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Conectivity Process |
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Documentation at the Front Desk
The patient hands over his insurance card. On the card copy the office manager needs to verify if a referral or pre-authorization needs to be obtained and then contact the respective Primary care physician (gatekeeper) and get this documentation. |
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Scanning
Demographics, super bills/charge sheets, insurance verification data and a copy of the insurance card i.e. all the information pertaining to the patient, is sent to the billing office. Billing office scans the source documents and saves the image file to an FTP site or on to their server under pre-determined directory paths. The Scanning department retrieves the files. Files are sent to the appropriate departments with the control log for number of files and pages received. Illegible/missing documents are identified and a mail is sent to the Billing office for rescanning. |
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Pre-Coding |
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Pre-coders then enter the key-in codes for insurance companies, doctors and modifiers. Pre-coders also add insurance companies, referring doctors, modifiers, diagnosis codes and procedure codes that are not already in the system. |
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Coding
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Coding team assigns the Numerical codes for CPT (Current Procedural Terminology) and the Diagnosis Code based on the description given by the provider |
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Charge Team |
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This department would first enter the patient personal information from the Demographic sheets. The relationship of the Diagnosis code and CPT is also checked. Then a charge is created according to the billing rules pertaining to the specific carriers and locations. All charges are accomplished within the agreed turnaround time with the client, which is generally 24 hours. |
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Audit |
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The daily charge entry then needs to be audited to cross-check the accuracy of this entry to ensure the billing rules are being accurately and meticulously followed. Also this department verifies for accuracy of the claims based on carrier requirements to ascertain a clean claim. |
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Cash Application |
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Cash Applications team receives the cash files (Check copy & EOB) and applies the payments in the billing software against the appropriate patient account. During cash application, overpayments are immediately identified and necessary refund requests are generated for obtaining approvals. Also underpayments/denials are passed on to the Analysts. |
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Analysis |
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AR analysts are the key to any group. The claims are researched for completeness, thoroughness and accuracy and work orders are set up for the call center to make calls. AR analysts are responsible for the cash collections and resolving all problems to enable the account to have clean AR. They also research the claims denied by the carriers, rejections received from the clearing house, Low payment by the carriers and appropriate actions are taken. Analyst reviews for global patterns and bulk problems are solved at one instance. |
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Calling |
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This is the hub of activity around which Medical Billing operates, where the caller would call up Insurance and verify if the claim is with the carrier and what is the current status of it. Whether it is being processed for payment or denial, based on his inputs the analyst goes to work, and gets the required pre-requisites needed, in case of payment he would compile a list of payment details or if denied then corrective action needs to be initiated. Calling team receives work orders from the analysts and initiate calls to the insurance companies to establish reasons for non-payment of the claims. All reasons are passed on to the Analysts for resolution. |
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Claims Transmission |
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Claims are filed and information sent to the Transmission department. Transmission department prepares a list of claims that go out on paper and through the electronic media. Once claims are transmitted electronically, confirmation reports are obtained and filed after verification. |
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