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Our reimbursement services cover the following functions:
Demographics Entry
Verification.
Pre-Certification Processing.
Superbill Analysis and Charge Entry.
Faster Claim submission.
Secondary Carrier Billing.
Claim Editing and Auditing.
Payment Posting.
Quality Process.
Denial Posting.
Insurance Follow up and Appeals.
Practice Analysis.
Activity and Insurance Reports.

Demographics Entry
Individual patient details are cataloged in billing software. The entries done consist of Patient Demographics, Insurance, Employment and sponsor details update if necessary.

Verification
Pre consultation and pre surgery verification process with the carriers and verifies the patient demographic details, benefits and service procedures to be rendered by the providers, to understand the covered and non-covered services and reimbursement patterns.

Pre-Certification Processing
We verify and/or initiate the pre-certification process as required by the insurance carrier before services are rendered.

Superbill Analysis and Charge Entry
If the super bills are prepared by the physician, the codes will be cross checked, especially for the missing 4th digit or 5th digit of ICD codes, payable diagnosis, modifiers, bundling and unbundling of procedure codes, which are the common error found in the super bills prepared by the physicians.

Alternatively we will prepare super bills from the physician notes and transcriptions that are available in their system. We take utmost care while coding. We follow HIPAA compliance and we update our knowledge regularly by attending seminars conducted by AAPC local chapters and journals etc. CPT, ICD-9, and HCPCS coding and assigning of appropriate modifiers and related information into the Billing Software will be done accurately.

Steps in preparing the super bill and generation of claim consists of:
Coding of the Diagnosis and the Procedure.
Checking the compatibility of the diagnosis with the procedure code.
Checking for the modifiers in relation to the procedure.
Quality checking before the generation of the claim.

Faster Claim submission
Claims will be submitted the next day of service; either electronic or paper claim submission. This results in faster inflow of revenues.

We process electronically for all carriers that currently accept electronic submission. Electronic claims are generally paid faster (usually within 15-30 days as opposed to 60-90 days). With electronic billing there is immediate notification of errors or missing information, thus reducing turn around time for payment.

Claims for providers who do not accept electronic submission we submit claims via paper.

Secondary Carrier Billing
We will automatically process secondary carrier claims upon receipt of the primary carrier.

Claim Editing and Auditing
Stringent edits and audits are done before the claims are transmitted to ensure submission of complete and clean claims.

We have 2 stages of checks for claim processing. This reduces underpayments and denials of claims substantially and provides prompt and accurate settlement of claims.
Stage 1: Our quality assurance team does complete checkup of each and every entry of demographic and charges fields in Billing software. We audit each and every field in demographic and charges.
Stage 2: In this stage of quality audit entries are randomly checked for errors. The fields and the entries such as patient name, DOB, insurance ID and others are verified for Demographic accuracy. Charges Entry checkup includes fields such as CPT codes, ICD codes, modifiers, Service provider and referring physician. Claims are then submitted electronically to the insurance company.

Payment Posting
We maintain accurate and up to date Accounts.
Our posting service includes primary and secondary insurance payment posting, adjustments and transferring to co-insurance to secondary insurance (if available) or patient, Personal Payment (self pay) posting. Posting of secondary insurance payment is also done.

Quality process
Our quality assurance team does complete checkup of entire process of cash posting. Checks are done to validate the fields such as check number, co-insurance transfer and adjustment. Denial and re-submission of claims posting service is very important as it involves a specific time period within which claim has to be re-submitted. Our quality team assures that all denial and re-submission of claims posting is done within time and without missing any record including all supporting documents and information.

Denial analysis and Processing
Claims needing resubmission that is claims denied by insurance are checked for all necessary documents like Medical Necessity records, Referral, Pre-existing information etc. and resubmitted.

Denials will be thoroughly analyzed to prevent them in the future and processing them for payment. All the No-pay letters and other correspondence from the insurance companies is downloaded and printed at our end. If correct reason for denial is not mentioned, we will call the insurance company and enquire about the correct reason for denial and work as per their clarification.

When Claim needs Medical Necessity notes, Pre Existing information, Place of service or type of service etc., the notes will be collected from the client’s server. If any of the information is not available, client will be called and requested to scan the required information from the patient charts. Once the required documentation is collected, it will be mailed to insurance company along with the copy of no-pay EOB.

Duplicate Claims: Due to charge posting error or payment applied to incorrect visit or line item and insurance processing errors etc., patient may see more than one doctor. For these, we call insurance and check the correct reason for denial.

Insurance Follow up and Appeals:
We will follow up via telephone (or letter if necessary) on all claims that have gone unpaid beyond 30 days. If an unpaid or underpaid claim requires an appeal we will process all of the required paperwork and handle all necessary follow up.

Practice Analysis:
Practice analysis will be prepared and submitted to the client. The type of Claims being rejected, why rejected and what can be done to minimize the same will be discussed and the following reports will be provided.

Activity and Insurance Reports:
Financial Class Activity Report.
Charge Type Analysis Report.
Daily Posting Summary Report.
Procedure Mix Activity Report.
Practice Analysis Report.
Other reports that may be of interest to clients and which can be generated on a customized basis include:
Accounts Receivable Aged Trial Balance & Financial Class.
Charges of Physician Report.
Payor Mix Report.
Quarterly Comparison Summary.
Revenue Analysis Report.
Top Referring Physician Report.

As soon as the client decides to start utilizing our services:
Signing the Business Associate Agreement, as required by HIPAA.
Checking/arranging the basic necessities at the clients end, which includes:
High Speed internet connection.
Collecting the data from the previous service provider and its compatibility with our Billing and Practice management software.
Establishment of VPN or any other secure way of accessing the client’s network.
Once the above is fulfilled, we provide online guidance to the client to scan and save all the billing related papers in the server to which we have access, if they are new to this process.
Request the client to scan all the patient demographics so that we can have access to it.

The Process:
Client scans all the billing related documents which includes Super bills, EOBs, Insurance correspondence and hospital documents. Client also scans all the records of payments received from any source by any means like co-pays and self-pays received in the form of cash, check or credit card within two business days of receipt, to enable us to process and submit claims in a timely manner, and follow-up on their account receivables.

Client gives us permission in writing to access their network, to contact insurance providers, patients, referring doctors, hospitals, nursing homes and any other party deemed necessary, and to obtain the information necessary to perform the billing function on their behalf.