Healthcare is constantly changing. So maintaining financial stability is challenging. Successful healthcare revenue cycle management strategies focus on front-end tasks to help claims move along. Many errors occur in the first stages of a patient’s account and these issues can carry through the revenue cycle to disrupt claims reimbursement.
We offer professional services with utmost care and precision. We currently take care of all aspects of RCM.
Patient demographics form the core of the data for any medical institution. Registration process on patient demographic data such as: Patient name, Date of birth, Address, Phone number, Doctor information, Social security number (SSN) and Sex. Patient Demographic also contains Guarantors or emergency contact information, Health insurance information becomes a part of the patient's medical record. it is important because correct and quality entry of such information will directly impact physician’s monthly revenue. This sheet is also called as face sheet of a charge or claim.
Successful billing depends on successful eligibility verification. To verify patient has active medical coverage for the date of service and their insurance plan covers for the services provided ensures that the provider will be paid for services rendered. This step is very crucial to ensure correct billing and reduce claim denials.
Medical Coding - is a little like translation. the medical coder would need to understand / read the patient’smedical chart recorded during the encounter. it would list the history, diagnosis, treatment provided, plan of care etc. These need to transferred into a set of universal medical codes. The AMA has a number of resources to help accurately bill procedures and services with Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes.The ICD (10th revision) is currently being used for coding.
Charges and codes for every medical procedure are updated often. The Specialist will be responsible for compiling billing information, assisting with coding & assign $ value as per the fees schedule.
Claims Submission / Billing- Once the claim has been properly completed, it must be submitted to the insurance payer for payment. Medical billers need to have access to the information they need about the insurance payer since there are so many variables for each insurance payer in determining how and when to submit a claim in a timely manner.
Accurately posts payments from third-party carrier and patient payments to accounts. Posts/documents on accounts' rejections notices from third-party carriers. Performs daily reconciliation of payments posted to billing system to payment batch and resolves discrepancies. Posts payments and adjustments to proper patient invoices. Recognizes problems in payment amount.Reconciles ERA files and EOBs to corresponding EFT deposits and paper checks.
Denial management is a critical element to a healthy cash flow, and successful revenue cycle management.Failing to adequately work denials from insurers translates to lost revenue for your medical practice. Our experts analyze the possible denial trends and also initiate ‘global action’ that can impact many claims with a simple fix to prevent repetition of the same denials.
A significant asset of all healthcare providers is their accounts receivable services. we ensure all billing and collections activities meet state and federal compliance requirements. consistent follow up on unpaid claims utilizing monthly aging reports and filing appeals when appropriate to obtain maximum reimbursement. Conducts timely follow-up activities on assigned accounts to reduce outstanding account receivables..
Credentialing and enrollment are critical business processes.Medical credentialing and payer or provider enrollment both are a type of credentialing process. Credentialing is a process where the providers need to be reviewed by evaluating their qualifications and practice history. where as Enrollment refers to the process of requesting participation in a health insurance network as a provider. The provider enrollment process involves requesting enrollment/contracting with a plan/ network.
Doctors share facilities, administration, income and expenses, support staff and equipment. Doctors can specialize in related medical practices or provide a wide range of specialties.
Emergency medicine department is the first point of call for emergencies in all specialties and deals with a vast spectrum of illness, from life threatening emergencies to minor ailments and social problems. it is the medical specialty dedicated to the diagnosis and treatment of unforeseen illness or injury. The doctors see patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders.
Artificial body parts like limbs which help the patient restore normal functioning of the missing part (amputations) and structural characteristics for people with musculoskeletal weakness.
A system of complementary medicine based on the diagnosis and manipulative treatment of misalignments of the joints, especially those of the spinal column, which are believed to cause other disorders by affecting the nerves, muscles, and organs.
Clinical medical care provided by a registered nurse, occupational therapist, physical therapist or other skilled medical professionals, and is often prescribed as part of a care plan following a hospitalization.
The medical specialty dedicated to the diagnosis and medical treatment of adults. A physician who specializes in internal medicine is referred to as an internist.It also deals with with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists, or physicians (without a modifier) in Commonwealth nations.
Orthopaedics is the medical specialty that focuses on injuries and diseases of your body's musculoskeletal system. it focuses on the diagnosis, correction, prevention, and treatment of patients with skeletal deformities - disorders of the bones, joints, muscles, ligaments, tendons, nerves and skin.
Inpatient care is the care of patients whose condition requires admission to a hospital.Inpatient care tends to be directed towards more serious ailments and trauma that require one or more days of overnight stay at a hospital.Inpatient care is broken into two parts: the facility fee and those related to the surgeon/physician.
Outpatient care, on the other hand, is medical service provided that does not require a prolonged stay at a facility. This can include routine services such as check-ups or visits to clinic
Radiology is the branch of medicine which produces images of the body using radiation, high frequency soundwaves or very strong magnetic fields, for the purpose of diagnosis and treatment of disease such as x-rays, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission tomography (PET), fusion imaging, and ultrasound.
Pathology is a branch of medical science primarily concerning the cause, origin and nature of disease. it is based on the laboratory analysis of tissues , surgically removed organs, biopsy samples, bodily fluids such as blood and urine, using the tools of chemistry, clinical microbiology, hematology and molecular pathology.
Psychiatric: a branch of medicine that deals with mental, emotional, or behavioral disorders. these include various conditions related to mood, behaviour, cognition, and perceptions. Psychiatrists are doctors who are dedicated to providing the best treatment and care for mental disorders with compassion and patience.
Dental - Dentistry consists of the study and treatment of prevention of diseases related to teeth and gums.
DME (Durable Medical Equipments) - helps to provide relief , comfort and therapeutic benefits to patients.DME that Medicare covers includes, but isn't limited to: Air-fluidized beds and other support surfaces (these supplies are only rented) Blood sugar monitors Blood sugar (glucose) test strips Canes (except white canes for the blind) Commode chairs Continuous passive motion (CPM) machine Crutches Hospital beds Infusion pumps and supplies (when necessary to administer certain drugs) Manual wheelchairs and power mobility devices Nebulizers and nebulizer medications Oxygen equipment and accessories Patient lifts Sleep apnoea and Continuous Positive Airway Pressure (CPAP) devices and accessories Suction pumps Traction equipment Walkers
A gynaecologist treats patients with female reproductive organs, An obstetrician is a doctor who specializes in pregnancy, childbirth, and a woman's reproductive system.
Therapy (Physiotherapy, Occupational & Speech Therapy) - Physical Therapy tends to focus on treating a patient’s injuries whereas Occupational Therapy involves in improving a person’s functional abilities. Both physical and occupational therapists are trained extensively in anatomy and the musculoskeletal system resulting in both being very knowledgeable about musculoskeletal injuries and rehabilitation than a general practitioner medical doctor. Speech Therapy is a treatment for speech and language disorders.
the branch of science that deals with tumours and cancers. it also prevention, diagnosis, and treatment of cancer.
OAnaesthesia is a complete or partial loss of physical sensation.Pain management is an approach to reducing pain and suffering associated with post operative patients or patients in other medical situations.
ODermatology is the medical science of diagnosing and treating skin diseases affecting the skin, hair, and nails. This also extends to the hair, sweat glands and any other related part of the body. It is a broad field which includes skin conditions caused by auto immune diseases, various skin cancers and cosmetic procedures.
The treatment of injuries or disorders of the body by incision or manipulation, especially with instruments.