REVENUE CYCLE MANAGEMENT


Let Offshore Hospital Billing handle your Billing and Collections. Outsourcing to offshore Hospital billing will reduce your overhead while decreasing the claim payment turn around time. Enjoy the benefits of Outsourcing Hospital Billing, Accounts Receivable Follow-up responsibilities to the experienced professionals in the Offshore Center. 

Hospital Billing Services embrace the entire reimbursement cycle - from claim submission to collection. By Outsourcing to Hospital Billing Services acheives maximum reimbursement for billings through a custom team approach that emphasizes timely and accurate account processing and extensive follow-up.

Challenges faced by Healthcare providers are

  • Increasingly complex coding
  • Managed care -: negotiating and enforcing contracts
  • Compliance and associated risk
  • Cash flows affected by declining reimbursements
  • Decreasing productivity; increased administrative requirements with few resources

Our Offshore Revenue Cycle Management Services

Our end-to-end Revenue Cycle Management is a cost-effective solution that is uniquely customized to improve your profits and relieve you of the pressures of hiring and training employees.

  • Patient Demographics
  • Pre-Surgery Authorizations
  • Efficient Charge Entry, allowing the claims to be sent out clean the first time – Multiple Specialties
  • Payment Posting – Manual & Electronic
  • Accounts Receivable Follow-up
  • Provider Enrollment and Credentialing
  • Customized Practice Management Reports

Patient Demographics

  • Patient Registration – Manual & Hospital Interface
  • Ability to work on scanned images as well as electronically submitted demographic sheets.
  • Ability to accurately process insurance information (selecting appropriate insurance details).

Pre-Surgery Authorizations

  • Hospital Billing Services offers this value added service which ensures clean claims are submitted to carriers and maximum reimbursements are collected in a timely manner.
  • Hospital Billing Services undertake pre-surgery verification process with the carriers and verifies the patient demographic details, benefits and service procedures to be rendered by the providers, to understand the covered and non-covered services and reimbursement patterns.

Charge Entry

  • Professional, Technical and Global Billing
  • Paper and electronic claims are sent daily. Electronic claims are submitted directly to: Medicare, Medicaid, Blue Cross/Blue Shield & most commercial insurance carriers
  • Stringent audits are done before the claims are transmitted to ensure submission of complete and 'clean' claims
  • Our Hospital Billing specialist’s brings expertise in multiple states, multiple specialties, and multiple hospital and physician management systems, Medicare, Medicaid, Managed Care, Preferred Provider Organizations and Indemnity Insurers. We know CMS 1500 and UB92 forms.

Payment Posting

  • Daily Deposits balanced accurately.
  • Denials are worked immediately and secondary claim reports are sent on daily basis.
  • For partial payments, analysis is done and corrective action is taken.
  • Documents refund requests.

Accounts Receivable Follow-up

Our Offshore Hospital Billing Collectors aim is to improve the client’s cash flow by reducing days in A/R and improving profitability, by increasing collections ratio. Our Offshore Accounts Receivable process mechanism helps in identifying category / payer combinations and works on resolving the mix that results in the best collections first. Using this approach, we are able to quickly achieve results and also apply early feedback across the entire category. Our Offshore Hospital Billing timely Accounts Receivable Follow-up accelerates revenue cycles improves cash flow, reduces receivables, and increases collection rates.

Our Offshore Hospital Billing Collectors is trained to identify patient accounts that require follow-up and take the necessary action to collect un- paid and partially paid claims. It is essential to follow-up and document unpaid claims prior to the 60 or 90 day timely filing limits assigned by many managed care contracts. Our goal is to keep the average age of Accounts Receivable at 45 days or less.

Our Offshore Accounts Receivable follow-up protocols and procedures have been designed and time tested to assure that each and every account is followed-up on in a timely and professional manner. No more untimely filings, questionable adjustments or unnecessary waiting.

Our Offshore Medical Billing Collectors are extremely familiar with the current State and Federal Insurance regulations and strive to obtain high rates of return from their Follow-up efforts.

Our Offshore Accounts Receivable includes

  • Receivable Analysis
  • Payer Follow-up
  • Denials management
  • Reporting

Effective Accounts receivable begins with proper coding. The claims are checked for proper order and placement of CPT codes and modifiers. Consistent, thorough, detailed follow-up is performed by our offshore Hospital Billing Specialists. All the claims are tracked until they are paid. Every payment is checked against the carrier's fee schedule. Our Hospital Billing specialists are expert in the appeals process. 

Additional payment is often received on appeals for-

  • Downcoding.
  • Nonpayment of E & M (evaluation and management) codes.
  • Assistant surgeons.
  • Secondary procedures considered incidental to the primary procedure.
  • Incorrect allowances as compared to the published fee schedule.

Provider Enrollment and Credentialing

Hospital Billing Services provide reliable enrollment and credentialing services to providers. The credentialing process can be burdensome and time consuming, but is absolutely necessary to the business health of the practice. Hospital Billing Services provides physicians with efficient and fast, enrollment and credentialing services, and enables them to focus on their core business of providing quality healthcare to patients.

Credentialing Services to providers include:

  • Compiling required enrollment documents
  • Completing and submitting the enrollment application
  • Tracking the enrollment application progress through approval
  • Maintaining critical records of enrollment documentation
  • Monitoring expirations of MA registrations, DEAs, and CLIA registrations
  • Processing re-credentialing applications as needed

Customized Practice Management Reports

Monthly, quarterly and annual reports with statistics including:

  • Number of procedures by charge type (modality).
  • Dollar amount of charges.
  • Amount of charges billed to the payers.
  • Dollar amount of adjustments.
  • Dollar amount of receipts.
  • Dollar amount of accounts receivable (A/R).
  • Number of days in A/R.

Activity and Insurance Reports

The different activity and insurance reports such as:

  • Financial Class Activity Report: Dollar amount charged for each financial class (FC) as well as the dollar amount paid and adjusted off for each FC.
  • Charge Type Analysis Report: Number of charges/charge type (modality) for each doctor by location.
  • Daily Posting Summary Report: Charges, payments, and adjustments posted each day.
  • Procedure Mix Activity Report: Dollar amount charged for each charge type (modality) and the payments that have been received for those charges.