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Revenue Cycle Management

Demographics Entry

1. Error-free capture of patient information is essential for clean claim submission and facilitates quick claims processing by Payers.

2. Accurate information about the patient is critical to ascertain the patient's eligibility and benefits, obtaining prior authorization, and error-free claims filing. Additionally, population health analytics is possible only by utilizing accurate patient information.

3. Our team members enter the validated data on the client's practice management software with a high degree of accuracy and within a turnaround time of 24-48 hours. We review and update the following information on the practice management system.

a. Demographics information
b. Healthcare Insurance Information
c. Medical Information
d. Payment Information

Entry of Patient's Demographic Information

Capture of Healthcare Insurance Information

Documentation of Medical Information such as allergies, medication, special assistance needs

Review and Capture of Payee Contact information

Coding Services

Facility Coding Services

Our team of certified, highly-trained medical coders provides comprehensive and specialized medical coding services for hospitals, FQHCs, outpatient centers, and laboratories

Professional Fee Coding Services

Accurate, timely professional fee coding is crucial for attaining proper reimbursement and maximizing practice revenue. CodeEMR remote medical coders capture the complexity of care provided across a broad range of specialties

HCC Coding Services

Our HCC coding services ensure your facility captures the highest level of reimbursement per patient. This allows your providers to focus on delivering exceptional patient care while our team focuses on accurate, comprehensive coding

Why Code EMR Coding?

Improved Medical Billing

Dedicated, certified medical coders use advanced tools and software to enter the right codes to bill the right amount for each diagnosis and treatment

Increased Revenue

Entering the correct medical code for each treatment makes a significant difference in reimbursements, increasing coverage and revenue from $20 to $2,000

Fewer Claim Rejections

Experience matters. CodeEMR coders work with many different electronic medical records and are well versed in all the latest evaluation and management of ICD-10, HCPCS, and CPT codes

Multidisciplinary Coding

CodeEMR has the multidisciplinary experience to code based on the type of visit (inpatient, outpatient, urgent care, or emergency department) and specialty, including family medicine, orthopedics, cardiology, and more

Streamlined Process

Our medical coders utilize advanced medical coding software to accelerate coding, improve accuracy, and streamline the insurance filing process for optimized revenue cycles

HIPAA Compliance

All CodeEMR coders receive comprehensive HIPAA training. We mostly prefer certified coders

Billing

Our claim billing technology can help maximize revenue collections by reducing denials, identifying unbilled items, and shortening accounts receivable cycles. It help you to achieve an almost 100% first-pass claim acceptance rate.

Claims Submission

Easy end-to-end claims processing with generated worklists, verification, scrubbing, review, submission, and collections

Central Billing Office

Manage and bill for multiple providers and office sites with detailed reporting, and overall account administration.

Reconcilitation & Reporting

Accurate billing process enables easy month on month reconciliation and avoid any revenue leakage. Auto generated reports helps you to monitor the progress on daily basis

Payment Posting

An Essential Step in Medical Billing Process:

Payment posting has a vital role in revenue cycle management for a healthcare organization. The process of payment positing has several essential steps such as posting, deposit functions and reconciling posting activities. Therefore, payment posting has a huge influence on managing your finance and hence it isn’t a point to be over looked. Payment posting gives a clear outline of your revenue stream and helps you catch errors faster. In addition, this helps yous you rectify the errors. Through this, you can see daily EOBs insurance payments and ERAs insurance checks, patient payments, etc., giving you a clear insight into your day to day finances. We process different types of remittances received with a high degree of accuracy, improved responsiveness, and follow the procedures defined by our clients. We perform the following services:

Our Payment Posting Process

Patient Payment

We receive information on the point of service payments made by patients from our clients. These payments are made via cash/check/credit cards and could be on account of co-pays, deductibles, or non-covered services. Our team reviews the information received and adjusted the same against each patient account

Insurance Payment

Electronic Remittance Advisory (ERA). We receive high volume ERAs from payers and process them in batches by importing them into the client’s practice management system. Each batch run throws exceptions that fall out, and we correct the same along with verification of batch totals.
Manual Posting: Our clients often send us scanned EOBs. Each EOB batch is accessed via secure FTPs or through the EHR system and processed in line with the client’s business rules for adjustments, write-offs, and balance transfer to secondary insurance companies or the patients

Denial Posting

We understand the payer-specific denial codes for most payers and have expertise in understanding ANSI standard denial codes. We record each claim denial in the practice management system and take actions to re-bill to the secondary insurance company, transfer the balance to the patient, write-off the amount, or send the claim for reprocessing

AR Follow-up & Denial Management

Follow-up with insurance companies

We work on multiple contact channels with insurance companies – Website, fax, IVR, and Phone to get an accurate understanding of the claims' status. We also work with the end provider clients to improve the adoption of Websites as a channel of contact

Develop policies and procedures for A/R follow-up

We monitor the aging bucket of the A/R and understand the dates by which the payers would have the information on the file. We initiate follow-up calls on the right number of days post submission of the claims, not to waste effort following with the payers before the date

Automation

We have created practical tools to login into the payer website, generate queries, and fetch information on the claim's status

Effective action plan

Our work does not end with merely obtaining the status of the claims. We go one step further and initiate the actions such as refiling of these claims and appeals to receive reimbursements, and perform analytics with a focus on reducing the days in A/

Filing Appeals

We analyze denial reasons, prepare appeal letters, and refile the claims by attaching clinical documentation and submit the claims via fax appeals in a payer-specific format

Reducing Denials Through Analytics

Different component processes within the revenue cycle chain can result in claim denials. Often, denial issues are practice-specific or facility-specific. We understand the trends in claim denials and launch an iterative process to reduce them based on specific causes

Credentialing

Identify the Required Documents

As we begin the provider credentialing process, we are aware that each insurance company requires different documentation and forms. We ensure to submit complete applications to each insurance company you plan to work with

Prioritize Insurance Companies

Make a list of your priorities and begin to assemble documents and applications accordingly

Check for Accurate Information

As we begin to assemble required documents and individual applications, we keep in mind that the quality and accuracy of information is 100% accurate

Wait for Verification

Post submission of your application to insurers, it’s time to wait for their approval. This can be a lengthy process. From 90 -150 days

Following Up

As a Credentialing healthcare professionals we consistently follow-ups for timely approval

Recertification

Finally, healthcare providers will receive their insurance panel credentialing. However, that doesn’t mean they’ll be credentialed forever. Healthcare provider credentialing is an ongoing process that requires more work down the line

Member Enrollment Process

We understand the terms & conditions of AMA membership requirement per CMS guidelines. It is critical to have enrollment completed timely, for which we ensure accurate documentation & quality check.

Get In Touch

info@alphacaresolution.com

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