Medical Billing Cycle


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Medical Billing Cycle

  3. 3. Atif G. Memon<br />Head of Operations<br />eClinic Assist<br />
  4. 4. OUR TEAM<br /><ul><li> Our Services, your Solution.
  5. 5. Dedicated to providing your practice with the latest re-imbursement strategies.
  6. 6. Our first priority higher re-imbursement in timely manner.
  7. 7. Highly experienced and motivated skills in healthcare industry to take your practice to the next level.
  8. 8. Complete Practice Management services & solutions to maximize your re-imbursement.
  9. 9. Providing services with fast, efficient & reliable service to our clients and their patients while maximizing our client's income level.</li></li></ul><li>WHY US?<br />We able you to;<br /><ul><li>Focus on quality patient care.
  10. 10. Focus on strategy to acquire new patients
  11. 11. Focus on policy and compliance
  12. 12. Focus on superior patient relations
  13. 13. Expedite and enhance revenue generation
  14. 14. Enhance productive office hours
  15. 15. Improve claim accuracy
  16. 16. Reduce office expenses </li></li></ul><li>WHAT WE DO?<br />Our team provide differentiated services spanning the entire spectrum of the revenue cycle, including:<br /><ul><li>Appointment Scheduling
  17. 17. Patient Registration/Enrollment
  18. 18. Insurance Eligibility Verification
  19. 19. Pre-Certification/Pre-Authorization
  20. 20. Medical Coding
  21. 21. Medical Billing/Charge Capturing
  22. 22. Claims Transmission
  23. 23. Insurance Follow-up
  24. 24. Payment Posting
  25. 25. Self Pay Follow-up
  26. 26. Denial Management
  27. 27. Medical Transcription</li></li></ul><li>HOW WE DO?<br />We have a unique process to ensure your outsourcing success. Regardless of where you are, depending on your needs we can cater to your requirements. <br />We analyze the situation to understand your needs. <br /><ul><li>We conduct a comprehensive study of the processes involved and give our input on the components of your business.
  28. 28. We establish a pilot project. We will clearly define parameters of quality, productivity, turn around time, and cost efficiency. Pilot program is carried out over a 30 day period, but this could vary depending on the service you are seeking.
  29. 29. We have a specialized team who would work with you and the execution team to make sure that standards and efficiency do not drop. The objective of this stage is to consistently meet expectations.
  30. 30. We ensure that you not only have a comfortable outsourcing experience, but never lose control over the entire process.</li></li></ul><li>PATIENT SERVICES<br />
  31. 31. APPOINTMENT SCHEDULING<br />We have Few options for your practice to Make Your Patients Next Appointment Scheduling Stress Free.<br /><ul><li>We help our customers schedule their appointment according to the mutual convenience of Physician and Patient.
  32. 32. We assist our customers in migrating to electronic scheduling for effective scheduling.
  33. 33. This helps us to manage Physicians’ as well as Patient’s time effectively</li></ul>We know the value of Physicians’ as well as Patient’s Time<br />
  34. 34. PATIENT ENROLLEMENT<br />Capturing patient’s demographic information accurately to.<br /><ul><li>Submit Clean Claims to various insurance carriers
  35. 35. Reduce delays in claim submission [we maintain a turnaround time of 5 days for claim submission]
  36. 36. 95-98% accuracy ratio.</li></ul>Rigorous controls in the data capture process helps to ensure 100% accuracy for critical information following HIPAA Law.<br />
  37. 37. ELIGIBILITY VERIFICATION<br />We verify the Insurance Eligibility and Coverage to. <br /><ul><li>Get paid better due to reduce denials due to terminated coverage
  38. 38. Improve Customer Relations
  39. 39. Strong Management skills
  40. 40. Healthy environment </li></ul>Thus, we can minimize denials and improve collections.<br />
  41. 41. PRE-CERTIFICATION/PRE-AUTHORIZATION<br />We coordinate with insurance carriers to get pre-authorisation or pre-certification identity details to manage receivables better and collect dues on time from insurance carriers<br /><ul><li>Receive timely Pre-Auth / Pre-Cert ID details from Insurance carriers
  42. 42. Get paid on time
  43. 43. Minimizing risk related to Patient Identification </li></ul>This helps to manage the receivables better and collect dues on time from insurance carriers<br />
  45. 45. BILLING SERVICES<br />
  46. 46. OUR SPECIALITIES<br />Our specialties are in the field of:<br /><ul><li>General Practitioners
  47. 47. Out-patients
  48. 48. In-patients
  49. 49. Home Visit
  50. 50. Nursing Home
  51. 51. Physical Therapy
  52. 52. Pediatrics
  53. 53. Psychiatry</li></li></ul><li>MEDICAL CODING<br /><ul><li>Our Medical Coding Team ensures correct Procedure & Diagnosis Codes that are identified from CPT and ICD-9CM manuals on the principle of “Code as per the documented information”.
  54. 54. Selection of appropriate codes helps our clients to get paid accurately for services delivered.
  55. 55. It also avoids the possibilities of under-coding or over-coding of reports which may further lead to loss of revenues. </li></ul>Training at regular intervals helps our Coders improve their skills, which in turn benefits our customer.<br />
  56. 56. MEDICAL BILLING/CHARGE CAPTURING<br /><ul><li>We capture the charges accurately through a team of experienced professionals.
  57. 57. We help our customers to submit clean claims.
  58. 58. We reduce the lead time of claim submission.
  59. 59. We reduce claim denials due to incorrect details. </li></ul>We maintain a turnaround time of 24/48 hrs for capturing charges.<br />
  60. 60. CLAIM GENERATION & SUBMISSION<br /><ul><li>We process electronic & paper claims.
  61. 61. We have powerful experience on EMR+PM & PMS based technologies
  62. 62. We generate claims within permissible filing limits
  63. 63. We reduce delays in claim submission. </li></ul>We maintain a 5-day turnaround time for claim submission.<br />
  64. 64. PAYMENT SERVICES<br />
  65. 65. PAYMENT POSTING<br />We post payments received in all forms i.e. EOBs, EFTs received from carriers, banks, credit cards and cash payments received from patients. <br />This helps our customers to:<br /><ul><li>Post payments timely to calculate revenue realization
  66. 66. Help resolve payment-related queries </li></ul>We maintain turnaround time of 48/96 hrs for posting payments in various forms<br />
  67. 67. PATIENT REVIEW<br /><ul><li>We conduct Payment Reviews periodically.
  68. 68. Track payment patterns
  69. 69. Check discrepancies in payments
  70. 70. Correct DSO Values
  71. 71. Facilitate payment realization at the procedural level </li></ul>This analysis helps our customers introduce corrective measures to improve revenue realization by reducing payment denials.<br />
  72. 72. A/R SERVICES<br />
  73. 73. AR ANALYSIS & FOLLOW-UP SERVICES<br />Our Services in Account Receivable include: <br /><ul><li>Denial Management
  74. 74. AR analysis
  75. 75. Insurance follow-up
  76. 76. Self pay follow- up </li></ul>Our Services also include on time reporting of: <br /><ul><li>Payer punctuality
  77. 77. Payer Mix
  78. 78. Aging analysis, Procedure code analysis, Insurance analysis, cash collection analysis, under payment analysis & expected collection report
  79. 79. Charges, payments and adjustments</li></li></ul><li>FOLLOW UP WITH INSURANCES <br />FOR OUTSTANDING RECIEVABLE<br /><ul><li>We run aging reports to categorize [Oldest to Latest & Highest to Lowest] outstanding claims and follow-up with carriers.
  80. 80. We help improve revenue realization.
  81. 81. We reduce DSOs.</li></ul>We maintain target of 45-50 days for DSOs.<br />
  82. 82. PATIENT FOLLOW-UPS<br /><ul><li>We follow up with the Patients for outstanding payments.
  83. 83. We help improve revenue realization.
  84. 84. We help in timely recovery of payments.</li></ul>Timely follow-up with patients helps reduce bad debts and maintain better customer relations.<br />
  85. 85. DOCUMENT MANAGEMENT<br />Our DM solutions enable clients to:<br /><ul><li>Search and manage millions of records in seconds
  86. 86. Share documents with other Medical professionals
  87. 87. E-mail or E-fax the documents to other medical professionals just with a click of the mouse with Encryption
  88. 88. Access the important documents from anywhere, at anytime</li></ul>Some of the other benefits include:<br /><ul><li>Quick retrieval of documents
  89. 89. Convenient and flexible indexing
  90. 90. Search facility based on different criteria
  91. 91. Files available anywhere and any time with no risk of document loss
  92. 92. Safe and secured control of important documents
  93. 93. Reduction in use of expensive office or storage space
  94. 94. Easy way to back up documents and enables off site storage and helps in disaster recovery</li></li></ul><li>DENIAL ANALYSIS & FOLLOW-UPS<br /><ul><li>Denial Analysis & Follow up:
  95. 95. We conduct thorough analysis of every denied claim, make the necessary corrections, and follow-up to convert it into a clean claim.
  96. 96. We help improved revenue realization.
  97. 97. We help introduce preventive measures for future billing.</li></ul>We maintain a turnaround time of 48/96 hrs for denials<br />
  98. 98. MEDICAL TRANSCRIPTION<br />Our expertise in the field<br /><ul><li>Highly qualified, trained & experienced Medical Transcription Professionals.
  99. 99. Close interaction with the clients helped us to improve dramatically.
  100. 100. We provides medical transcriptions that suit your needs.</li></ul>Technically Speaking<br /><ul><li>We use secure networked Medical Transcription & document routing with advanced auditing process for the dictation.
  101. 101. Formatted & ready to print or insert into your Electronic Medical Records.</li></li></ul><li>CHARGES<br /><ul><li>Virtual Front Desk services as low as $7-$9 per hour.
  102. 102. Complete Medical Billing services as low as 4% - 7%.
  103. 103. Medical Transcription as low as 4¢ per65 character line.</li></ul>Sounds Good?<br />For our client satisfaction we provide pilot project that helps our client experience working with eClinic Assist before going live.<br />
  104. 104. Thank you for your time and attention!<br />Contact us for more information about Revenue Cycle Management Services<br /><ul><li>24 Hour Helpline: 832.604.4115
  105. 105. Fax: 469.621.8147
  106. 106. Email:
  107. 107. Web:</li>