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Insurance Verification and Eligibility
It is the procedure of verifying a patient's insurance in terms of three different stages such as coverage status, Active or Inactive status, and Eligibility status this process will confirm a patient's insurance coverage and benefits prior to an encounter. More importantly, it's the process of confirming that a patient's insurance plan covers the services. By verifying eligibility, practices can determine a patient's medical insurance coverage status prior to the appointment and report demographic information accurately on insurance claims
Medical Coding
Medical coding is the translation of medical reports into a short code used within the healthcare industry. This helps summarise medical reports into efficient and data-friendly codes. Medical coders are individuals responsible for translating physicians' reports into useful medical codes.
Charge Capture and Data Entry
Charge entry is the process of assigning to the patient account an appropriate value as per the chosen medical codes and corresponding fee schedule. The reimbursements for the healthcare provider's services are dependent on the charges entered for the medical services performed.
Claim Transmission
Claims transmission is when claims are transferred from the care provider to the payor. In most cases, claims are first transmitted to a clearinghouse. The clearinghouse reviews and reformats medical claims before sending them to the payor. In some cases, healthcare providers send medical claims directly to a payor.
Account Receivables and Denial Management
Healthcare providers experience long receivables cycles that delay revenue, destabilize cash flow, fatigue billing teams, and frustrate financial management. These elements are further compounded by accurate and inaccurate claims denials.