We begin our services at provider office with patient registration services (patient demographic info), and appointment fixation.
We handle the process of checking insurance eligibility of the patient even before he/she visits on appointed date. This will ensure if patient is still eligible with the insurance we have for him on our records, the co-pay/deductible part, the co-insurance and so on. This will help the front office to collect the patient cost share upright avoiding lot of administrative cost, like sending paper bills and phone calls.
Referrals and Authorization
Our expert referrals team members
- Acquire an immediate response to patient authorization request
- Attach supporting documentation
- Update authorization requests
- Check status of previous requests and follow up
Our provider analytical software engine empowers us to keep a track of the patient and ensure follow up with regards to any referrals and further course of treatment as driven by the primary PCP.
Based on the encounter form, charges are created under a claim and checked for the mapping between the CPTs and ICDs to make it ready for submission to insurance companies.
Claim submission and Tracking
Billing ready claims are submitted electronically through a clearing house to corresponding insurance companies. Clearing house sends the report of accepted/rejected claims. Team makes the necessary corrections and resubmits the claims. Claims which cannot go through electronically are sent via paper.
Upon submission of the claims to Insurance companies, based on the statutory claims processing turn around time, EOB (Explanation of Benefits) is received. The payment is posted in the EMR based on the EOB and tallied to penny.
Complete Denial Management
In the EOB, along with payment some denials are also expected. Our team is experienced to sort out and segregate the denials to find out the root cause. We ensure that necessary checks are put in place to avoid such cases subsequently.
MRA and HCC
Traditional Medicare payment based on the FFS approach has been changed of late. Payments/incentives will be based on the Hierarchical Condition Categories (diagnosis grouping model) based MRA (Medicare Risk Adjustment) score. Which means doctor treating sick patients will be paid more compared to healthy patient as sick patients need more care/supervision. Our team is trained on ensuring that the right analysis is done and best recommendations are provided to the doctors.
Incentive Programs Guidance
Of late due to new healthcare reforms, CMS came with many incentive programs like â€˜meaningful useâ€™, EHR, PQRI and so on which will bring decent remuneration into the practice as bonus. We have good knowledge in setting up for these incentive programs.
Account Receivable Follow-up
The biggest challenge for Providers is collection of Accounts Receivables (AR) because claims have filing limits and correcting mistakes through first submission can be a lengthy process in some instances. Our team is well trained to handle these issues swiftly and with quick follow-up.