Workflow – Medical Billing Outsource to India

Workflow – Medical Billing Outsource to India

Kaiser Healthcare Strategies has been providing financial management to Healthcare providers/ Hospitals/ Billing Companies since last five years. Being a HIPAA compliant, our workflow for medical billing is streamlined and made simple to ensure efficient and timely services to our clients.

 Overview – Medical Billing

 The workflow begins with the patient going to a hospital/healthcare provider and gets treated. The front office of the healthcare provider/ hospital uploads the demographic details and the details of treatment in a secured server. Kaiser download the details to our FTP, submit the claim and follow up with the insurance company and ensure payment is done promptly.

 Workflow – Medical Billing

 Front Office, Healthcare provider/ Hospital/ Billing Companies: Once the patient gets treated, the front office uploads the demographic details and the details of the treatment in to their secured server in FTP.

 Quality Manager: The Quality Manager downloads the demographic details and the details of treatment, checks it and sends it to the Coding Team.

 Coding: The specialized coding team qualified as AAPC (American Academy of Professional Coders) goes through the treatment details. As per the ICD 9 (International Classification of Diseases), codes the diagnosis code. As per CPT (Current Procedure Terminologies), codes per the treatment given. Modifier is added as specified by the provider. The same goes through a quality check and then is delivered to the Charge entry Team.

Charge Entry: The Charge Entry Team as per the laid down rules and regulations enters the charge within a turnaround time of 24 hrs. The team is well trained and specialized in numerous medical billing software like, Medisoft, AdvanceMD, CollabarateMD, Allscript and OfficeAlly. A quality check of their entries is done and sent to the quality team.

Quality Check: The quality team checks the charges for their accuracy. Having satisfied with the charge entry, he goes ahead with Electronic Claim Submission.

Electronic Claims Submission: Submitting the claims electronically is more accurate, timely, and easy to keep a track and reduces paper work. The quality team having checked the accuracy of the charge entry submits the claims to a Clearing House. Every insurance company has a format of their own. The clearing house reformats and sends the claim to the insurance company as per their format.

Fixing Rejection by Clearing House: The clearing house might have some objections/ rejections if the claims are not complete. The clearing house sends all rejected claims back for completion. The rejected claims are updated and corrected by the charge entry team and resubmits the claim to the clearing house through the quality team.

Action at the Insurance Company: The insurance company receives the claim from the clearing house and processes it. After processing the claims the insurance company prepares an EOB (Explanation of Benefit), stating the status of the claim whether passed/ rejected and sends one copy to the patient and the other copy to the Healthcare Provider/ Hospital/ Billing Company. The Front office at the Healthcare provider/ Hospital/ Billing Company receives the EOB and uploads the same in the server by FTP. The same is downloaded by the quality manager at our domain and sent to Payment posting team.

Payment Posting: The payment posting team checks the EOB for the correctness of the payment made. If the payment is completed by the insurance company, the account is closed and the details are sent to the Healthcare Provider/ Hospital/ Billing Company. If the claim is denied by the insurance company with reasons there to, such claims are sent to the Account Receivable Follow up Team.

Account Receivable Follow Up: This team analysis the reason for denial or under payment and resubmits the claim to the insurance company. Then follows up with the insurance company till such time the payment is not completed. The client is kept informed about these pending payments till such time the payment is made and account closed.

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