Healthcare Backoffice Services

Revenue Cycle Management

 

The whole Revenue Cycle Management incorporates everything from determining patient eligibility, gathering their co-pay, coding guarantees accurately, following cases, gathering installments and catching up on denied claims. Revenue Cycle Management keeps away from poor work process and have a clear detail for patients and doctors, before the patient scheduled appointment.

Revenue Cycle Management involves the following process

Appointment Scheduling and Patient Reminders

Our Revenue Cycle Management customized service gives doctors and institutions ability to set appointments, and allows patients to get reminders and access to service without any delays. Addressing future payment issues that might occur, registering patients and verifying insurance even before the patient steps in for their appointment are also offered as part of this service. All relevant patient information is collected days before the actual appointment, and with information from the payers, payment terms can be sorted out with the patient even before the appointment takes place. This ensures that patients get smooth service, and ultimately results in institutions being paid on time or patients being informed of co-payments in real time.

Benefit & Insurance Verification

This is a critical component of our service during which we determine patient eligibility for insurance and benefits. With the aid of this service institutions are able to check the insurance product the patient has and verify the specific coverage provided by primary payers and secondary payers. Co-payment information, starting dates and end dates for insurance coverage and additional information such as relevant group IDs are collected, verified and stored during this phase. Point of sale collection requirements can also be assessed and conveyed to the patients in advance. A number of related services are also offered, and these include collecting additional data such as patient demographics and Medicaid enrollment.

Coding

We employ coders certified by the American Academy of Professional Coders to process documented clinical visitor service codes. Proficient in CPT-4 and ICD-9-CM code sets, and many others our coders have also mastered the usage guidelines for each. We offer a range of coding services that cover over two dozen clinical specialties currently provided in hospitals and clinics. As part of our coding services we also audit codes already input by professional healthcare staff or other coders. Our services are strengthened by the experience we have earned over the years dealing with E&M, procedure codes and many modifiers. Additional coding services offered include short term handling of workload when employees are on leave and coding reviews for compliance purposes.

Claims scrubbing

Our claims scrubbing service involves state of the art procedures and intricate methodologies that aid in the quick acceptance of insurances claims. Constantly adapting our service deals with the ever changing requirements of medical insurance payers, and helps doctors and institutions sidestep the need for constantly relearning processes. This service can be customized to fit any claim submission need present within an institution, and so can deal with a wide variety of claims and their submission. We employ a unique combination of automated claim editing software and manual editors, and so can pick up everything from common data entry mistakes to faulty procedure codes or any error that would cause a claim to be rejected.

EDI Claim Submission

Under this service we electronically handle everything right from the moment of claim enrollment to submission, then track the claim and finally check if the claim is rejected or paid. Using our electronic claim submission process, large institutions and even small clinics do not have to worry about administrative delays and can submit huge amounts of claims on time. We have tailor made our service to be efficient, and streamlined it for submitting claims while concurrently increasing the accuracy of the process. Using our service means that every claim is tracked from the moment it is created, until it is filed with the insurance payer and is processed completely.

Physician Credentialing

Our service takes over the task of physician credentialing and is formulated specifically to ensure that credentials are uniform and accurate in the National Provider Identifier database, and any other database used by insurance carriers. Very often payments from insurance carriers are delayed due to faulty physician credentials which can often be as small as a missing comma in a name. Recognizing the need for accurate and timely physician credentialing we have taken the initiative to offer our specialized service. Ultimately our service is geared towards getting physicians and providers their payments on time without going through unnecessary procedures.

Underpayment analysis

When using our service simultaneous and daily underpayment analysis can be performed, and underpayments identified can be pursued within the limitation period specified in contracts. Importantly our service is designed to fully complement or replace existing underpayment identification and recovery processes within healthcare institutions. With our highly trained in house staff and customized software, we aim to increase patient service payments made by payers. Most such underpayments can be identified and flagged within a few hours of the initial payment being received.

Insurance Accounts Receivable Follow-up

We understand that revenue is most often lost when insurance accounts receivable follow up is not adequate or done aggressively enough. This is why our insurance accounts receivable follow up service is aggressive and relentless as long as a claim is pending. Importantly, it is designed to bring about increased cash flow and reduce the number of days a claim spends in the overall accounts receivable process. Claims are tracked through the different stages of this process with the aid of specialized software packages, and status of each is recorded in an effort to receive payments in the shortest period.

Patient Accounts Receivable Follow-up

Payments for patient services can be tracked and followed up on with our patient accounts receivable follow-up service. Created to track down payments that have not been processed by the insurance company our service also handles inbound and outbound calls to payers. As an additional benefit to our clients, we keep a lookout for changed rules in insurances payers in an effort to reduce the number of insurance denials and maximize the number of successful claims.

Denial Management

With our denial management service we aim to get insurance denials routed to the correct individuals, researched and re-filed quickly in order to obtain payments. In other cases we perform a detailed analysis of the causes for the denials, so that procedures can be put in place to stop such events occurring again. Patterns arising out of errors and problems that occur repeatedly can be identified with the use of our denial management service, which is designed to operate concurrently with a number of patient accounting software packages.