Patient insurance eligibility verification is the first—and perhaps most critical—step in the billing process. Physicians need to verify each patient’s eligibility and benefits to ensure they will receive payment for services rendered. The process of verifying patient eligibility and benefits can be a time-consuming process for clinics and hospitals, no matter how many patients there may be.
The process of obtaining the insurance eligibility verification of a patient is necessary to ensure that the patient has coverage, services that are being provided are covered, denials and appeals can be minimized and payments are expedited at the appropriate rates. Denied claims due to no active coverage, out of network, unauthorized patient procedures or visits can be a major loss in revenue and should not be taken lightly.
Before the patient’s visit to the provider, we perform pre-insurance verification to check eligibility regarding the particular insurance, whether any co-payment has to be collected, and whether the patient’s insurance covers the service sought from the provider. We also check the requirement for any pre-authorization or referral, and if the patient has met the deductible, the amount of co-insurance the patient shares.
Patient demographic contains every specific detail related to the patient. It involves the entry of needful information related to a Patient’s Name, Address, Residence, City, State, PIN/Zip Code, Social Security Number, Employer and Insurance Details. This information is first captured in a patient registration form and then from there it is entered in the practice management/billing software before finally being transmitted to the Payer.
Patient demographics process is critical as it decides the amount of reimbursement that the healthcare provider will receive from the insurance payer. Error-free patient demographic entry is required for claims submission, as it provides accurate data that facilitate quick processing of the insurance claims by the insurance company.
Once we receive all the information from the client, our team of medical billing experts will thoroughly review all the documents provided in the file and validate the information. We ensure that all the information is correct and accurate before we enter the data into the medical billing system. We understand the importance of this process very well and always ensure that claims are accurate and sent faster to payers.
The charge entry process is where your claims are actually created. The key details, that are needed to get claims processed are entered here, and includes, the face sheet of the patient, physician details, information about the insurance coverage of the patient and billing information. In the charge entry process, patient accounts are assigned with the appropriate $ value as per the coding and appropriate fee schedule. The charges entered will determine the reimbursements for the physician’s service.
It is essential that utmost attention is given to charge entry process to ensure that the charges from the coded documents are entered correctly and only a clean claim is submitted to the payer. Proper care should be taken to avoid any charge entry errors which may lead to denial of the claims.
We cross verify patient demographics and medical codes applied to charts. Your fee schedule is taken into consideration and claims are filled accordingly. From document scanning to updating in the EMR/EHR, charges are submitted daily through our secure, systematic, accurate, and reliable processes. Before transmitting the claims to the insurance payer through the clearinghouse, the entered charges are audited by the quality assurance team to ensure a ‘clean claim’ is submitted.
Payment posting allows providers to view their payments and provides a snapshot of a practices’ financial picture, making it easy to identify issues and solve problems fast. Payment posting involves posting and deposit functions and reconciling posting activities with deposits. Although it seems simple enough, this is a fundamental feature of the revenue cycle.
When payment posting is done right, your practice can thrive. With better cash flow from better collections, problems being spotted faster and dealt with quicker, the entire medical billing process is sure to run smoother. Billing issues can be addressed quickly, secondary payers will be billed correctly and patients will receive their statements promptly increasing the entire medical billing cycle’s efficiency.
We initiate the process for denied claims in case the actual claim is far below the expected one. Reconciliation takes place on a daily basis. Our specialty lies in working on the most advanced electronic remittance scenarios, including denials, underpayments, overpayments, multiple adjustments, automatic cross-over, secondary remittance, reversals, and more.
In order for your medical practice to keep the lights on and maintain the professional staffing level that you and your patients rely on, you must pay close attention to the flow of revenue. It’s crucial that you obtain every dollar for every visit in a timely fashion. Collecting payments is easier when you have some expert assistance backing you up.
Effective collections follow up results in the speedy resolution of your medical claims. Claims follow up should begin as quickly as 7 to 10 days after your claim has been submitted for payment. Immediate efforts to get claims paid will not only reduce your accounts receivable days but also increase cash flow.
We have a separate team of executives dedicated to calling only patients. Calls are made to patients to obtain missing demographics, insurance information and discuss outstanding patient dues. Each patient account is meticulously tracked and followed-up by our trained and experienced staff until the payment is received. Processes are clearly laid out involving sending letters, statements, notices, making phone calls, etc. to expedite collections.
MEDICAL BILLING REPORTS
Medical billing reports will provide you with accurate information regarding the health of your practice saving you from lost revenue, keeping your practice financially sound while allowing you to free up your clinical staff and resources to better serve your patients, increasing your reimbursement average, reducing insurance company denials of payment, taking care of unpaid accounts, and decreasing denied claims.
Our medical billing reports provide the key performance indicators around collections, accounts receivable, productivity, patient demographics. Taking a proactive approach with medical billing reports will help keep your business profitable while giving you more time to focus on patient care.
We provide medical reports like the Accounts Receivable aging, Key Performance Indicators, Payment Trend, Insurance Analysis, Patient Payments, and Clearinghouse Rejections. The Key Performance Indicators Report tracks total number of collections, procedures and charges, to pinpoint a practice’s most profitable appointments and CPT codes. The Accounts Receivable Aging Report records claims in detail to uncover payment issues, and enables billers to determine if the practice’s accounting department is doing an adequate job.
ACCOUNTS RECEIVABLE MANAGEMENT
Accounts receivable or AR is a term used to denote money owed to your practice for services you have rendered and billed. Any payments due from patients, payers, or other guarantors are considered AR. A goal of every practice is to manage its AR to ensure that it gets paid correctly in a timely manner.
Many a time, practices and facilities have accumulated unresolved accounts receivables due to lack of proper AR follow-up; lack of skilled staff; or due to poor AR management done by another medical billing company. Having a skilled AR team will help you in recovering overdue payments, minimize the time for those outstanding accounts which ultimately leads to the financial stability of your practice.
We analyze the various accounts receivable reports provided by the client and determine the strategy to collect maximum unpaid claim amount. Once the claims are submitted to the payer for processing, our expert AR team resolutely pursues all unpaid insurance claims that have crossed the 30 days bucket. Sometimes, the claims are underpaid by the insurance payer, and in this case, we ensure that the underpaid claims are processed and paid correctly. The denied claims are appealed by our AR team.