Reduce the burden on your billing staff and minimize administrative costs
Patient Registration and Charge Posting
The first step in a clean claim is to make certain that the demographic information has been entered into the system correctly. This process involves collecting patient demographics from clinics and hospitals. Our team is trained to process, verify, and validate demographic information into the billing system.
We have a highly trained staff that performs eligibility verification of benefits in order to avoid delays or errors in insurance coverage. Then the team verifies coverage on any primary or secondary payers by utilizing payer websites, automated voice response systems, or by making phone calls to payers. We also offer real-time pre-authorization services for walk-in patients.
Our team of expert medical coders then starts to abstract and assign the appropriate coding on your claims. They assign the appropriate CPT, ICD-10, and HCPCS codes in order to facilitate accurate claim submission downstream in the process.
Claim Submission & Clearinghouse Denials
Once all the charges are posted into the system, we submit your electronic claims to the respective payers (including HCFA 1500 claims). We work on all your clearinghouse denials and give proper feedback with suggestions to reduce the number of claims that do not pass the clearinghouse. A detailed report will be sent to you on a daily, weekly, monthly, and yearly basis.
Payment Posting & Payment Reconciliation
Insurance payments are posted to patient accounts from EOB’s into the client’s software systems, with a turn-around-time between 24-48 hours. We also generate secondary claims and mail them to the correct insurance companies. Daily payments are posted into the system where they are reconciled with the bank’s deposit sheet on a daily basis.
Denial and Accounts Receivable Management
Most insurance carriers are required to pay the claim or provide a denial in writing within 30 days of receipt. Using our proactive approach to handling denials, we can improve your “days in AR” substantially. All the denials are segregated and forwarded to our denial management team for prompt resolution. The team then measures, monitors, analyzes, and resolves all the denials received from each payer.
One of the most difficult areas to staff in a revenue cycle management company is the patient interaction function. Traditionally, this function has been kept in-house and not outsourced. With our new operations center in Manila, Philippines, we can smoothly and effectively handle in-bound patient statement calls and outbound patient balance calls. There is no need to worry about accents that are difficult to understand or knowledge of the American culture. Your end clients deserve the collection of every dollar.