Credentialing (Provider Enrollment, Provider Portals, ERA/EFT)
Credentialing and provider enrollment is core and significant step in medical billing process. As without provider’s enrollment revenue is never guaranteed. Our credentialing experts affiliate provider with Medicare, Medicaid and other commercial insurance companies with all the documents required, in a timely manner under the HIPAA guidelines. Additionally on behalf of our clients we create provider’s web portals, EDI/ERA and EFT setups with different national and commercial insurances to modify the revenue management cycle.
Claim entry and submission
Claim entry and submission is the basis for revenue collection, whole revenue cycle is dependent on claims submission. Submitting clean claims with accurate patients and provider’s information, correct CPTs and valid diagnosis codes (ICD-10) reduces the chances of error in billing. Our experienced billing professionals make sure to follow all the billing steps and protocols in order to submit clean claims as it is our priority. Team completely keeps in mind all HIPAA and PHI protocols and is well aware about waste, fraud and abuse for better entry levels. We submit both outpatient inpatient claims along with updating patient’s demographic details in billing instruments.
Coding
Medical coding is the process of translating all the healthcare procedures (i.e. Doctor’s Diagnosis, symptoms, services provided to patient, equipment used during treatment, lab tests etc.) into universally accepted alphanumeric codes. Our certified coders with adequate knowledge of CPT, ICD, HCPCS, general coding guidelines and through perfect coding with compliance help practices to get rid of coding errors, denials and rejections in order to improve revenue system.
VOE/VOB
We also provide patient’s Eligibility verification services including verification of benefit and cost estimation prior to claim submission. Eligibility verification is vital to smoothen the practice performance, without verifying patient’s insurance activation or if patient is permitted or not by plan to receive certain services from doctor, there is no purpose to execute further billing process. Our professionals verify patient’s eligibility through various sources i.e. Real time eligibility verification, Provider’s portals, call to insurance and if verification through listed sources are unattainable then we contact patients to confirm their eligibility.
Prior Authorization
Prior authorization also known as Preauthorization/Precertification is the process that is required prior to the provision of services to patient. It is an agreement between healthcare provider and insurance payer in which insurance agrees to cover for specific services mentioned in claim form. We have a team of skilled authorization specialist. The services which are not covered, we apply for their authorization immediately as per provider’s demand. Our certified coders are also capable of identifying CPT or diagnoses codes that are not covered by the plan so they inform authorization team on time, in that manner we effectively reduce authorization related denials (CO-197) and improve claim accuracy.
AR follow up
CCS has the finest set of experts in AR follow up team. Practice aging will be the least of concern for any provider working with CCS. High aging is a major issue in any practice because as much as claims aging increases, collection starts decreasing swiftly. Our AR specialists pulls out high aging claims and resolve their issues in a systematic and efficient manner keeping timely filing limits of different insurance companies on mind. Our aim is to obtain rightful reimbursement against every single services provided by the doctor.
Patient statement and Inquiries
We also provide services on patients end to detach the load from front desk shoulder. These services includes generating patient statement and help desk for patient inquires. Patient Statement consist of the remaining balance on patient’s end after appropriate reimbursement made by the payers along with explanations. Our help desk team is always available to assist patients on statement related queries in exceptionally professional fashion.
Reporting
We preserve the provider’s right to know their financials and practice performance. CCS also provides weekly/monthly reports on revenue collection and other financial aspects of practice in a precise and easy to read format on provider’s demand. The reports reflect the areas of improvement in practice management plus our performance as an organization.
