Healthcare
|
|
At Hainesbpo, we follow the following process for Healthcare Services. We can assist you through the different stages, ensuring high-quality error-free Healthcare Services. |
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 DeskAfter 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. ScanningDemographics, super bills/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 Hainesbpo, 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.
HAINESBPO'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.
Hainesbpo'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 TeamOur 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.
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 TransmissionClaims 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 HAINESBPO
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.
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.
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 reasearch is completed appropriate action will be taken.
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).