1. Pre-sales Requirements Analysis

Our Healthcare Revenue Cycle Management team conducts a Client Requirements Analysis once we receive the client's approval. We then conduct a process study and submit a presentation on the benefits of business process management through outsourcing.
The study will cover

• The specialties involved
• Required turnaround time
• Type of files
• Reports required
• Formats to be followed

2. Upload of files from US

• The billing company/client in the US scans the Superbills, patient registration sheets, EOBs, insurance card copies and copies of checks using a duplex scanner and saves them as image files.
• Scanned images are segregated into Charges and Payments, then batched together and sent to us through an FTP Server as batch files.

3. Receipt of files from client:

• We receives scanned copies of documents in ".tif" format from the client through an FTP site.
• (for more info log on to(www.flatworldsolutions.com)
• These include patient registration sheets, superbills, and insurance card copies.

4. Download and allocation of files

• The scanned batch files are downloaded from the FTP server and stored in the data server at our office. This is done by the Medical Billing team.
• The Team Lead allots the batch files to Process Executives who can now view the files from the data server.
• The Process Executives log into the Billing Server using a proxy server through VPN/firewall connectivity to gain access to the Billing Software.

5. Coding

• Our AAPC trained coders review the Superbills/Charge sheets of the patients for any correction in CPT and ICD codes.
• They also check on the correct aging of the CPT codes with ICDs.

6. Charge Entry

• The Process Executives in the Charge Entry team input all charges associated with the procedures that are coded into the billing system .
• They also check for valid charges such as DOS, CPT codes, ICD codes, Billing Provider, Referring Provider, Facility Name/code and referral/pre-authorization number if available.
• Once the Process Executives complete processing the batch files, the Team Lead allots the files to the QA Executive for audit.

7. Patient Demographics Entry

• The Process Executives in the Demographics Team enter details such as the patient's first and last name, social security number, insurance and guarantor details.
• They check for data validity while entering or updating demographic information such as patient name, DOB, address, sex, marital status, Insurance policy/group ID and insurance mailing address.

8. Claims Submission  

• On successful completion of the Charge Entry process, a claim is submitted electronically from the client billing system to the insurance company.
• For paper claims, CMS 1500 or CMS 1450 forms are filed, scanned, and uploaded to our FTP site and from there to the client. The client can then mail the claims.
• The QA executive audits the batch files for accuracy and makes changes if required. A further check is done by the Team Lead who performs a random audit on the batches.
• The EDI claims are transmitted to insurance companies.

Step 9: Cash posting

• The Team Lead allots the batch files to the Process Executive to enter EOBs into the billing software.
• The Process Executive checks for valid information for processing EOBs such as EOB/check date, check number, DOS and CPT codes for which payment is received and transfers like co-pay or co-insurance and Insurance from where payment is received.
• The Process Executive completes the batch files by posting insurance or patient payments and sends a report to the Accounts Receivable department on unpaid claims.
• The Team Lead allots the completed batch files to the QA Executive for audit.
• The QA Executive audits the batch files for accuracy and makes changes, if required.
• The QA Executive also prints the Secondary Claims or Patient Statements, if required.
• The Team Lead does a random audit on the batches.

Step 10:  Accounts Receivable

• The Analyst in our Healthcare Revenue Cycle Management team receives the work order from the Cash Posting department on unpaid claims.
• The Analyst reviews the unpaid claims and allots them to the Calling Executive to resolve the unpaid claims.
• In order to track outstanding receivables, the Analyst runs an "insurance aging report" on a weekly basis and segregates the claims based on the aging days of the claim such as 30, 60, 90 and over 90 days.
• The claims are sorted by claim age (oldest to newest) and assigned priorities based on the claim age and insurance filing limit. The focus is on getting the best collections first. They are then passed on to the Calling Executive for follow up to collect unpaid and partially paid claims.
• The Analyst takes action on the calls made to the insurance company, sends any requested information to the insurance company and also re-files the claims if required.

Step 11: Reports

Daily Reports

Charges - We prepare reports on

• The files received by us and the transactions entered in the billing software
• Electronic Claims submission and Paper claims.

Payments - We prepare reports on

• The files received by us
• The transactions entered in the billing software and daily monies
• Unpaid claims.

Accounts Receivable - We submit reports on

• The calls made to the insurance companies
• The follow up to the unpaid claims

Weekly/Monthly

• Charges - Consolidated report on the transactions processed for the entire week/month.
• Payments - Consolidated report on the transactions processed and the amount collected for the entire week/month.
• Accounts Receivable - Reports on the amount collected from the unpaid claims and pending claims for follow up.

Step 12 : Client Feedback

On receiving feedback on quality from the client, our Healthcare Revenue Cycle Management team works towards improving and refining the Billing Process in order to provide the most accurate and reliable services.

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