REPORTS

PATIENT COLLECTION

  • PATIENT STATEMENTS
  • PATIENT COLLECTION
  • PATIENT-PAYMENT POSTING

Our Specialities

This is the list of medical specialities where we have extensive knowledge and are our core expertise:

Family Medicine

Thoracic Surgery

Internal Medicine

Pediatrics

Cardiology

Mental Health

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Physical Therapy

Optometrist

Pain Management