Patient Scheduling and Registration:
ACP provides customized patient scheduling and registration process that works the way you want it to work by providing:
- Personalized schedule templates and appointment types
- User-defined schedule views – by appointment type, location or provider
- Customizable welcome email for new patients
- Automated phone and email appointment reminders and confirmations
Insurance information of every new patient sent to us is verified and updated as follows:
- Receive patient schedules from the hospital via fax, email or EDI
- Verify patients’ insurance coverage
- Contact patients for additional information
- Update the billing system with eligibility and verification details including member ID, group ID, co-pay information, coverage start and end dates, and so on
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.
- Offshore coding audits
- HCC medical coding
- HCPCS, ICD -10 and CPT-4 Coding
- Payer specific coding services
- Chart Audits and Code Reviews
Demo and Charge Entry
Once the insurance verification process is completed and respective codes for diagnosis are assigned, our healthcare billing team moves to the next phase of creating medical claim process that adhere to rules pertaining to specific carriers and locations. Claims are usually created within a period of 24 hours.
- 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:
- Payment Posting from Explanation of Benefits (EOBs) to Patient Account
- Indexing of EOBs to patient account
- Analysis of EOBs for under-payment or over-payment
- Reconciliation to Match Payment Posting to Actual Deposits
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:
- Identifying the root cause of denials – We identify and interpret patterns to quantify the causes of each denials
- Supporting accurate workflow priorities – We collect every piece of information related to denied claims, including status, escalation and correspondence with payers, which will be very helpful in streamlining the recovery process
- Providing timely and accurate statistics – We provide accurate analytics and reports that can go a long way in preventing future denials
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:
- Timely Filing
- Inclusive Denial
- Non-Covered Service
- Reduced payment
- Medical Necessity
- No authorization
- Avoiding out-of-timely filing
- Analyzing the effectiveness of the resolutions
- Identifying business process improvements to avoid future denials
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.