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The Key Steps to know for successful Medical Billing Services

Outsourced Medical billing services are composed of experts with a sound experience in handling various medical billing software & follow strict quality standards which cuts the room for errors that may lead to Denials. It is challenging for the practices to process billing with in-house staff because of the billing complexities, frequently changing regulations, new technologies.

Medical Billing & Coding is the process of translating information from patient records, treatments, tests, procedures, and diagnoses into the standardized codes used to bill patients and third-party payers such as private companies or government-owned agencies (Medicare/Medicaid). The ICD-10 & CPT codes are extract from clinical data charts and physician’s notes. Coding must be in compliance with the patient’s encounter with the physician and must be as specific as possible in regards to capturing reimbursement for rendered services.

Claim Processing & Submission

We believe that the precise eligibility verification directly impacts the reimbursements, minimize the Denials / Rejections, help to submit clean claims & to increase upfront collections. Insurance Coverage Benefits Verification is vital element of avoiding insurance claim denials & increased profitability. We ensure prompt & precise eligibility verification that provide a detail view of the patient’s coverage, primary / secondary payer’s details, including member ID, group ID, coverage period, co-pay, deductible, co-insurance out-of-network benefits, & payment obligation.

Claim Creation is one of the key area of Revenue Cycle & we have an excellent skills in handling the Charge Entry & Claims Submission on various billing software for multiple specialties. To avoid revenue leakage we need to address the common billing errors like  nonspecific coding; missing information; timely filling; incorrect patient identifiers; duplicate claims; up-coding & unbundling; and not supporting medical necessity. The clean claim submission minimizes the denials which boost Practice profitability & Cash flow and it helps in decreasing the medical office outlays.

Denials & Appeals Management

Payment Posting is one of the most vital step in the RCM process & precise posting represents overall billing proficiency and sorts out reasons for low influxes, if any. We ensure error free posting of Payment & Adjustments. We deal with denials, overpayment, recoupment / refunds with proper documentation. Denials posting helps in resolving the reason for denial and prevents future claims getting denied for the same reason. Our posters & denials analytical staff review down coded payments, contractual adjustments and contracted fee-schedule while posting EOB/ERA Payments.

Our experts track every unpaid claim to rectify denials & get faster reimbursements. We believe that minimizing denials boost your Practice profitability & Cash flow. Effective Tracking & Prevention approach enables us to identifying the denials for corrective action & resubmission. Our staff perform regular Follow Up on resubmitted claims to make sure that appeals should be successful to optimize your payment cycle.

Accounts Receivable (AR) / Follow-Up

Accounts Receivable directly impacts the cash flow, therefore, we design internal controls to manage A/R follow-up and put in place to recover the funds. Our A/R Follow process ensure timely payments & quick settlement of Aged & unpaid claims. We constantly follow up on accounts Aging 20+ Days with insurance companies (via web-portals, fax, IVR & Call) to increase Revenue Collection & to reduce Accounts Aging.

At PhysicianRCM, We know our job as a RCM & Billing Services Company, if you are looking for ways to improve, we will likely have the best ideas. In the changing environment of Healthcare regulations & technology, the Practices need an innovative partner for Medical billing Services who can help in improving clinical & financial workflows, increasing Profitability, & reducing practice operational expenses. We are the trusted HIPAA-Compliant Company & provide Billing services to healthcare providers of all sizes.

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