PRE-INSURANCE VERIFICATION
Before the patient's visit to the provider, we perform pre-insurance verification to check eligibility regarding the particular insurance, requirement for any pre-authorization or referral, whether any co-payment has to be collected, if the patient has met the deductible, the amount of co-insurance the patient shares, and whether the patient's insurance covers the service sought from the provider. This step is important because many insurance providers do not provide retro-authorization.
MEDICAL CODING
We access the superbills and detailed patient information from the physician's office through a secure network. The medical documents are verified and their validation is communicated to the client. The healthcare documents are then sent to the medical coding department to assign CPT and ICD codes. The coded documents are subjected to proof-reading and cross-checked by the medical coding manager. The coded documents are then forwarded to the charge entry team. We also validate the code entered by the clients.
CHARGE ENTRY
The charges from the coded documents are entered into the particular patient account. If the patient is new and an account number does not exist as yet, then the patient account is created by entering all the demographic details from the patient registration form. Before transmitting the claims to the insurance payer through the clearing house, the entered charges are audited by the Quality Assurance (QA) team to ensure a 'clean claim' is submitted.
CLAIMS TRANSMISSION
Once the charges are entered and audited, the claims are then filed with the payer electronically. We also have the capability to process paper claims. Usually at clearing houses, the claims go through some type of cursory filtering software to ensure that they are accurate and all information is contained within the document. Within 24 hours, a paper report is sent back with errors that have been caught. Once we have the report, the incorrect claims are rectified with the necessary information within 24 hours and the claims are resubmitted to the insurance company.
PAYMENT POSTING
When our team of experienced medical billing outsourcing professionals receives scanned EOBs (Explanation of Benefits) and checks, these payments are entered into the system. As part of this task, we also charge appropriate patient accounts and initiate the process for denied claims in case actual claim is far below the expected one. Reconciliation takes place on a daily basis.
INSURANCE FOLLOW-UP
Once the claims are submitted to the payer for processing, our expert medical billing BPO follow-up team resolutely pursues all unpaid insurance claims that have crossed the 30 days bucket in order to reduce the accounts receivable (AR) days of the claim. Sometimes, the claims are underpaid by the insurance payer, and in this case, we ensure that the underpaid claims are processed and paid correctly. The denied claims are appealed by our AR team.
DENIAL MANAGEMENT
The denied claims are addressed on priority basis - our billers and coders find the missing puzzle pieces fast, and re-file or appeal the denial. We have Denial Analysts on board who fix the issue and send the claim for reprocessing. If the claim needs more information from the provider, then these gaps are filled promptly; if the claim is denied and the patient is responsible, the claim is billed to patient.
PATIENT FOLLOWUP
We follow up with patients for any pending balance due after the insurance claim is processed A patient statement is generated and filed on a weekly or monthly basis, as per your business requirement. Follow-up is done through phone calls. If no response is received from the patient, we move those balances to collections, generate a report for it and send it to you for further action
REPORTS
Our reporting package contains monthly customized reports, including insurance aging reports and Key Performance Indicators (KPI) report, offering a detailed picture of your practice's financial health and the length of your claim payment cycle.
CREDIT BALANCES
As part of our medical billing outsourcing services, we can perform credit balance processing of the payer or patient, after verifying that it is a case of over payment. This ensures correct and timely refunds to the appropriate entity.
PROVIDER ENROLEMENT AND CREDENTIALING
billing and healthcare BPO services. We complete all applications and necessary paperwork on your behalf with the chosen payer networks and government entities. We follow all payer contracts through to contract load date and provide copies of fully executed contract and fee schedules to your practice or billing company. We also maintain and update CAQH profile.