Patient Care services are rendered in accordance with the Physician’s orders. The Physician’s orders are entered into the hospital’s information system and distributed to the appropriate departments. During the patient stay, hospital personnel from various clinical and ancillary departments are involved in providing care to the patient. Diagnostic and therapeutic services are provided by departments such as Radiology, Pathology/Laboratory, and Rehabilitation. All patient care activities are recorded in the patient’s medical record.
We are proficient at both CPT and ICD 10 Coding. Our certified coders are very experienced in coding multispecialty records.
With respect to Charge Entry, Transmission, and Rejections, we enter charges and submit claims in all the formats, including CMS 1500, UB 92 and UB04 formats depending on the service.
We understand the categories of services and items such as Accommodation, Operating and Recovery Room, Medical/Surgical Supplies, Pharmacy, Ancillary and other Clinical Services.
We have a standardized approach towards Charge Description Master like Charge Master Number, Department Number, Item or Service Description, Procedure or Item Code, Revenue Code, Quantity or Dose, and Charge.
We are proficient in both EOB and ERA posting. Our staff is well trained on reimbursement methods like Traditional Fee for Service, Fee Schedule, Percentage of Accrued Charges, Usual Customary and Reasonable (UCR). Fixed Payment – Capitation, Case Rate, Contract Rate, Flat Rate, Per Diem, Relative Value Scale (RVS), Prospective Payment System (PPS), Ambulatory Payment Classification (APC), Diagnosis Related Group (DRG), Resource-Based Relative Value Scale (RBRVS).
We work on Current Denials otherwise called as Zero Pays on a day-to-day basis.
We divide AR follow up into two: Current AR which is not more than a year old, and Old AR which is older than a year.
We offer Eligibility Verification services for various specialties with a turn around time as low as 24 hrs. Our specialized team obtains authorizations and referrals with proper follow up methodologies to ensure that the services are authorized in advance.
Analyzing Patient Balances, sending statements in 3 cycles and following up with the patients on unpaid balances is also one of our major areas of expertise.
We follow up on Patient AR closely and completely before any account is handed over to collections. We understand the loss to hospitals in uncollected Patient Balances, and the higher costs hospitals incur in engaging collection agencies. Therefore, we do a thorough follow-up on Patient AR to maximize collections before handing off uncollected AR to collections agencies.
We ensure statements are sent to appropriate and most recent address as per the availability in the EHR systems. We reduce the probabilities of statements being returned back due to incorrect address. We follow up with patients, and if they are not reachable, we follow up with guarantors and explain to them the bill carefully so that they understand the reason for their balance.
Credit Balances are usually accounts with a negative balance which is most likely an overpayment from the payer or from patient. It may also be due to some payment posting adjustments. Our Credit Balance analysis team have both payment posting and analytical expertise. We help you to clear the credit balances faster so that your ageing reports look clean.