We provide detailed error-free charge entry to ensure first-time approved claim submission. We take the demographics and charge info for each patient from you. Our billers enter the charges daily for the claim processing. We improve the charge entry accuracy and clean claim submission rate. This results in faster Turn Around Time (TAT) and reduction in cost per claim processing.
We are a team of experts who provide benefits verification and/or prior authorization processes to determine the patient's eligibility. Some estimates indicate that as many as 75% of the claims getting denied are on account of the patient not being eligible for the services rendered by the healthcare provider. We confirm the patient’s eligibility and obtain necessary prior authorization before the patient visits the physician’s office. This gives our providers a clear view of patient's coverage, out-of-network benefits and related insurance information.
We perform below steps as part of verification process
1. We receive the appointment schedule and the patient healthcare provider’s office – hospital and/or clinic
2. Perform entry of patient demographic information
3. We then verify primary and secondary coverage details:-
In case of missing or invalid information or if further information is needed, patient is contacted.
4. Where required, the team will initiate prior authorization requests and obtain approval for the treatment
5. Update the hospital’s revenue cycle system or the patient’s practice management system with the details obtained from the payers
Coding is imperative reason being, there were over 1.4 billion patient visits in the past year according to the Centers for Disease Control (CDC).That’s a stat that includes visits to physician offices, hospital outpatient facilities and emergency rooms. Medical coding allows for the efficient transfer of huge amounts of information. Coding also allows for uniform documentation between medical facilities.
Medical coding, at it’s most basic, is a little like translation. This is where we come in with our diligent, foolproof process to ensure compliance with coding guidelines. We ensure accuracy as it leads to a huge impact on revenue and reimbursement cycle.
Payment posting is a meticulous and important part of medical billing, as it ensures accurate accounting of all funds received, helps identify payment discrepancies, and maintains financial records for the healthcare provider. Proper payment posting practices are essential for an efficient revenue cycle management.
EaseMed Solutions have a dedicated team of payment posters who carefully go through the payment ERA/EOB’s and posts the payments, in their respective patient account as per the date of service and procedures for which payment is received. The payment posting is typically done as below:
The payment posting executive enters the payment information into the billing software. This includes checking details such as the patient's name, account number, date of service, payment amount, payer (insurance company or patient), and any adjustment or write-off amounts.
For insurance payments, healthcare providers often receive electronic remittance advice (ERAs) that correspond to the payments. These ERAs contain detailed information about the services paid, denied, or adjusted, along with codes (such as Adjustment Reason Codes and Remark Codes) explaining the reasons for any adjustments. The payment posting staff will match the ERA to the associated claim to ensure accuracy.
Payments are allocated to the appropriate patient accounts. If a payment covers multiple services for a single patient, the payment posting staff will distribute the payment across the relevant accounts accordingly.
In some cases, insurance companies may make adjustments to payments, such as deductibles, co-insurance, or denied services. The payment posting staff will ensure that these adjustments are correctly applied, and any necessary write-offs are made according to the provider's contractual agreements with the payer.
If the payment is coming from a patient, the payment posting staff will record the payment in the patient's account and update the patient's balance accordingly.
In case a claim is denied by an insurance company, the claim is forwarded to the denial handling team who record the denial and makes the appropriate corrections as per the denial received or initiate the appeals process to challenge the denial.
Payment posting staff may generate reports summarizing the payments received, adjustments made, and any outstanding balances. These reports can help the healthcare provider keep track of their financial performance.
In cases where overpayments occur, refunds may need to be issued to patients or insurance companies, and these refunds are also recorded in the billing system.
Denials management is a crucial aspect of medical billing that focuses on identifying, appealing, and minimizing claim denials from insurance companies. Claim denials can lead to delayed payments and revenue loss for healthcare providers.
EaseMed solutions has a dedicated team for denial handling who are well experienced and trained in handling the denials. They are well aware of the insurance requirements and its processes. They are provided with regular inhouse trainings to keep the updated about the industry changes and procedures.
The denial executive at EaseMed Solutions handles the a denied claim as below:
Denial Identification:
For denials resulting from incorrect coding, documentation issues, or minor errors, the denial executive makes appropriate corrections and resubmit the claims with the necessary documentation to the insurance company.
There may be claims that has been incorrectly denied or needs some additional information in such cases those claims needs to be appealed, the denial executive initiates the appeals process which involves submitting additional documentation or written appeals to the insurance company, explaining why the claim should be reconsidered and paid.
The denial executive forwards all the claims to AR team that needs follow up with insurance companies to track the status of appealed claims and confirm whether they have been approved or require further action.
Effective denials management is essential for maximizing revenue and ensuring timely payment. By addressing and preventing common denial reasons, healthcare providers can improve their financial health and maintain a smooth revenue cycle.
AR analysis and follow up are essential components of the medical billing process. Managing AR effectively ensures that healthcare providers receive timely payments for their services.
Here's how AR analysis and follow-up is done at EaseMed Solutions
The process begins with the generation of an AR aging report from the billing software. This report categorizes outstanding claims or invoices by the number of days they have been unpaid. Common categories include 30 days, 60 days, 90 days, and over 90 days.
The AR analysts review the AR aging report to identify accounts that are overdue and require attention. Each outstanding claim or invoice is examined to determine the reason for non-payment.
Accounts are prioritized based on factors such as the amount outstanding, the age of the claim, and the likelihood of collecting the payment. High-priority accounts, especially those approaching the timely filing limit, are addressed first.
For the unpaid claims, the AR executive initiates follow-up with the respective insurance companies. This may involve contacting the insurance company's claims department by phone or through an online portal to inquire about the status of the claim and seek resolution. They submit corrected claims or appeal denied claims when appropriate.
For patient balances the patient account representatives communicate with patients to collect outstanding balances. This can involve sending statements, making phone calls, or setting up payment arrangements.
When payments are received from insurance companies or patients, they are posted to the respective accounts in the billing system. Adjustments are made as necessary to reflect the correct payment amount.
AR analysts and billing managers regularly review the progress of AR follow-up efforts and may generate reports to track key performance indicators (KPIs) such as AR days outstanding, denial rates, and collection rates.
Effective AR analysis and follow-up are critical for maintaining a healthy revenue cycle in healthcare organizations. Timely and diligent follow-up helps maximize revenue, reduce the AR days outstanding, and ensure that the healthcare provider is properly reimbursed for services rendered.
An excessive credit balance can provide an inflated view of the practice's financial health and lead to erroneous financial decisions. Failure to refund credit balances promptly could result in Litigation and significant fines or even imprisonment. We analyze each patient's account, identify and validate credit balances, and initiate refund checks to zero out the account balance.
Providers should process refunds within 60 days from the date of the refund request. We validate each request, and if found to be valid, we process the refund. If the refund request is invalid, we raise an appeal after thorough validation.
Our streamlined process brings efficiency by expert handling of returned mails. Impacts high recovery thus reducing write offs. We demonstrably deliver value and bring satisfaction and delight. Identification of the correct address is superefficient and ensure cash flow within promised time frame. We bring in unique agility with planned out process owing to our decades long expertise in reducing risk and confirmed customer satisfaction.
Here we focus on the source of the issue. These rejections occur as the insurance is unable to identify the Patient, Member ID, provider information, Missing insurance type, under coding and poor documentation. Missing/Incorrect information on the claim will cause the insurance to reject the claim. We step here with analyzing the challenge and implement improvements/corrective actions.
It is imperative to clear backlogs timely to ensure continuous cash flow. Reason for payment delays could be errors, omission, multiple denials, deadline miss. Our experts will track outstanding receivable balances, investigate denials, and provide periodic reports on pending claims. We will also ensure that the insurance companies receive and file your claims correctly the first time.
Medical credentialing, also known as provider credentialing or physician credentialing, is a crucial process in the US healthcare system. It involves verifying and evaluating the qualifications, training, and professional background of healthcare providers to ensure they meet the standards and requirements of insurance companies, hospitals, and other healthcare organizations.
Medical credentialing is a complex and time-consuming process that helps ensure the quality and competence of healthcare providers within the healthcare system. It also allows patients to have confidence in the qualifications of their healthcare providers and enables providers to participate in insurance networks and offer their services to a broader patient base.
At EaseMed Solutions the credentialing process begins with collecting all necessary documentation and information from the healthcare provider, including:
The credentialing executive from the healthcare provider side assists in completing applications for participation with insurance networks, hospitals, and other healthcare entities. These applications can be extensive and may require detailed information about the provider's education, training, work history, and more.
The completed credentialing applications are submitted to insurance companies, hospitals, and other healthcare organizations where the provider wishes to participate as a contracted provider.
After the applications are submitted, the credentialing team may follow up with the various entities to ensure the process is progressing smoothly. They may also monitor the status of the applications to identify any delays or issues that need to be addressed.
Once the credentialing process is complete, the provider receives approval from the insurance companies and healthcare organizations. Contracts are typically signed, specifying the terms of participation, reimbursement rates, and other relevant details.
Credentialing is not a one-time process, it must be regularly updated and renewed. Healthcare providers must undergo re-credentialing at specified intervals, often every two to three years, to maintain their status with insurance companies and healthcare organizations. Our credentialling team maintains all the records and regularly monitors the expiry dates. They ensure that the provider insurance contracts are maintained and renewed in a timely manner.