Medical billing process flow chat

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Medical billing process flow chat

  1. 1. Medical Billing Flow Chart Revenue Cycle Management System EligibilityPatient’s coverage isverified prior to visit Clearing Houses Clearing Houses Coding For ForMedical Records arereviewed and coded by Electronic Clearance Electronic ClearanceCertified Coders •Demo Entries •Demo Entries Hospital Insurance InsuranceDemographic & Charge Entry Hospital •Charge entries /Doc’s •Charge entries CompanyBilling specialists enter /Doc’s •Medical Coding Companypatient demographics and office •Medical Coding Releasingcharges into the PMS office •EOB’s Releasing generates •EOB’s Claims payments generates •Payment Postings payments Super bills •Payment Postings Transmission and Posting Super bills •DenialsClaims are sent to the •Denialsclearinghouse and payments •Claims Submission •Claims Submission(EOB) received are applied •A/R Analysis •A/R Analysisto the PMS •Follow up’s •Follow up’s •Insurance Calling •Insurance Calling Accounts Receivable •Patients StatementIncrease in collection ratio •Patients Statementthrough accurate analysis •Patient Calling •Patient Callingand timely follow up •Customer Care •Customer Care Revenue RecoveryOld AR are analyzed andcorrective measures aretaken (Resubmission) Doc us TM About people, process and technology
  2. 2. Medical Billing Flow Chart Revenue Cycle Management SystemCLIENT IN US SCANNING TO INDIA CODING ACCESSSING SOFTWARE PATIENT DEMOGRAPHICS ENTRY CHARGE ENTRY QUALITY AUDIT Paid Claims for Unpaid Claims cash application TRANSMISSION OF CLAIMS THRU CLEARING HOUSES For corrective action CASH APPLICATION AR ANALYSIS / CALLING CASH TALLYING ACTION ON DENIALS / REJECTIONS GENERATION OF REPORTS REPORTS TO CLIENT Doc us TM About people, process and technology
  3. 3. Medical Billing Flow Chart Revenue Cycle Management System Scanning Documents to India Medical Coding US Office scans Patient Demographics, Log to be maintained with File name, Total Charge Sheets, Insurance Card Copies, charges, Specialty details, etc before etc. Coding. Scanned copies would be saved as *.TIF (Tagged Image Format) file and placed in Coding of Diagnosis to the utmost FTP Site specificity using ICD-9 CM Manual.In the FTP Site, Files would be placed in the common path which can be accessible by India Coding of Procedures by referring to CPT / HCPCS.Mail to India on Scan date, File name anddirectory path. After Coding, files to be handed over to Charges Department for processing. Doc us TM About people, process and technology
  4. 4. Medical Billing Flow Chart Revenue Cycle Management SystemDemographics entry Documents to be sorted Patient wise before entering into the system Patient Account Numbering to be done, if system does not generate automatically If any clarification is required, send Patient #, Name(LFM), Address, SSN, Sex, Employer, Home mail to US office Ph, Work Ph, Guarantor, Marital Status, Subscriber details, Doctor#, Insurance information etc to be entered in the system After entering, printouts to be taken and data to be checked Log to be maintained with Total Patients, Patients entered, Pending details, etc. Doc us TM About people, process and technology
  5. 5. Medical Billing Flow Chart Revenue Cycle Management SystemCharge Entry Patient Demographics and Coding to be done before entering Charges Charge File to be sorted by Patient / Date of ServicePatient #, Doctor # , Place of Service, Type of Service, Date of If any clarification required, sendService, Procedure Code, Diagnosis Code, Modifier, Units, Value, mail to US office.Referral , Prior Authorization, On Bill comments, etc. to beentered in the systemAfter entering data, file to be given to Quality Audit forchecking After checking and corrections, Claims to be transmitted. After Transmission, Charges completion details to be sent to US If any incorrect details found, Charges office. department to be informed Doc us TM About people, process and technology
  6. 6. Medical Billing Flow Chart Revenue Cycle Management SystemQuality Check Quality Audit for Patient Demographics and Charges before sending batch wise update to client Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph, Guarantor, Subscriber details, Employer, etc to be checked in Patient Demographic File Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Place of Service, Type of Service, Referral, Prior Authorization, On bill comments, Location, etc to be checked in Charges File After Quality Audit, files to be given to Supervisor / Manager for sending Batch Update to client. If any incorrect details found, Charges Team to be informed of Log to be updated with patients checked, charges checked, the same and correction done correction details, etc Doc us TM About people, process and technology
  7. 7. Medical Billing Flow Chart Revenue Cycle Management SystemClaim TransmissionElectronic/Paper After Quality Check is through, List of Electronic Claims to be separated Transmission processes to be accurately followed to avoid rejection Claims to be transmitted electronically through different clearing houses After transmission, log to be updated with patient If any incorrect details found, Charges #, claim#, total claims transmitted, pending department to be informed claims, etc. Send mail to Charges department after completion of Transmission Doc us TM About people, process and technology
  8. 8. Medical Billing Flow Chart Revenue Cycle Management SystemCash PostingChecks and EOB(Explanation of Benefits) to bearranged before doing Cash Posting Insurance Name, Check #, Total Check Value to be cross verified with the Check and EOB Copies In the EOB Copy, Claim#, Date of Service, Procedure , Units, Charges to be identified before postingApplication of Payment, Deductible, Co-insurance,Adjustments, Write offs, etc in the Cash Posting If any incorrect details found or any detailsAfter Cash Posting, Claim#, Patient Name and Value missing, follow up to be done withto be checked for tallying data with the EOB Insurance Log to be updated with Total Checks, Total Value, Posted details, Pending details, etc Doc us TM About people, process and technology

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