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You could have a team of professional physicians who possess the right qualification and license but without enrollment, you could invite risk of payment hurdles. To enhance the performance of your practice you must complete primary source verification to – enroll with payers, switch practice, or add new physicians to existing groups. If you lack the know-how to navigate the physician credentialing process, you need to outsource provider enrollment services to professionals like us.
Benefit and Insurance Verification – With Gravity Technology, denials due to improper eligibility verification is history…
Getting the claims accepted, on the first submission!
Insurance eligibility verification is the most important and the first step in the medical billing process. Research confirms that most of the claims are denied or delayed due to inadequate or incorrect coverage information provided by the patients during visits and current coverage information not updated by the office / hospital staff. This lack of or improper insurance eligibility verification directly impacts the reimbursements.
Insurance companies regularly make policy changes and updates in their health plans. Therefore, it is important for the medical billing company or the provider to verify if the patient is covered under the new plan to get maximum reimbursement. Confirming the insurance coverage facilitates acceptance of the claim on the first submission, whereas non-verification leads to several discomforts like rework, decreased patient satisfaction and increased errors other than causing delays and denials.
Accurate charges are critical for higher first-pass rates of claims. Gravity Technology gets it right the first time, every time…
Charge entry is one of the key areas in medical billing. In the medical billing charge entry process, created patient accounts are assigned with the appropriate $ value as per the coding and appropriate fee schedule. The charges entered will determine the reimbursements for physician’s service. Therefore, care should be taken to avoid any charge entry errors which may lead to denial of the claims. Moreover, good co-ordination between the coding and the charge entry team will produce enhanced results.
RemittMed, provides charge entry in medical billing as a part of the healthcare revenue cycle management services suite or as a stand-alone service. Teams at Gravity Technology have prior experience in handling the charge entry process on various medical billing systems and for several medical specialties. So the teams can start with the process directly after just a few calls to understand the nuances to be followed, saving training time and effort. The teams have pre-defined account specific rules in charge entry for different medical specialties and just add the nuances to them for each client, which reduces the room for errors and contributes to clean claims.
An experienced medical Coding team with AAPC certification – for both Coding and Audits…
Gravity Technology is one of the leading medical coding companies in India. At Gravity Technology, we understand that medical coding is one of the most important processes in healthcare revenue cycle management preceding a claim submission. Accurate medical coding services are essential to reduce denials and generate more revenue for our clients.
One of the main reasons for claim denials is medical coding errors. To assist our clients in preventing these errors, we have a team of AAPC (American Academy of Professional Coders) certified medical coders, who maintain highest level of accuracy in medical coding. By meeting and exceeding the industry standards and compliances without compromising on quality, Gravity Technology guarantees accurate coding and complete satisfaction to our clients. The principle followed by the Coding team is simple – “If it is not documented, it cannot be coded”.
Our experienced and well-trained coders are proficient in providing the following medical coding services:
Every step in the process of medical coding is accomplished with perfection to ensure that an accurate and error free claim is submitted to the insurance carriers. There is a separate sub-group of experienced coders who handle the HCC medical coding and the offshore coding audits. There are also separate audit team that audits all the coding done before the charts are processed.
Precision and accuracy in medical coding methodology produces consistency and eliminates the risk of errors. Gravity Technology’s clients who outsource medical coding services also receive regular feedback on any coding guideline changes and coding-related denial analysis.
Unlike some medical coding companies that rely on external training, Gravity Technology continuously imparts professional training in medical coding to all our coders to ensure that they remain well informed and updated with the latest developments.
At Gravity Technology, payment posting in medical billing is one of the key processes that get the utmost attention from our Operations management. The payments in lieu of claim, which are received from the Payer and Patients, are posted in the medical billing system of the client to reconcile the claim. Gravity Technology also does electronic payment posting in to the medical billing software and handles the exceptions (fallouts) manually to make sure no payment is missed. The posted ERAs are stored either in the billing system or a Document Management system (DMS) for future reference.
Insurance Payment Posting: All payers either send an EOB (explanation of benefits) or ERA (electronic remittance advice) towards the payment of a claim. The medical billing staff posts these payments immediately into the respective patient accounts, against that particular claim to reconcile them. The payment posting is handled according to client-specific rules that would indicate the cut-off levels to take adjustments, write-offs, refund rules etc.
When the client’s office delays in either depositing the Payer checks or sending the ERAs and EOBs for posting, then a negative balance prevails for that claim, which is a false representation of the actual scenario. This false representation would show an inflated AR, resulting in the Physicians not knowing exactly how much revenue is due to them.
Patient Cash Posting: There could be several reasons why the patient needs to pay a part of the expenses including co-pays, deductible and non-covered services. If the amount due from the patients is very minimal, the Provider can set a mandate for taking write-offs. If the amount is quite large, then it should be collected from the patients either prior to or after rendering the services. Patients typically pay through checks or credit cards (via patient portals) and these need to be correctly accounted against the claim to avoid any inflated AR and proper closing of the claim.
One of the key areas in medical billing that directly impacts the cash flow is accounts receivable management. Therefore, it is only logical that a system of internal controls to properly manage medical billing AR follow-up is designed and put in place.
At Gravity Technology, the AR management team is structured to be a complete solution provider to address difficulties that occur in cash flows and is operated as a part of the medical billing team. The goal here is to recover the funds owed to the client as quickly as possible. We aim at accelerating cash flows and reducing the Accounts Receivable days by submitting error-free, clean-claims, proper analysis of denied claims and regular follow-ups with insurance companies and patients for outstanding claims and dues.
Management Clean-up projects
Gravity Technology also undertakes clean-up of old Accounts Receivables. Many a times, practices and Facilities have accumulated unresolved Accounts Receivables either through lack of proper AR follow-up due to lack of manpower or sometimes they end up with these backlogs due to poor AR Management done by another medical billing company. Gravity Technology teams analyze the various accounts receivable reports provided by the client and determine strategies to work on the AR management strategy. The strategies are developed and executed, so that there is reduction of the bad debts and AR collections are maximized.
Gravity Technology is dedicated to minimize lost reimbursements and denials with highly efficient systems and services designed to meet our clients’ needs. One of the major problems faced by healthcare providers and medical billing companies is that a large proportion of rejected claims goes unattended and is never resubmitted. Gravity Technology’s Denial Management process uncovers and resolves the problem leading to denials and shorten the accounts receivables cycle. The denial management team establishes a trend between individual payer codes and common denial reason codes. This trend tracking helps to reveal billing, registration and medical coding process weaknesses that are then corrected to reduce future denials, thus ensuring first submission acceptance of claims. Also, the payment patterns from various payers are analyzed for setting up a mechanism to alert when a deviation from the normal trend is seen.
Appeals for Denied Claims
For claims that are denied and need to be appealed, appeal letters are prepared and sent along with supporting documents including Medical Records for processing. If the insurance permits telephonic or fax appeals, the same is also handled through those channels.
Patient Follow-Up
Gravity Technology has a separate team of executives dedicated to calling only patients. Calls are made to patients to obtain missing demographics, insurance information and also discuss outstanding patient dues. Each patient account is meticulously tracked and followed-up by our trained and experienced staff till the payment is received. Processes are clearly laid out involving sending letters, statements, notices, making phone calls, etc. to expedite collections.
Credit Balance Audits
During the process of collection retrieval, an audit of all the accounts is undertaken to reconcile unidentified and duplicate payments. Processes are set such that the payer and patient overpayments are refunded or adjusted as per the policies of each client. Refund requests are prepared and sent to the clients to handle necessary refunds, after thorough research of the patient account to establish overpayments.