Outsource Quality Process for Medical Claims Processing

We take steps to reduce your denials, save significant staff time, and improve your cash flow.

1. Reviewing all medical claims before submission

   The supervisor or team leader reviews all medical claims before submission. This significantly cuts down our error rate and greatly reduces the risk of denials at a later stage.

2. Maintaining billing and coding claims review log

   Our billing staff create logs that include the most common reasons for claims rejections. This log list is used as a handy reference to track trends on the remittance advice from Medicare as well as the EOBs from all third-party payers, for each provider, and/or for the healthcare group as a whole. By monitoring and evaluating these trends, it is possible to find ways to “fix” the problems that are causing the denials and rejections for your practice, thus increasing your reimbursement while decreasing the chances of future claims rejections.

3. Monthly Billing Review

   We hold monthly billing reviews among the staff who perform data entry, coding and documentation,
   billing and payment posting, and reviewing denials and down codings. An agenda for these monthly meetings include:

   • A review of all recent insurance carrier newsletters and notices of any billing or coding changes
   • Current practice issues that pertain to the billing function
   • An analysis of the trends noted from the claims review log, including how they are being handled and the effect on the accounts receivable, measured both in percentage of error and as “dollars and cents.”
     

   With the proper tools, tracking, and good communication skills, our practice effectively reduces your rejections and avoids payment delays from Medicare as well as from other third-party insurance payers.

4. Maintain Provider Registration/Credentialing Files

   A patient may be covered by numerous insurance plans. Sometimes, you may not be notified of changes in their insurance. You will need to keep track of whether you are a member of their new insurance plan or your provider status has expired. By maintaining credentials and provider status, we will be aware of an expiry or the need for renewal status. In addition, if our client base continues to add insurance carriers even for secondary payment, we will have contact information to contract with new insurance carriers to provide services to an even wider range of patients, which translates into a greater opportunity to expand your practice.

5. Interact Regularly with Insurance Carriers

   By staying current with changing insurance policies, our office will remain informed, eliminating the need to resubmit large batches of claims because of a change in billing policy. If outstanding insurance claims are not actively collected, we would be missing out on a vital interactive source for learning new insurance policies and billing practices. Making a commitment to collecting on insurance claims also allows us to question insurance representatives of claims that have been rejected. Staying aware of CPT and ICD-10 codes and the policies of each insurance carrier that is used by your patients ensures that patient claims will be processed correctly.

6. Check Contact Information/Addresses Regularly

   Regularly checking the addresses of our patients and insurance companies prevents costly mail returns and billing errors. By maintaining contact information, a resolution to billing and collection problems can be easily corrected without facing more mail returns due to incorrect information.

7. Provide a line-item-billing statement

   We provide line item billing statement which will produce billing statements that are capable of telling patients on a line-by-line basis, which charges have been paid and which remain. We have a software packages that allow us to customize the patient statement so that their statements clearly define what charges have been paid and what amount is outstanding.

8. Be Ready to Appeal Denials

   Because many physicians opt not to appeal denials, whether it is for the paperwork required or the added frustration of following the appeal, errors in the insurance carriers’ processing can go undetected, costing providers lost revenue.
   We make sure that all claims that are submitted have supporting documentation and are ready to be transmitted to fight for your money.

9. Staff Training

   We are committed to your practice by regularly training our staff about changes that affect the coordination of benefits, including federal regulations as well as policies by major insurance carriers to your practice.
   

Outsource Medical Claims Processing to O2I

Do you require high quality, customized medical claims processing services? Why not consider outsourcing to O2I? Read more specific information about infrastructure, competency, price ranges, and benefits.
If you would like to find out more about outsourcing medical claims processing work to O2I, please fill in the inquiry form and our Client Engagement Team will contact you within 24 hours.

Please contact Outsource2india here with your outsourcing requirements.