SERVICES

REVENUE CYCLE MANAGEMENT

A careful and competent revenue cycle management is very important for any healthcare business in order to ensure its perpetual cash flow, to accelerate revenue realization and to achieve greater profitability.

We, at AIMS Medical Billing, are mainly focused on ensuring a dependable revenue cycle management services for our clients. The main components are :

• ELIGIBILITY
• MEDICAL CODING
• PATIENT DEMOGRAPHIC ENTRY
• CHARGE ENTRY
• ELECTRONIC CLAIM TRANSMISSION
• CLAIM TRACKING FOR REJECTIONS, PENDING CLAIMS, CLAIMS WITH NO RESPONSE
• PAYMENT POSTING
• A/R MANAGEMENT
• DENIAL MANAGEMENT

ELIGIBILITY

This is the first step of the RCM process and is carried out to run complete eligibility check on the patient's insurance plan. It is only after this process that the Billing Department makes the claim with accurate information on patient and insurance company and plan. List of those patients whose demographic data or active insurance card are not attached with the practice management and thus can not be verified, is prepared and sent on daily basis.

We all know that 'prevention is better than cure'. A thorough check of insurance is a must before raising a bill. This precaution will reduce the chances of claims being rejected or fully denied and also ensure acceptance of the claim on its first submission.

Depending upon clients' requirement the scale of this service may vary.

MEDICAL CODING

Medical service providers are required to submit the claim for the services by assigning CPT & ICD - 10 codes. Every medical specialty and the services provided in it have a specific coding. Use of accurate code in claim is necessary to get claim. Accurate coding helps the RCM process a great deal.

Our Coding team codes the diagnoses and procedures in accordance with the coding guidelines after reviewing the complete patient record. We have trained and certified medical coders with updated knowledge about CPT, ICD - 10 coding also on the use of various modifiers both AMA and Managed Care specific ones. We use various up-to-date coding tools and ensure continual training and certifications of team members.

PATIENT DEMOGRAPHIC ENTRY/CHARGE ENTRY/ELECTRONIC TRANSMISSION

Our Medical Billers have a good working knowledge of relevant medical terminology for claims form completion, and coding. They also process responses from the insurance companies which include the invalidation reports from clearing house or explanation of benefits (EOB) from the payer.

All our billers have a good understanding of the basic and major medical coverage plans, such as the Medicare, Medicaid, Fee-for-Service Plans (FFSP), Health Maintenance Organizations (HMOs), Point-of-Service Plans (POS), and Preferred Provider Organizations (PPOs). It does help them preparing a clean claim. And all these services are provided in an efficient and cost effective manner for maximum client satisfaction.

The claim is sent to the payer insurance company after a thorough check.

ACCOUNT RECEIVABLE FOLLOW-UP

Our accounts receivable follow-up is a process specifically designed for the payment not processed by the insurance company. Accounts Receivable team runs the ageing report every month and tracks all unpaid and partly paid claims. We keep our clients informed on changed rules and reimbursement guidelines to reduce denials. Reprocessing of records for appeal is done whenever required. Focus is on ensuring approval of the best possible reimbursement for the services rendered.

PAYMENT POSTING

Payments are posted to patient accounts on a daily basis. Scanned EOBs and checks are sent to us wherein all payments are entered into the system. The amounts from EOBs/checks and amounts posted in the system are reconciled on a daily basis. A daily log is updated with these data and reports sent.

DENIAL MANAGEMENT

Denied claims are further analyzed immediately, so that the secondary claim is filed in time. If it is felt that the claim has been wrongly denied appeal is sent. We keep ourselves updated with ever changing rules of various insurance companies.

Depending upon clients' requirement the scale of this service may vary.

REPORTS

Reporting to any individual client company is customized according to the software being used.

• Weekly EOB reports
• Weekly denial report
• Rejection Report
• Review (for inaccurate demographic or active insurance info) Report
• Posting Report
• Daily Superbills Receiving & Missing Superbills Reports
• Weekly Incomplete EHR daily notes report