What we Do ?

Coding

Interpreting a physician’s notes, assigning the correct code to the patient's condition, reviewing the medical records as per the guidelines while keeping up-to-date with the ICD-10 implementation - are all part of a coders profile. Our team of experienced coders help assure that patients receive the correct diagnosis for the services/procedures rendered, so that the coded charts are error free and all set for Submission.

Demo Entry & Charge Submission

Verification of a patient's demographics as per the patient charts and loading into the client software, forms pretty much the basis of the billing Process. We take utmost care to ensure that the demo entries and the subsequent electronic/paper charge submissions are validated thru our internal audit team, so that the submitted charges are error free and well within the turn-around-time.

Payment Posting

Posting payments through ERA and check is an important part of the billing cycle wherein all posted payments are validated and balanced to ensure accuracy is maintained. All of the posted payments are verified and audited while they are captured in the client software. In addition to the above, payment posters would also capture the denials encountered while posting payments.

Denial Management

Claims denied by the insurance which are transferred to our denials team by the payment posters, would be verified and validated as per the EOB, post which corrective actions would be initiated and the claim further moved to a resolved status.

Claims Status Verification

Usually the AR Analysts/Callers would be assigned for claims status verification based on the aged trial balance report downloaded from the software. Priorities to work would be given based on the aging days so that the higher buckets are addressed first before working on the lesser buckets. The verification process would range from checking the online portals, verifying the EOBs from Software and calling the payors (if required); and thereby taking necessary action items to get the claims paid based on analytical and client specific approach.

Appeals Processing & Submission

Although the Conversion % of appeals is a little low, all steps are taken to get the claims appealed with post appeal follow-ups until the appeal decision is reversed or upheld

Patient AR

Patient liabilities too form a substantial part of the overall AR outstanding. Hence the team is given specific training on how to handle and collect the patient AR while getting the patient statements generated.