MedCrossRCM

For processing of data, we consider these:

--The super bills and EOBs are scanned and converted to image files.

--These image files are placed on a FTP site for the service provider to download, print and process.

--The documents stay in the clients’ location while we only receive the image file for processing.

As service provider, we have the best in communications technology to deliver a world-class output. Our offices are connected with the US clients through secured VPNs (Virtual Private Networks), which provide access to our staff to work on the billing system in the customer’s office. We ensure end-to-end medical billing services and also utilize IPLC (International Private Leased Circuit) which provides us connectivity with US-based telephone companies to make calls to insurance companies while also provide tollfree 1-800 numbers to receive patient inquiries.

EOBs and check copies are scanned the same way as super bills are. We receive copies of the checks with the EOBs and ensure that the total of checks and EOBs tie up for balancing purposes and are logged in to reconcile with the bank deposits.

We offer end-to-end solutions for Billing companies and Physician practices. By choosing these services you could concentrate on your core business and leave the billing hassles to the service provider.

Claims data entry

We have the data processed and put into the system within a span of 24/48 hours of receipt for normal workflow. The data is then audited for accuracy to ensure the claims submitted are clean and in compliance with rules to ensure optimal and faster reimbursement.

Claims generation and submission (electronic and paper)

Most of our claims are submitted electronically to avail benefit of faster payment. We use clearing houses and other direct submission modes. Paper claims with attachments (primary and secondary) are printed and dispatched for postage in US on frequent basis should a customer opt for the service. This takes about 3 business days to reach the clients’ office.

Payment Posting

The copies of check and EOBs are scanned and received by the service provider for payment posting. All payment posting is completed with 24/48 hours of receipt. End of day, balancing of posted to deposit is done and then included for month-end receipts’ balancing.

Underpaid/unpaid claims identification, appeal and followup

Denials/underpaid claims are identified at the time of payment posting and by scrutiny of the regular mail. All identified items are researched for further resolution by calling up insurance companies or by taking appropriate action. All the denied claims are acted upon within 3-4 business days of receipt.

Account receivables analysis and management

We have experienced analysts who research unpaid claims by the insurance company to identify potential problems and take appropriate action. Payment patterns of major insurance companies are identified and all unpaid claims over the benchmark days are set up as work order for our call center agents to call up insurance companies and check on claim status. It is a policy to check the claim status and this process results in identification of the problems early and increase in collections by 15-20 per cent thus reducing the reimbursement cycle.

Financial reporting including customised reports when required

We have a dedicated MIS team to complete financial and other practice reports on agreed timelines. The client’s requirement of reports, which occurs during the month, is met on a timely basis.

The general month reporting would include as per client protocols.

--Daily recap summary

--Patient type/financial class activity

--Doctor-wise financial summary

--Service analysis by doctor, location, department etc.

--Aged receivables report by financial class

--Any other report requested by the client as part of month end reporting

Patient billing and follow-up

Service provider discusses with client to evolve a policy on balance billing the patient. Patient billing is carried out as per policy for frequency, value and number of bills before it is sent out for collections. Follow up with patients depends on the policies set forth by clients, since they may want to handle all patient interactions.

--Handling patient enquires

We have diligent and courteous staff to handle sensitive patient enquiries and offer explanations on clarifications they may seek on bills sent.

--Provider enrollment assistance

The service provider staff checks the provider details with insurance companies regularly to ensure details of provider are correctly reflected. We assist the practice in submission of application forms and track the processing on a weekly basis to ensure provider enrollment is done accurately on time.

At the time of transition of an account, we write a transition manual with the client and then proceed to do an operational manual, which will lay out the policies and procedures for

--Charge entry

--Payment posting

--Batching system

--Month end reconciliation

--Refund policies

--Patient billing policies, etc.

We have a team to verify the manuals/websites /newsletters for any changes in billing rules. We also call up the insurance companies to prepare a checklist for the way they would prefer to see a claim. The team also reviews all materials/documents received out of subscriptions to insurance updates by emails from the industry forums for identification of change in processing rules.

When documents are scanned, the computer assigns a number to each file. This must be entered in a Control Log which will carry the file number as also the number of pages scanned. The Control Log is also a scanned post which the service provider prints the control log and checks off each file printed. Any file not clear in scanning or pages not tying up will result in an email sent to the client for variation.

The transmission team responsible for claims prepares a log of each transmission and cross-verifies with the confirmation reports received from the insurance carriers. On a weekly basis a summary log is prepared to list the transmissions by payer and the number of claims that were rejected in edits.

The transmission team logs the rejections and provides the claims to the operations team to correct before retransmission. Email for clarification is sent to the clients in case of assistance required.

The minimum qualification for all employees is graduation while account managers/analysts are professionally qualified. We have a very low attrition rate considering staff gets fair market rates as compensation and enjoys a cordial work atmosphere. The average experience of the staff in medical billing is 3-5 years.

The trainees undergo classroom training session to understand the basics of medical billing and software training. They are then deputed to work with senior operators to understand the work flow and processing routines. It takes 4-6 weeks for the staff to accept live assignments.

In case of call centre agents, it takes about 6-8 weeks before they are allowed to handle independent assignments. Their training apart from product knowledge will also cover soft skills in American accent, telephone skills, etc.

The service provider will log into the clients’ software and do the processing, more like telecommuting from India to the US office. The staff is trained in various clients’ medical billing software like Medic, Medical Manager and Medisoft, etc... Besides, they can be trained to handle other softwares.

Yes, our QA system ensures we audit all claims before they are updated into the system. The audit will cover for data entry error and billing rules compliance. This ensures that the claims submitted by the service provider are error free and have fewer rejections resulting in increased cash flow and reduced payment cycle.

Any processing rule changes can be communicated by email, fax, phone, etc. These changes are corrected on our operational manual. On a weekly basis (or as desired) tele conferences are conducted with the clients to discuss changes and review the performance.

Reports, as specified by the client, are provided on the agreed dates. Typically, month-end reports would include

a) Patient type/financial class summary

b) Doctor financial summary

c) Daily activity report

d) Aged accounts receivable report

e) Service analysis reports

f) Payment posting reports

We frame billing rules along with the operation manual. The staff is trained accordingly and our QA team audits all claims before submission to ensure that billing rules have been complied with.

--Ensure monthly collection targets are met

--Identify problem claims and resolve for quick payment

--Establish trends as per carrier for delayed processing and focusing on such claims

--Formulate billing rules per plan/carrier to generate clean claims

--Advise physicians of denials and bundling issues

--Call on each outstanding account over the benchmark days and arrive at an action plan.

--Aggressive follow up until the issues are resolved.

--Conversion of data into claims within 24-48 hours.