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:
- Scrubbing- Mandatory fields has to be filled without any mistake. Otherwise, the software would reject the claim.
- EDI rejection- Invalid information held in the patient’s record will cause claim rejection by EDI.
- 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
Accu Care Solutions, it is also one of the few billing of companies that provides comprehensive Credentialig & Enrollments, Medical Billing Services and turn-key management of the practice problems. We also offer services for the creation of the electronic health record EHR-EMR, payment options and the code is flexible and the prices.
Credentialing
Accu Care Solutions, LLC offers Credentialing Services for medical practices to get them affiliated with maximum payers. As a result, you become an in-network provider to get payments from insurance payers. Being an expert in the provider enrollment and credentialing services, we navigate the paperwork, update practices about their status regularly, and save your time.
Practice Management
We offer Practice Management Services in USA to enable practices to achieve seamless workflow. Further, we help providers to get better patient outcomes by reducing their administrative hassle. In fact, our experts can handle your administrative tasks. As a result, you can focus on providing quality care to patients. Hence, you are able to focus on core areas. So, make your practice profitable with us.
Medical Billing
We offer Medical Billing Services to practices of all sizes. Accu Care Solutions takes care of all the aspects of revenue cycle process to make sure your practice avoids claim denials. We are one of the Best Medical Billing Companies in the USA aimed to empowering physicians thrive financially. We find all the loopholes in the claims submission process and implement strategies which can help you boost practice revenue.
Revenue Cycle Management
The revenue cycle process is the most important part of a healthcare practice. Thus, hire our Revenue Cycle Management Services in USA to manage the financial cycle of your practice. Also, make your practice worthwhile with our RCM experts. Also, we provide a viable solution for your revenue cycle problems. Therefore, you come to know where your practice lacks and get rid of delayed payments.
Our Added Services
EHR & PM SETUP
- ELECTRONIC HEALTH RECORD
- PRACTICE MANAGMENT SETUP
- CLEARINGHOUSE SETUP
- EDI/ERA ENROLLMENT
- ELECTRONIC FUND TRANSFER
CREDENTIALING / PROVIDER ENROLLMENTS
- 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
Pricing
Revenue Cycle Management
Boost Productivity with our RCM Services- Medical Billing Services
- Provider Credentialing
- Monthly Practice Reports
Medical Billing Services
Maximize Practice Revenue with Accurate Billing and Coding- Clean Submission & Monthly Follow Up
- Denial Management
- Monthly Practice Analysis Reporting
Credentialing & Enrollments
Helping Physicians to get credentialed with Insurance Payers- Medicare & Rail Road Medicare
- State Medicaid & Tricare
- Commercial Insurances
Our Specialities
This is the list of medical specialities where we have extensive knowledge and are our core expertise