Medical & Dental Billing
1. Pre-certification & Insurance Verification
The patient list, a copy of the insurance card and demographic details are sent to us via email/fax or secure FTP. Our medical billing specialists call up the insurance company prior to the appointment. Pre-certification is done for specific lab tests, diagnostic tests and surgeries. The details are sent to the hospital/clinic in the prescribed format.
2. Patient Demographic Entry
The medical billing specialists enter patient demographic details such as name, date of birth, address, insurance details, medical history, guarantor etc as provided by the patients at the time of the visit. For established patients, we validate these details and necessary changes, if any, are done to the patient records on the practice management system.
3. CPT and ICD-9 Coding
Our coding team works in accordance to CPT codes and ICD-9 and ICD-10 Coding compliance, and consists of AAPC certified coders with over 2 years of multi-specialty coding experience. You may send us super bills with diagnostic notes with or without ICD and CPT codes. If codes are already provided on the super bill, they are validated by our coding team compulsorily to prevent any 'up-coding' or 'down-coding' and therefore, any denials.
4. Charge Entry
The fee schedules are pre- loaded into the practice management system. CPT and ICD-9 codes are entered into the system. The billing specialists ensure that all details have been provided in the claim and ready to be filed.
5. Claims Submission
Claims are submitted electronically via the practice management system. However, we can process paper claims also. At this stage, a thorough quality check is done by a senior billing specialist and then submitted. The rejection report received from the clearing house, if any, is analyzed and the necessary changes are done. These claims are then resubmitted.
6. Payment Posting
Scanned EOBs and checks are sent to our team. All payments are entered into the system. The amounts from EOBs/checks and amounts posted in the system are reconciled on a daily basis. A daily log is updated with these data.
7. Account Receivables Follow-up
All claims in the system are examined and priorities are set. First the claims close to their filing limits, and then work down from the age of the claim. Periodic follow-ups over phone, email and/or online is done to get the status of each claim submitted to the insurance company.
8. Denial Management
Analysis of denials and partial payments is done by our senior medical billing specialists. Payors, patients, providers, facilities and any other participants are called to follow-up on denied, underpaid, pending and any other improperly processed claims and the action is documented in the system. We will call patients, if authorized by the provider, to obtain information from the patient needed for billing such as ID# and to update the COB (Coordination of benefits) with their insurance companies. Secondary paper claims are processed and sent to the client office for submission.
9. Daily Reports
- 1. Scan control log (Charges)
- 2. Scan control log (Payments)
- 3. Pending log (Charges)
- 4. Pending log (Payments)
- 1. Weekly AR report
Reports can be customized and provided as per your requirements.
- ELIGIBILITY / BENEFITS VERIFICATION
- PAYMENT POSTING / ADJUDICATION, ADJUSTMENTS & DENIAL PROCESSING
- A/R FOLLOW-UP AND CLAIMS STATUSING - INSURANCE AND PATIENT COLLECTIONS
- CLAIMS ADJUDICATION AND RESUBMISSION
- CREDENTIALING, ENROLLMENT, AND RE-CREDENTIALING
- OUTBOUND / INBOUND CALLING
- DENTAL SPECIAL PROJECTS