Medical Billing

We understand that medical coding is one of the most important processes in healthcare revenue cycle management preceding a claim submission. Accurate Medical coding services are essential to reduce denials and generate more revenue for our clients.

One of the main reasons for claim denials is medical coding errors. To assist our clients in preventing these errors, we have a team of AAPC (American Academy of Professional Coders) certified medical coders, who maintain the highest level of accuracy in medical coding. By meeting and exceeding the industry standards and compliances without compromising on quality, we guarantee accurate coding and complete satisfaction to our clients. The principle followed by the Coding team is simple – “If it is not documented, it cannot be coded”.

We provide the following medical coding services

ICD-9-CM, CPT-4, HCPCS coding, ICD-10-CM and ICD-10-AM medical coding
Chart Audits and Code Reviews
HCC medical coding
Offshore coding audits
Payer specific coding requirements

Every step in the process of medical coding is accomplished with perfection to ensure that an accurate and error-free claim is submitted to the insurance carriers. There is a separate sub-group of experienced coders who handle the HCC medical coding and the offshore coding audits. There is also a separate audit team that audits all the coding done before the charts are processed.

Precision and accuracy in medical coding methodology produces consistency and eliminates the risk of errors.

Our clients who outsource medical coding services also receive regular feedback on any coding guideline changes and coding-related denial analysis.

Accounts Receivables Management

One of the key areas in medical billing that directly impacts the cash flow is accounts receivable management. Therefore, it is only logical that a system of internal controls to properly manage medical billing AR follow-up is designed and put in place.

AR management team is structured to be a complete solution provider to address difficulties that occur in cash flows and is operated as a part of the medical billing team. The goal here is to recover the funds owed to the client as quickly as possible. We aim at accelerating cash flows and reducing the Accounts Receivable days by submitting error-free clean claims, proper analysis of denied claims, and regular follow-ups with insurance companies and patients for outstanding claims and dues.

Insurance Verification

Health insurance verification is all about the process of checking a patient’s active coverage with the insurance company and verifying the eligibility of his or her insurance claims.

In order to avoid claim rejection, the verification process must be done before the patient is admitted to a hospital. Otherwise, it might lead to denials and the need for rework. Patients would be ineligible for benefits when they provide wrong or outdated information, or when their policies have been terminated or modified. A simple error can result in claim rejection or denial, so you have to be sure it is being done correctly.

Insurance Verification Process
Insurance eligibility verification involves many steps.

1) Receiving patient schedules from the hospital via EDI, email or fax

2) Verifying patients insurance coverage

3) Contacting patients for additional information

4) Updating the billing system with eligibility and verification details such as coverage start and end dates, member ID, group ID, co-pay information and much more.

Denial Management Services

Healthcare denial management services that include AR follow-ups, claims status checks, resolution of denied claims, preparing appeal letters, etc.

It is important to note the terms claim denial and claim rejections are often used interchangeably by office billing personnel as both may be considered part of the denial management processes. Rejected claims will not be processed as they have not been received/accepted by the payor, therefore, these claims do not make it into the adjudication system. This simply means that a rejected claim must be submitted when the errors are corrected. Often times this causes a reduction in cash flow because no one is looking at system rejected reports or they believe they will receive a denial EOB. Is your staff looking for and resolving rejected claims sent to the payer via either electronic data interchange (EDI) or paper? A denied claim has been received by the payor and has been adjudicated and payment determination has already been processed. A denied claim has been determined by the insurance company to be unpayable. Denied claims represent unpaid services and lost or delayed revenue to your practice. Does your practice execute a denial management strategy- process?

Claims submission

The medical billing insurance claims process starts when a healthcare provider treats a patient and sends a bill of services provided to a designated payer, which is usually a health insurance company. The payer then evaluates the claim based on a number of factors, determining which, if any, services it will reimburse.

Today, claims are mainly sent electronically. The insurer is billed for medical care provided using the physician’s retail charge for those services. Once the claim is received for processing, the payer’s claim adjudication system determines whether the patient is a subscriber “match” in the payer’s system and is eligible to receive benefits for the date(s) of service identified on the claim. If the patient “matches” and is eligible, the payer’s system then typically determines whether the services are “covered services” according to the patient’s benefit plan. The submission process itself presents unique challenges whether done electronically or manually, in an office/clinic or facility/ hospital. This is because of the standardized claim forms used industry-wide. The CMS-1500 (formerly known as an HCFA-1500), and the UB-04

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