Revenue Services

Charge Entry

Based on the encounter form, charges are created under a claim and checked for the mapping between the CPTs and ICDs to make it ready for submission to insurance companies.

Claim submission and Tracking

Billing ready claims are submitted electronically through a clearing house to corresponding insurance companies. Clearing house sends the report of accepted/rejected claims. Team makes the necessary corrections and resubmits the claims. Claims which cannot go through electronically are sent via paper.

Payment Posting

Upon submission of the claims to Insurance companies, based on the statutory claims processing turn around time, EOB (Explanation of Benefits) is received. The payment is posted in the EMR based on the EOB and tallied to penny.

Complete Denial Management

In the EOB, along with payment some denials are also expected. Our team is experienced to sort out and segregate the denials to find out the root cause. We ensure that necessary checks are put in place to avoid such cases subsequently.

MRA and HCC

Traditional Medicare payment based on the FFS approach has been changed of late. Payments/incentives will be based on the Hierarchical Condition Categories (diagnosis grouping model) based MRA (Medicare Risk Adjustment) score. Which means doctor treating sick patients will be paid more compared to healthy patient as sick patients need more care/supervision. Our team is trained on ensuring that the right analysis is done and best recommendations are provided to the doctors.

Incentive Programs Guidance

Of late due to new healthcare reforms, CMS came with many incentive programs like ‘meaningful use’, EHR, PQRI and so on which will bring decent remuneration into the practice as bonus. We have good knowledge in setting up for these incentive programs.

Account Receivable Follow-up

The biggest challenge for Providers is collection of Accounts Receivables (AR) because claims have filing limits and correcting mistakes through first submission can be a lengthy process in some instances. Our team is well trained to handle these issues swiftly and with quick follow-up.