Outsource2india's Healthcare Process

At Outsource2india, we follow the following process for healthcare BPO. We can assist you through the different stages, ensuring high-quality error-free healthcare BPO.

1. Front Office

• A patient visits a doctor and explains his/her problem.
  
• The doctor then diagnoses the ailment and draws a chart explaining the treatment that needs to be rendered.

2. Documentation at the Front Desk

• After the doctor completes the diagnosis, the patient hands over his insurance card copy at the Front Desk to claim for insurance. In case the card requires verification, information is obtained from the Insurance Agency.

3. Scanning

• Demographics, superbills/charge sheets, insurance verification data, a copy of the insurance card and any other information pertaining to the patient, are scanned and uploaded on to our secure FTP site.
  
• The team at Outsource2india will then retrieve the files, split the images from the files and arrange them according to the respective patient names.
  
• The files will then be sent to the appropriate departments with the control log for the number of files and pages received.
  
• Any illegible or missing documents will be identified and a mail would be sent to the Billing office for re-scanning.

4. Pre-Coding

• O2I's Pre-Coders will enter the key-in codes for insurance companies, doctors and modifiers.
  
• Our Pre-coders will also add diagnosis codes and procedure codes that are not already present in the system.

5. Coding

• Outsource2india's Medical Coding Team will assign the numerical codes required for CPT (Current Procedural Terminology) and the diagnosis code based on the description given by the provider.

6. Charge Team

• Our trained Medical Billing professionals will enter personal information about the patient from the Demographic Sheets.
  
• The Team will then check the relationship of the Diagnosis Code with the CPT.
  
• A charge will then be created according to the billing rules pertaining to specific carriers and locations.
  
• All charges will be accomplished within the turnaround time agreed with the client, which is generally 24 hours.

7. Audit

• The daily charge entry will be audited to check the accuracy of the entry based on carrier requirements to ascertain a clean claim.

8. Claims Transmission

• Claims will be filed and relevant information sent to the Transmission Department.
  
• The Operations Team will then prepare a list of claims that are transmitted electronically. Once the claims are transmitted electronically, confirmation reports will be obtained and filed after verification.
  
• Paper claims will then be printed along with attachments and dispatched to Insurance Agencies.
  
• Finally, transmission rejections will be analyzed and appropriate corrective action will be taken.

Outsource Medical Claims Processing to O2I

9. Carrier Adjudication

• The Carrier Utilization Review Department will review the processes regarding the claim for payment.
  
• The check and an Explanation of Benefits (EOB) will then be sent to the provider.

10. Cash Application

• The Cash Applications Team will receive the cash files (A copy of the check and EOB).
• The Team will then apply the payments in the billing software against the appropriate patient account.
• During cash application, overpayments are immediately identified and necessary refund requests are generated.
  
• The Analysts will then be informed of underpayments and denials.

11. Analysis

• Accounts Receivable analysts will research the claims for completeness and accuracy. The AR analysts will then set orders about making calls for the call center.
  
• The analysts will also research denied claims, rejections received from clearing houses and low payments by carriers. After this research is completed appropriate action will be taken.

12. Calling

• The call center executive will call the Insurance Agency and verify current status of the claim (whether it is being processed for payment or is being denied).
  
• Based on the claim status, the analyst will get the pre-requisites needed. If the claim is being processed for payment, a list of payment details will be compiled. If denied, corrective action will be initiated.
  
• The Call Center Team will receive work orders from the analysts. The Call Center Executive will then initiate calls to the insurance companies to establish reasons for the non-payment of the claims. All such reasons will be passed on to the Analysts for resolution.

13. Compilation

• This scenario will be compiled in Excel for future use, when similar problems occur in any other specialty.
  
• This information will also be made available to anyone who needs to review past records, to identify solutions to any particular present scenario.

14. Month End Reports

• At the end of the month, O2I will run procedure code usage reports and aged summary reports to asses what has been achieved for that particular month, and also to identify patterns of non payment if any.
  
• If any claim is found to be older than 60 days, immediate action will be taken. Any claims pending for clarification will be passed on to the respective account manager for remedial action.
  

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Confidentiality of Information

At Outsource2india,, we take measures to ensure data privacy and confidentiality through best-of-breed technology and best practices in management. We do this by using data encryption and password-protection during electronic processing and transfer of data via multiplex, router or modem. We have dedicated leased lines and firewalls to ensure maximum security of your data. We ensure compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). We respect all patient information provided by our client and will not disclose any information. You can be sure your data is safe with us.

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