More Related Content
What's hot
What's hot (20)
Similar to Medical billing process
Similar to Medical billing process (20)
Recently uploaded
Recently uploaded (20)
Medical billing process
- 1. Medical Billing Process FrequentlyAskedQuestionsby Clients Whenwe approach a clientwe are askedseveral questions.Here are some frequentlyasked questionsbyclients.Letuslookatthemone by one. Do I lose the control over my process ifoutsourced to TMST? No,in fact TMST considersitself astrategicextensionof yourorganization.Hence,we deliverthe workthe wayyoudo. We keepyouinformedaboutthe everysingleactionbeingtakenandgive the mutual accessto your Practice ManagementSystemandalsoprovide youwiththe reportswhich allowyouto retaincontrol overyouroutsourcedprocesses. Are you HIPAA compliant?How do I ensure that the Privacy and Integrityof my customer data is protected? Yes,we are HIPAA compliant.Based onclientspecifications,TMSTemployeessignanon-disclosure agreementatthe beginningof anyengagementwiththatparticularclientandwe alsopractice additional measuresrequiredbyclients,if any. TMST has implementedstrictpolicytoensure confidentialityof customerdata.Oursecurity measures,includingelectronicandphysical,ensurethatconfidentialdatadoesnotgo outof the workplace. Does TMT possessthe abilityto understand my business,Deliverablesandrequirementssothat I can outsource effectively? TMST ProjectManagementGroupand DomainCompetence Teamhave yearsof experience intheir ownarea of expertise.Thisenablesustounderstandclientbusinesses,deliverablesand requirementsbetter. How do you continue to service customerswhen some key staff membersleave the organization or go for a long leave? TMST has lucrative HRpoliciestoretainitsemployeesatall positions.Asasafetymeasure we have strongsuccessionplanforthe backup of each employee.Extratrainedworkforce isalsoavailable to overcome anysuchsituations.Regulartrainingisacontinuousprocessin TMST throughwhichwe keepmakingourstaff subjectmatterexpertsalthoughtheycanhandle multiple processes. How does your pricing compare withrespect to your competition?How do I pay you? TMST goesby negotiableindustrystandardsandworksforthe end-to-endservices.However,we alsohave differentpackagesbasedonyourspecialty,type of work,areaof workand volume of work.We bill the appropriate percentage of revenuesonthe lastdayof everymonth.There are no annual or Start-upFeesrequired How do I signa contract or give a work order? It isso simple- All youneedtodois complete the formatgivenbyus andfax a signedcopyback.You can sendus the workorder as an email attachmentorFax or through FTPsetup.We customize this optionas peryour needsize of the practice.
- 2. Medical Billing Process How will you handle my project? Partial Work order: In the beginningyoutransferapart of your processto evaluate our performance anddecide whetheryouwanttooutsource yourentire projecttous. Project Transition:We transferall the data in orderto workfrom ouroffice.We implementa 'ProcessKnowledgeTransferMethodology'thatassuresaseamlesstransitionof yourproject offshore.Thiswill greatlyreduce youroutsourcingrisks. Project Management:You will have asingle pointof contact,accountmanager,who will be responsible forcommunicationandmanagementof everystepof the project. ClientRelationship:We take regularfeedbackof the progressof yourprojectand implementit. Do you accept outsourcingwork on specificpart/functionsof our medical billingprocess? You can outsource specifictasksof yourmedical billingprocesslike onlyARoronlycharge entryor onlypaymentpostingorentire project,asperyourconvenience. What informationdo I needto send to you requiredto file a claim on my behalf? Generally,we require the followingdocumentsto be scannedandsentoverto us: . NewPatientInformationForm . A copyof the patient’sinsurance card/WC ID card . A copyof the patient’swrittenprescription . The patient’sfirstsuperbill/treatmentform Do you file both electronicand paper claims? Dependinguponthe insurance carrier,we submitclaimsbothinelectronicandpaperformats. How do you handle a case when there is no paymentfrom insurance in spite of sendingclaims? Our personnel analyze whetherthe denial isvalidornot.If valid,we write off the paymentandif invalid,we requestthe carriertoreprocessthe claim.We follow-uponeachclaimuntil ithas been paidor until a reasonable response hasbeengivenbythe carrier. What qualificationsdoyour employeeshold? Our employees are experiencedandexcellentindomainexpertise.Ourstaffshave leadership developmentTrainingprograms.HighlycompetentbillingspecialistsandcertifiedcodersfromAAPC.
- 3. Medical Billing Process Process Setup We setupyouraccount within48 hoursof time.All you needtodoisfill upthe ProviderInformation Sheetandsendus back.Restof the thingswill be done byus. ProviderInformationSheetcontainsafew fieldswhere providerhasto provide hisinformationin orderfor us to submitthe claimonhisbehalf. Forexample we wouldneedTax id#,ProviderId#, PTAN #, Individual ProviderId#, UPin,Providerpractice address,phone #etc Process Flow chart FTP Setup
- 4. Medical Billing Process Super Bill and Insurance Card Super Bill and Insurance Card Scannedcopyof Superbill
- 5. Medical Billing Process Whena claimis to be submittedtoinsurance,it shouldbe supportedbynumerous details/records/documentswhichissentbyTMST’s office.Once the same are made available tous, eitherthroughfax or viaFTP server,ourpersonnel checkformissingorduplicate/illegal documents. Accordingly,areporton dailybasisismaintainedandsenttoyouforconfirmationwhichmayhave requesttosendadditional dataif notreceived. Medical Coding Whenall requireddataisreceived,efficiencyincodingisimperative.BasedonCPTandICD- 9 and otherstandards,ourcodersfix the procedure anddiagnosticcodesforeach patient/claim.Sometimes,codingisprovidedbydoctor’soffice andwe justneedtoverify thembefore gettingintothe nextstepof claimsubmission.
- 6. Medical Billing Process Charge Entry Our office will enterall patientregistration,insurance information,andotherrelatedinformation intoour billingsoftware once obtainedfromyourpractice within24hours.
- 7. Medical Billing Process Akamai PM Software Screenshot
- 8. Medical Billing Process Quality Check A randomand regularcheckis done bythe professionalstoensure thatthe codingisperfect, demographicsare correctand claimsisas per billingrulespertainingtogiveninsurance carriersand locations.ClaimisforwardedtoQualityControllerswhorecheckeverydetail againtoeliminate probabilitiesof errorsormissinginformation.if anyerrorisfoundclaimissentback to the relevant area and the error isrectifiedandagaincomestothisarea for furtherstep.The auditedclaimsare thensentto the claimssubmissionteam, fromwheretheyare dispatchedtothe relevantinsurance carrier. ClaimTransmission
- 9. Medical Billing Process HCFA 1500 Claim Form Claimformhas got 33 differentfields. Informationenteredcomesinformof filledclaimformwhichissentto insurance companies eitherelectronicallyoronpaper. Cash Posting Afterpaymentisreceived,ourstaffspostthe same intothe billingsoftware.
- 10. Medical Billing Process Account Receivables/Denial Management - Our ARand Denial ManagementSpecialistsreceive extensive traininginARfollow-up. - Aggressive follow-upstarts21 daysafterclaimsubmission. - Our Specialistsare chosenfortheiranalytical skillsandare providedwith accesstoall the documentationrequiredtomake sure thatthe claim is paidon the firstcall. E.g. Whenthe Insurance repsaysthat the claimlacksauthorizationnumber,ourSpecialistsare taughtto immediatelyretrievethe authorizationnumberfromourdatabase andfax it while theyare still on the call. At TMST Denial Managementis handledby: Identifyingkeydenial reasons. Identifying non-contractualadjustmentsdue todenials. IdentifyingProblematicPayers. Identifying contractual issues. Identifying denialreasons. Understandingthe financialimpact. TMST Denial Managementisdifferentby: ProperDocumentation. The use of accurate Procedure codesandmodifiers. Skilled,trainedandqualifiedstaffs. - Within24 Hourson receiptof EOB Deniedclaimsare workedon,rectifiedandresubmitted. - EOB is posted onthe same day and All Denialswhichrequireadditional documentation,are sent to the TMST’ s office. - We are well versedwithusingcorrectappeal proceduresinknowingHealthcare Laws andwe specialize inworkingonoldAccountReceivables.
- 11. Medical Billing Process Account Receivables/Denial Management The shape of the distributioncurve of AccountsReceivable illustratesbillingquality.A steepdropin termsof percentsof accountsreceivable showsgoodquality.How longdoesittake toget50% of claimspaid?National average is73 days.A goodqualitybillingprocesshasrelativelysmall median, e.g.,half of the claimsmustbe paidwithin30 days,Measure completenessof payment.Whatisthe percentof accounts receivablebeyond30 days,60 days,and 120 days? The actual amountof AccountsReceivable beyond120days isconsidereduncollectable andlabeledasa provider'slossfor write off. A graphical presentation of Revenue Cycle
- 12. Medical Billing Process PatientCalling/StatementProcessing In this,the callercallsupthe patientforvariousreasons.Some of the commonreasonson whichthe callercallsupthe patientare: i) To follow-uponthe billssenttothe patient,whenthereisnoresponse fromthe patient. ii) To check the appropriatenessof the insurance informationgivenbythe patientif itisinadequate or unclear. iii) To checkthe insurance informationincase of self-paypatients. iv) To getclarificationoninsurance coverage incases,whereinformationprovidedbythe hospital or TMST’s office isinsufficient. v) To getinformationforwhichclaimsare pendedbythe insurance company. In thiswaythe AR Analysisandthe ARCallingdepartmentworkhand-in-hand,andmake the claims paid.It isthe co-ordinationbetween these twodepartmentsthatmakesthe carriertodischarge the paymentsfaster.The majorcriteriaforassessingabillingoffice’sperformance are highcollections and lowAR,and thiscouldbe attainedonlybythe AccountsReceivablesdepartment –the back bone of Medical Billing PatientCalling/StatementProcessing Screen shot of Patient Statement Reporting We provide customizedreportstothe clientondaily,weeklyandmonthlybasis.Regularreporting enablesabillingcompanyandclienttocloselymonitorperformance andprovide feedbackto improve the process.