For healthcare providers that are offering critical care services, optimizing the medical billing process is a primary concern to ensure sustained, long-term operations. From streamlining the complex collections process to overcoming continual declines in settlements, several tasks constitute the medical billing process and lead to the successful close of a revenue generation cycle.
We are a leading Medical Billing Outsourcing Services company, will enable your healthcare business to accelerate the cycle of revenue generation, reduce operational costs, and increase the efficient result delivered by the system.
We provide end-to-end medical billing process outsourcing services and act as a mediator between insurance companies and healthcare providers. Healthcare organizations are facing the possibility of losing large quantities of their money every year due to under-pricing, errors, non-settled claims, and missed charges. When you outsource medical billing services to us, we provide high-quality output with optimum accuracy and eliminate the chance of occurrence of these losses.
End-to-End Medical Billing Services
Eligibility Verification/Pre-Insurance Verification: When the patient visits the hospital/healthcare provider, we perform pre-insurance verification to check eligibility regarding the particular insurance, requirement for any pre-authorization or referral. This step is important because many insurance providers do not provide pre-authorization.
Medical Coding: We access the bills and patient information from the provider'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 for medical coding to assign CPT and ICD codes. The coded documents then go for proof-reading and cross-checked by the medical coding team. The coded documents are then forwarded to the charge entry team.
Charge Entry: The charges from already coded documents are then entered into the patient account. If the patient is new and an account number does not exist, then the patient account is created by entering all the demographic details from the patient registration form. Before sending the claims to the insurance payer, 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 checked, the claims are then filed to the payer. Usually, at clearinghouses, the claims go through some type of filtering software to ensure that they are accurate and all required 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 within 24 hours and the claims are resubmitted to the insurance company.
Payment Posting: When our team of medical billing outsourcing professionals receives scanned Explanation of Benefits and checks, these payments are entered into the system. As part of this task, we also charge relevant patient accounts and initiate the process for denied claims in case the actual claim is far below the expected one. Reconciliation takes place daily.
Accounts Receivable Follow-Up: Once the claims are submitted to the payer to get it processed, our expert medical billing follow-up team pursues all unpaid insurance claims that have crossed the time frame of 30 days in order to reduce the accounts receivable (AR) days of the claim. Sometimes, the claims are underpaid by the payer, and in this case, we make sure that the underpaid claims are processed and then paid correctly. The denied claims are appealed by our AR team.
Denial Management: The denied claims are addressed on a priority basis - our billers and coders find the errors and re-file or appeal the denial. We have Denial Analysts who fix the issue and send the claim for re-processing. 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 the patient.
Patient Follow-Up/Patient Statements: We do follow up with patients for any pending amount due after the insurance claim is processed. A patient statement is generated and filed on a weekly or monthly basis, as per your healthcare provider requirement. Follow-up is done through phone calls. If no response is received from the patient, we move those unpaid amounts 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 reports and Key Performance Indicators 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 ensuring that it is a case of overpayment. This ensures correct and timely refunds to the appropriate entity.
Provider Enrollment and Credentialing: We offer a range of medical billing and healthcare BPO services. We complete all formalities and necessary documentation on your behalf with the chosen payer networks and government entities.
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