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.
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 STATEMENTS
- PATIENT COLLECTION
- PATIENT-PAYMENT POSTING
This is the list of medical specialities where we have extensive knowledge and are our core expertise: