Physician Billing Process
PATIENT SCHEDULING AND REGISTRATION:
INSURANCE INFORMATION OF EVERY NEW PATIENT SENT TO US IS VERIFIED AND UPDATED AS FOLLOWS:
ACP has put in place an expert team of highly credentialed and experienced coders. All our coders are AAPC certified, have a minimum of five years of experience and are continually working to stay on top of latest changes in the industry. Leveraging this vast repository of expertise, we can provide following medical coding outsourcing services.
DEMO AND CHARGE ENTRY
Medical Claims Audit – The claims are then put through a series of rigorous auditing sessions, which involves extensive testing at various levels. The completed claims then go through the second round of examination for validation of information, including correctness of procedures and diagnoses codes. Only those claims that are error-free go to the next step.
CLAIM TRANSMISSION AND WORKING ON CLEARING HOUSE REJECTIONS
Once the charges are created and their correctness is established, they are filed with the payer electronically. At the clearing houses, the accuracy of information contained in the claims is validated and a report is sent back within 24 hours in case of any inconsistencies. Once we get the report, the inaccuracies in the claims will be rectified and within next 24 hours’ error-free claims will be resubmitted to the insurance company.
OUR EXPERIENCED TEAM OF MEDICAL BILLING AND CODING EXPERTS CAN CARRY OUT ALL PAYMENT POSTING PROCESS INCLUDING:
We track every claim that is denied and present it in a manner that allows fast identification of trends. With this kind of powerful intelligence in hand, we can dramatically drive up the first-time claim acceptance rate and stop the torrent of claim denials.
SOME OF THE KEY FUNCTIONS OF OUR DENIAL MANAGEMENT PROCESS ARE AS FOLLOWS:
REJECTED MEDICAL CLAIMS FOR APPEALS
Appeal plays an important role in the RCM cycle when a claim gets denied or underpaid. Before filing an appeal, it is important to evaluate the claim to determine whether it is worth spending the time and money. At ACP our well trained RCM specialists review every intricate denial and understand the possibilities of an appeal to ensure they are cost effectively resolved and most importantly ensuring that we give priority and act within the specific appeal timeframes of each insurance so that our efforts are not exhausted and would result in revenue that would benefit both the provider and the biller.
SOME OF THE KEY DENIALS THAT OUR TEAM REVIEWS TOWARDS RESOLUTION ARE:
AR FOLLOW UP
Here our team of accounts receivable management experts rigorously tracks all unpaid insurance claims that pass the 30 days’ bucket and ensure that they are collected, thereby greatly reducing accounts receivable (AR) days. They also ensure that all underpaid claims are processed and paid correctly by the insurance payer, while making sure that all the denied claims are appealed in time.
Patient Follow-Up/Patient Statements
We approach patients regarding pending balances that are due after the claim is processed. Those that receive no responses are moved to collections and the client is notified to take further action.
This is the final and most important step in the medical billing cycle, wherein we persistently follow-up with patients for final settlement of payments and get the job done within the shortest possible time.
How can we help you?
Contact us by submitting a business inquiry online.