Appointment scheduling often becomes a complicated task for healthcare professionals in hospitals, large clinics, multispecialty practices and other healthcare establishments. The reasons can range from a heavy flow of patient traffic to a physician that practices in a number of clinics and moves from one medical office to the other. An inefficient appointment management system can cause overlapping appointments, no-shows, general patient dissatisfaction, and revenue losses.

The Right Strategy for Better Patient Scheduling Efficiency

In the present age, many healthcare professionals turn to a combination of:

• Phone-based scheduling
• Computerized appointment scheduling using state-of-the-art patient scheduling software.

This coupled with the services of outsourcing solution providers helps them achieve better efficiency, and save time.Convenience, Ease and Speed

Some of the advantages of the above mentioned strategy of appointment scheduling for healthcare professionals are:

• Multiple-user accessibility.
• Depending on what's most suitable for the office; appointments can be viewed by day, week or month; by treatment or equipment room; or by multiple providers.
• Makes easy cross-scheduling and the scheduling of recurring appointments.
• No time lag in identifying appointment availability for clients and patients.
• Patients can conveniently be scheduled for visits, procedures, treatments, and exams.
• 24/7 accessibility
• Helps to track business and employee performance.
• Customer letters and appointment reminders can be generated.
• Patients can easily be referred to other offices.
• Enables updating of patient contact information.
• Enables easy identification of confirmed, unconfirmed, checked in, checked out, cancelled or missed appointments.
• Reduces scheduling mistakes.

Patient Demographic Entry

• Get patient's details and verify them before entry, including guarantor, emergency, employer information, next to kin etc.
• Verify Insurance eligibility with effective/expiry date with co-pay, deductible and policy limitation etc.
• If plan require authorization will verify authorization number before charge entry.

Insurance Eligibility Verification

Benefits from insurance eligibility verifications are improve collections, reduce denials and reduce AR days also gives high quality in claims for your practice.

• Verify coverage on all Primary and Secondary insurance (Coverage type, plan, member ID, Group#, coverage period, co-pay, deductible, authorization requirement, payer ID, other benefit details etc)
• Updating the billing system with eligibility and verification details
• If patient not eligible inform physician office/hospital.

Medical Transcription

Medical transcription is an allied process, which deals in the process of transcription, or converting voice-recorded reports as dictated by physicians or other healthcare professionals, into text format.

The skills and abilities of our transcriptionists

• Knowledge of basic to advanced medical terminology is essential.
• Knowledge of anatomy and physiology.
• Knowledge of disease processes.
• Knowledge of medical style and grammar.
• Average verbal communication skills.
• Above-average memory skills.
• Ability to sort, check, count, and verify numbers with accuracy.
• Demonstrated skill in the use and operation of basic office equipment/computer.
• Ability to follow verbal and written instructions.
• Records maintenance skills or ability.
• Above-average typing skills.
• Knowledge and experience transcribing (from training or real report work) in the Basic Four work types: History and Physical Exam, Consultation, Operative Report, and Discharge Summary.
• Knowledge of and proper application of grammar.
• Knowledge of and use of correct punctuation and capitalization rules.
• Demonstrated MT proficiencies in multiple report types and multiple specialties.

Medical Coding (ICD, CPT, HCPCS & Modifiers)

• Our certified coders refer documents before coding ICD-9-CM, LMRP, CPT Assistant, and HCPCS Level II and check for the compatibility of diagnoses with procedural codes with the appropriate modifiers.
• Chart deficiencies are sent for client address
• Coded files go through quality assurance process

E-Superbill Conversion / Charge Entry

Verify all patent with appointment to make sure all patient charges and billed.

• Charges are entered with all required fields, like DOS, CPT, Diagnoses, Modifier, Unit, POS, Provider Name, Referring Physician, authorization number etc.
• Post co-payment or deductible if collected by provider's office.
• Will be provided to client daily/monthly report after batch processed.

Claim Submission (Electronic and Paper)

• Submit claims to clearing house/Insurance.
• If any rejections will work and resubmit claims to clearinghouse / Insurance.

EDI rejections handling

• Analysis and take action on rejected claims.
• Scrubber detailed report will be sent to client.

EOB, Denial & ERA Posting

• ERAs and EOBs are posted to the particular accounts based on DOS.
• All payment posted batch will be tallied.
• Refunds, off-set and underpayments will be addressed.
• Daily and weekly payment reports will be provided to client.
• Month-end reports based on requirements and variables will be provided to client.
• Denials will be addressed and recorded.
• Denials report will be provided to client monthly or weekly based on client requirement.

Patient Statement Generation

• Patient statement will be sending based on client requirements.

Insurance AR and Denial Analysis and Follow-up

• Denied claims are followed up on a daily basis and routine denials will update to doctor front office to reduce denials.
• Greater than 30- day claims are addressed
• All appealed claims will be followed up.
• To generate aging report every month and work likewise on claims based on $ amount.
• Detailed AR report with claim status will be sent to doctor every month.

Patient AR Analysis and Follow-up

We have a separate team of executives dedicated to calling only patients.

• Alert notes are keyed in to follow up on payments pending from patient.
• If payment not received from patient, will inform provider office to plan on patient payment.
• Insurance denials caused due to lack of or incorrect information from patient side is addressed.
• Delinquent letters sent for payment purpose and on no response from patient, the account details are moved to collection agency.

Patient Demographic Entry

• Get patient's details and verify them before entry, including guarantor, emergency, employer information, next to kin etc.
• Verify Insurance eligibility with effective/expiry date with co-pay, deductible and policy limitation etc.
• If plan require authorization will verify authorization number before charge entry.

Insurance Eligibility Verification

Benefits from insurance eligibility verifications are improve collections, reduce denials and reduce AR days also gives high quality in claims for your practice.,

• Verify coverage on all Primary and Secondary insurance (Coverage type, plan, member ID, Group#, coverage period, co-pay, deductible, authorization requirement, payer ID, other benefit details etc)
• Updating the billing system with eligibility and verification details
• If found patient not eligible inform physician office/hospital.

E-Superbill Conversion / Charge Entry

• Verify all patent with appointment to make sure all patient charges and billed.
• Charges are entered with all required fields, like DOS, CPT, Diagnoses, Modifier, Unit, POS, Provider Name, Referring Physician, authorization number etc.
• Post co-payment or deductible if collected by provider's office
• Will be provided to client daily/monthly report after batch processed.

Claim Submission (Electronic and Paper)

• Submit claims to clearing house/Insurance.
• If any rejections will work and resubmit claims to clearinghouse / Insurance.

EOB, Denial & ERA Posting

• ERAs and EOBs are posted to the particular accounts based on DOS.
• All payment posted batch will be tallied.
• Refunds, off-set and underpayments will be addressed.
• Daily and weekly payment reports will be provided to client.
• Month-end reports based on requirements and variables will be provided to client.
• Denials will be addressed and recorded.
• Denials report will be provided to client monthly or weekly based on client requirement.

Medical Coding (ICD, CPT, HCPCS & Modifiers)

• Our certified coders refer documents before coding ICD-9-CM, LMRP, CPT Assistant, and HCPCS Level II and check for the compatibility of diagnoses with procedural codes with the appropriate modifiers.
• Chart deficiencies are sent for client address
• Coded files go through quality assurance process

Our Account Receivable Service Include:

Insurance AR and Denial Analysis and Follow-up

• Denied claims are followed up on a daily basis and routine denials will update to doctor front office to reduce denials.
• Greater than 30- day claims are addressed
• All appealed claims will be followed up.
• To generate aging report every month and work likewise on claims based on $ amount.
• Detailed AR report with claim status will be sent to doctor every month.

Patient AR Analysis and Follow-up

• Alert notes are keyed in to follow up on payments pending from patient.
• If payment not received from patient, will inform provider office to plan on patient payment.
• Insurance denials caused due to lack of or incorrect information from patient side is addressed.
• Delinquent letters sent for payment purpose and on no response from patient, the account details are moved to collection agency.

Old Account Receivable recovery service

We also undertake old AR recovery service. Significant number of unpaid and unresolved AR is accumulated by many practice, this is usually a result of lack of follow-up of these accounts or due to their acquisition from other medical billing companies. We focus on old AR which is pending in >90 days and this will not change your current staff or process also this will reduce the bad debts and maximize collections. We will be providing practice analysis report or feedback on practice at the end of the old AR project.

Typically 20 to 30 percent of the insurance claims are rejected every year, which results in huge loss for the physicians or healthcare facilities. ClaimsXperts MRSP will not only decrease the revenue cycle but also liquidates the cash flow of the customer by minimum of 10%.

Trend Analysis

A skilled team of A/R analyst does an in depth analysis of ADV, collection & denial pattern, thus giving a better understanding of our customers RCM. Segregation and Prioritization:

Once the Aging reports and EOBs are received from the client site it is segregated and prioritarized based on the key customers, high dollar and small dollar accounts thus help us build work lists which instantaneously align with our customer's accounts receivable collection strategy. Root Cause Analysis:

Our A/R Analyst does a High- end analysis which helps them checking for underpayment denials and lost or ignored claims, provider credential check, and finally come up with action plan that eliminates the leakage in the revenue cycle.

Recovering the "Difficult Dollars"

The more difficult dollars are often hard to tap, as they are ignored most of the time. Our current process workflow helps our A/R analyst to squeezing out extra receivables.