Charge Entry and Charge Posting. We provide support for all software and are well-versed with most billing systems. We are able to provide support for UB 92, HCFA and so on.

Charge Team
In this department, we have competent individuals who first enter the patient personal information from the demographic sheets. They then check for the relationship of the Diagnosis code and CPT. They then create a charge, according to the billing rules pertaining to the specific carriers and locations. All charges are accomplished within the agreed turn around time with the client, which is generally 24 hours.

Audit
The daily charge entry then need to be audited to double check the accuracy of this entry, in other words, this is the check to make certain the billing rule is being followed accurately. Also this department verifies the accuracy of the claims based on carrier requirements to be sure we have a clean claim.

Claims Transmission
Claims are then filed and this information is sent to the Transmission department. The transmission department prepares a list of claims that go out on paper or through electronic media. Once claims are transmitted electronically, confirmation reports are obtained which are filed after all verification processes. Paper claims are printed and attachments done, and if necessary, put into envelopes and sent to the US for postage and mailing. Transmission rejections are analyzed and appropriate corrective action is taken.

Carrier Adjudication
The carrier Utilization Review department would then review the claim. Once the review is completed, the claim would then be adjudicated and processed for payment. Then the check and Explanation of Benefits (EOB) is sent to the provider.

Cash Application
The Cash Applications team receives the cash files (Check copy & EOB) and applies the payments in the billing software against the appropriate patient account. During cash application, overpayments are immediately identified and necessary refund requests are generated for obtaining approvals. Analysts are informed of underpayments and/or denials.

Patient Billing
When our analyst team requests that the patient be billed for a deductible or for the balance, the charge team would proceed to do so.

Collections
We also provide comprehensive collections to ensure high reimbursements.

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We believe that the most important part of billing and collections in an outsourced model is reports. Being able to see what has been billed, what has not yet billed, what collections have been done, A/R, A/R aging, Procedure code analysis, Insurance analysis, payment analysis, cash collected and so on.

Daily reports
Daily reports would include a daily call status, daily billing status and collection reports. This report can be customized according to your needs. During this time we also provide reports on what is necessary to run daily operations.

Weekly Reports
Weekly reports would include a daily and weekly call status, daily and weekly billing status and collection reports. This report can be customized according to your needs. During this time we will also provide reports on what is necessary to run weekly operations. A bi-weekly telephone meeting can be conducted to evaluate progress and make adjustments.

Month End Reports
Monthly reports would include a set of financial reports, procedure code usage reports and aged summary reports. These would allow us to assess momentum and/or see where there is a pattern of non payment. In this way we could once again tackle any bulk pending issues. For example, any claim beyond the 60 day pending needs to be acted upon and if it is pending for clarification, the respective account manager at the center must be informed so that remedial steps can be initiated. Monthly meetings and on request, video conferencing will be conducted.

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