Your Path to Better Health
Your Trusted Partner in Health, Committed to Excellence and Patient-Centered Care
ExploreWhat Our Achievements
350+
Employees
2+
Million Orders Processed
87.42%
Of Accuracy Maintained
52+
Various Activities Been Handled for Client
85-90
Collection Rate Achieved by Our Clients
Who we really are &
why choose us
we are dedicated professionals specializing in optimizing the financial performance of healthcare organizations. Our team comprises seasoned experts in medical billing, coding, and revenue cycle management, who work tirelessly to ensure that healthcare providers can focus on what they do best: delivering quality patient care. With a deep understanding of the complexities of healthcare reimbursement, we leverage advanced technology and best practices to streamline billing processes, reduce errors, and maximize revenue for our clients.
Expertise and Experience.
Improved Financial Outcomes.
Personalized Solutions.
Cutting-Edge Technology.
Dedicated Support.
RCM Steps to starts inhance your Knowlage
to improve Revenue Cycle management
01
Pre-registration
This process involves collecting crucial patient data and verifying their insurance eligibility well in advance of any scheduled medical services.
02
Insurance Verification
The RCM journey entails confirming a patient's insurance coverage and benefits and ensuring that healthcare services are correctly billed and reimbursed.
03
Patient Registration
Patient registration is the bridge between initial contact and healthcare delivery, serving as a critical juncture in revenue cycle management. During this stage, healthcare providers gather comprehensive patient information, medical history, and consent forms.
04
Charge Capture
Charge capture is a pivotal phase in revenue cycle management where healthcare providers record and document the services, procedures, and supplies provided to patients.
05
Claim Submission
Claim submission is a critical step where healthcare providers compile and send claims to insurance payers for reimbursement. This process demands precision, as any errors or omissions can lead to claim denials and delayed payments.
06
Claim Adjudication
Claim adjudication is a vital process where insurance payers assess and make determinations regarding submitted claims. During this stage, payers review claims for accuracy, completeness, and compliance with policy terms. They then decide on payment or denial and the amount to be reimbursed.
07
Payment Posting
Payment posting is a major step where received payments from insurance companies, patients, and third-party payers are recorded and applied to patient accounts. This process demands precision to ensure accurate tracking of payments, adjustments, and patient balances.
08
Denial Management
Denial management is a critical component of healthcare revenue cycle management, focusing on identifying, analyzing, and resolving denied insurance claims. Denied claims can lead to significant revenue loss if not addressed promptly and effectively. This stage involves investigating the reasons for denials, correcting errors, and resubmitting claims to ensure reimbursement.
09
Accounts Receivable Follow-up
Accounts receivable follow-up in revenue cycle management involves the monitoring and pursuit of outstanding payments from insurance companies, patients, and third-party payers.
10
Patient Statement Processing
Patient statement processing is an RCM component responsible for generating and delivering financial statements to patients. These statements provide a breakdown of medical services rendered, associated costs, and the patient's financial responsibility after insurance adjustments.
11
Patient Payment Collection
Patient payment collection stands as a cornerstone of healthcare revenue cycle management, focusing on the retrieval of payments from patients for their portion of medical expenses. It encompasses educating patients about their financial responsibilities, offering flexible payment options, and efficiently securing payments.
12
Revenue Analysis and Reporting
Revenue analysis and reporting constitute the cornerstone of effective healthcare revenue cycle management. This critical phase involves the systematic examination of financial data to gain insights into the financial performance and overall health of a healthcare organization.
13
Compliance and Auditing
In revenue cycle management, compliance and auditing are paramount. These processes entail rigorous adherence to legal and regulatory requirements and internal policies and procedures. By conducting regular audits, healthcare organizations can ensure that their revenue cycle operations remain compliant and efficient.
We have different Project
different specialties
Here are some selected plants from our showroom, all are in excellent shape and has a long life span. Buy and enjoy best quality.
Behavioral-Healhcare
Hospital Billing
Therapy
Cardiology
multispeciality Project
Some common questions
were often asked in interview
how will your work on no authorization scenario?
Authorization is required for high dollar services, Arcilary services or any surgery
EnM services POS 11 Clinics - If I am working on EnM services the maximum dollar billed for CPT 99215 would be $600 & when we cordinate with insurance rep we get to know that claim is denied for authorization bcos your provider is out of network (OON) that means we should get our provider in network (IIN)
Pos 21 & 22 (inpatient & out patient) if claim gets denied by insurance for Auth I will cordinate with hospital to cross verify whether they have obtained auth or not because my provided visited to hospital & performed the service if I get Auth from hospital I will take and will call insurance and ask rep to reprocess the claim
If no auth obtained by hospital - I will call insurance to verify why they need Auth for CPT depending upon reply from insurance rep like initial 2 services no Auth required but from 3 visit Auth is required or based on patient plan Auth is required. I will verify whether insurance retro Auth if yes maximum TAT is 24 to 72 hours so I will document the information & task to client for next action if client says appeal with medical records (MR) I will appeal.
Explain CO 50 Not medically necessity ?
Follow up are different on Medicare & Commercial
Medicare - If claim gets denied by Medicare for CO 50 I will check Medicare FSCO, CMS. GOV or NGS portal on google to cross verify whether DX billed on claim form is listed as per LCD (Local coverage determination) if DX is not listed as per LCD I will task to coding department for review to suggest any additional DX
Commercial - If claim gets denied by UHC or Aetna I will call insurance to verify what documents they need like MR, letter of medical necessity to prove that services were medically necessity & prepare an appeal with requested documents & send to insurance claim mailing address or fax number.
How will you work on Inclusive denial ?
If more than 2 services billed on claim form so insurance paid 1 CPT and another CPT gets denied as inclusive.
Steps - Cross verify on encoder pro by putting all CPT to see whether CPT is included with paid CPT
If yes
Will see any modifier is appended or not
If no modifier appended will task to coding
If modifier is already appended will call insurance to reprocess if rep is not reprocessing will appeal with MR.
How will you work on Non covered denial?
There are types of codes on non covered CO 96 & PR 96
PR 96 steps
I will check my system whether same CPT & DX were paid earlier
If Yes I will call insurance & ask rep to reprocess claim.
If No than I will call insurance to verify whether services are covered under patient plan or not if no than we will bill claim to patient.
CO 96 Steps
I will call insurance to verify whether services performed by Doctor are eligible or not if no I will task it to client.
Explain Modifier 76, 77, 24 & 25 ?
Modifier 76 - if services performed twice in a day by same physician but timing should be different than we will append modifier 76
Modifier 77 - if services performed twice in a day by 2 different doctors under same group & timing are different than we will append modifier 77
Modifier 24 - Used on EnM services when EnM gets denied for global to surgery so we need to cross verify whether DX for surgery & EnM are same or not if DX are different than will append modifier 24 if DX are same than we will append modifier 57
Modifier 25 - Used on EnM services when more than 2 services billed on claim form on same day & EnM gets denied for inclusive we will append modifier 25
how to work on Duplicate?
There are 3 to follow up on Duplicate denial
A. Claim billed twice in error as per claim billing history tab so we will follow up with insurance to crossverify about original claim If it's paid or denied we will take action accordingly.
B. If there are 2 differenve encounters with same CPT & DX For Radiology & pathology claim we will check MR to crossverify whether timing on MR are same or different if same it's true Duplicate or if timing are different thn we will append modifier 76 for same Dr or 77 for different Dr.
C. EnM - if 2 EnM services billed on same day 1 gets paid n another gets denied no modifier will work out we will task for Adjustment approval.
Can you explain Medicare parts ?
There are 4 parts of Medicare
Part A covers hospital
Part B covers physician claim
Part C is an advantage plan
Part D drugs & pharmacy