Patient Registration and Appointment Scheduling
A patient can get a doctor’s appointment through call, online or by visiting the provider office.
- Patient sets an appointment, sharing necessary information like patient demographics, insurance information and reason for visit, etc.
- Patient Registration, the process of ensuring the patient’s information is 100% accurate from start to finish.
- We need to have patient’s information like address, phone number, and insurance information et all
- During registration, Front desk needs to have signed financial forms from the patients
Insurance Verification (Eligibility)
Insurance verification is the process of contacting the patient’s insurance company and confirming the patient’s insurance status.
- Medical billing and claim processing can be complex and time-consuming, so it is important to verify eligibility before beginning the process.
- Inaccurate information or ineligible insurance will only result in a denied claim later in the revenue cycle.
- Patient eligibility and benefits are checked with patient insurance to verify that the services that patient will get are covered or not.
- Patient co-pay, coinsurance, deductible, prior authorization (if required) is also obtained at this time.
- After eligibility and benefits verification, the patient gets the services from the doctor at the scheduled time.
Credentialing for medical billing and claim processing is a process of obtaining authorization for a provider to accept payments from an insurer. The credentialing process can be complex and time-consuming, but it is essential to ensure that providers are paid for their services.
There are several steps in the credentialing process:
- The provider applies to the insurer for credentialing.
- The insurer reviews the provider's credentials.
- The insurer approves the provider for payment.
- The provider submits claims to the insurer.
- The insurer processes the claims and pays the provider.
We ensure all the scheduled patients have a valid coverage.
- services are covered under the insurance plan prior to the patient’s type of appointment.
- If the patient is new and an account number does not exist as yet, then the patient account is created by entering all the demographic details from the patient registration form
The charges from the coded documents are entered into the particular patient account
- Before transmitting the claims to the insurance payer through the clearing house, the entered charges are audited by the Quality Assurance (QA) team to ensure a ‘clean claim’ is submitted.
- We follow a rigorous process of scrubbing claims during the charge posting process oriented towards maximizing first-time payments from insurers and minimizing denials.
Claim Transmission is a process that has something to do with the sending of the claims from our billing software.
- We take care of this at the best where we verify each and every claim before releasing them to the insurance companies.
- Also, we make things sure of the number of claims getting transmitted in a particular batch.
Insurance payments are posted to patient accounts from the EOB. All payments received will be posted within 24 hrs.
- To ensure that all payments received are posted, we compare bank deposits with the total payment posted in the PMS
- We also take care of patient payment posting in the practice management software so your staff can concentrate on other important tasks.
- We identify instances of denials for medical emergency, denial of authorization of services, non-covered service, among others and initiate measures to prevent their re-occurrence.
Account Receivable in medical billing and claim processing involves the recognition of revenue.
- This recognition of revenue is based on the number of days a medical claim took to get processed and received by the insurance company.
- The medical billing and claim processing team will use this information to generate a report that will show the number of days it took for each claim to be processed and received.
- This report will help the team to identify any areas where the claims processing time can be improved.
- The medical billing and claim processing team will also use this information to generate a report that will show the number of days it took for each claim to be paid. This report will help the team to identify any areas where the claims payment time can be improved.
There are many different types of denials in medical billing and claim processing.
- The most common type of denial is when a claim is denied because the patient does not have insurance.
- Other common denials include when a claim is denied because the provider does not accept the insurance, when a claim is denied because the patient has not met their deductible, or when a claim is denied because the service is not covered by the insurance.
Correspondence Followup is the process of checking and responding to correspondence received from payers, patients and providers regarding your medical practice.
- It is important to have a process in place for correspondence followup so that nothing falls through the cracks and you are able to keep on top of any issues that need to be addressed.
Self Pay Followup
Self Pay Followup is a process in which the provider contacts the patient directly to collect payment for services rendered.
- This may include sending a bill to the patient's home, making phone calls, or sending emails or text messages.
- The goal of self pay followup is to increase the likelihood that the patient will pay their bill in full and on time.
Collection is something that is handled with care at CG Meditrans.
- We commit to ourselves to manage the AR (Account Receivables) below 15 percent in the 120+ bucket, 15 percent of the total pending AR.
ERA/EFT Set up
ERA/EFT Setup is a process that is done to manage the remittances in the billing software.
- The sooner we collect the remittances (paper and electronic) from the insurance, the sooner we will be familiar with the outcome (Acceptance for payment or Denial) of the claim, and the better we can be at solving the problems and improving the revenue.
- We have to tie up with the insurance companies separately for setting up options for sending us the ERA/EFT into our billing software.
The Medical Insurance Payment System (MIPS) is a program that was created by the Centers for Medicare and Medicaid Services (CMS) to encourage healthcare providers to improve the quality of care they deliver to patients.
- The MIPS program has four main categories: Quality, Cost, Promoting Interoperability, and Clinical Practice Improvement Activities. Each category has its own set of measures that providers must report on in order to receive a payment adjustment.
- The Quality category is the most important, and it includes measures such as patient satisfaction, rates of hospital readmission, and rates of preventable hospitalizations. The Cost category includes measures such as the total cost of care and the efficiency of care. The Promoting Interoperability category includes measures such as the use of electronic health records and the exchange of health information. The Clinical Practice Improvement Activities category includes measures such as participation in a patient-centered medical home or an accountable care organization.
- In order to receive a positive payment adjustment, providers must submit data for at least one quality measure, one cost measure, and one clinical practice improvement activity. Providers who do not submit data for any of the measures will receive a negative payment adjustment.