Eligibility Patient s coverage verified prior to visit Coding Medical Records are reviewed and coded by Certified Coders Demographic & Charge Entry

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1 Eligibility Patient s coverage is verified prior to visit Coding Medical Records are reviewed and coded by Certified Coders Clearing Clearing Houses Houses For For Electronic Electronic Clearance Clearance Demographic & Charge Entry Billing specialists enter patient demographics and charges into the PMS Transmission and Posting Claims are sent to the clearinghouse and payments (EOB) received are applied to the PMS Accounts Receivable Increase in collection ratio through accurate analysis and timely follow up Hospital Hospital /Doc s /Doc s office office generates generates Super Super bills bills Demo Demo Entries Entries Charge Charge entries entries Medical Medical Coding Coding EOB s EOB s Payment Payment Postings Postings Denials Denials Claims Claims Submission Submission A/R A/R Analysis Analysis Follow Follow up s up s Insurance Insurance Calling Calling Patients Patients Statement Statement Patient Patient Calling Calling Customer Customer Care Care Claims Insurance Insurance Company Company Releasing Releasing payments payments Revenue Recovery Old AR are analyzed and corrective measures are taken (Resubmission)

2 CLIENT IN US SCANNING TO INDIA CODING ACCESSSING SOFTWARE PATIENT DEMOGRAPHICS ENTRY CHARGE ENTRY QUALITY AUDIT Paid Claims for cash application TRANSMISSION OF CLAIMS THRU CLEARING HOUSES Unpaid Claims For corrective action CASH APPLICATION AR ANALYSIS / CALLING CASH TALLYING ACTION ON DENIALS / REJECTIONS GENERATION OF REPORTS REPORTS TO CLIENT

3 Scanning Documents to India US Office scans Patient Demographics, Charge Sheets, Insurance Card Copies, etc. Medical Coding Log to be maintained with File name, Total charges, Specialty details, etc before Coding. Scanned copies would be saved as *.TIF (Tagged Image Format) file and placed in FTP Site Coding of Diagnosis to the utmost specificity using ICD-9 CM Manual. In the FTP Site, Files would be placed in the common path which can be accessible by India Coding of Procedures by referring to CPT / HCPCS. Mail to India on Scan date, File name and directory path. After Coding, files to be handed over to Charges Department for processing.

4 Demographics entry Documents to be sorted Patient wise before entering into the system Patient Account Numbering to be done, if system does not generate automatically Patient #, Name(LFM), Address, SSN, Sex, Employer, Home Ph, Work Ph, Guarantor, Marital Status, Subscriber details, Doctor#, Insurance information etc to be entered in the system If any clarification is required, send mail to US office After entering, printouts to be taken and data to be checked Log to be maintained with Total Patients, Patients entered, Pending details, etc.

5 Charge Entry Patient Demographics and Coding to be done before entering Charges Charge File to be sorted by Patient / Date of Service Patient #, Doctor #, Place of Service, Type of Service, Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Referral, Prior Authorization, On Bill comments, etc. to be entered in the system If any clarification required, send mail to US office. After entering data, file to be given to Quality Audit for checking After checking and corrections, Claims to be transmitted. After Transmission, Charges completion details to be sent to US office. If any incorrect details found, Charges department to be informed

6 Quality Check Quality Audit for Patient Demographics and Charges before sending batch wise update to client Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph, Guarantor, Subscriber details, Employer, etc to be checked in Patient Demographic File Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Place of Service, Type of Service, Referral, Prior Authorization, On bill comments, Location, etc to be checked in Charges File After Quality Audit, files to be given to Supervisor / Manager for sending Batch Update to client. Log to be updated with patients checked, charges checked, correction details, etc If any incorrect details found, Charges Team to be informed of the same and correction done

7 Claim Transmission Electronic/Paper After Quality Check is through, List of Electronic Claims to be separated Transmission processes to be accurately followed to avoid rejection Claims to be transmitted electronically through different clearing houses After transmission, log to be updated with patient #, claim#, total claims transmitted, pending claims, etc. If any incorrect details found, Charges department to be informed Send mail to Charges department after completion of Transmission

8 Cash Posting Checks and EOB(Explanation of Benefits) to be arranged before doing Cash Posting Insurance Name, Check #, Total Check Value to be cross verified with the Check and EOB Copies In the EOB Copy, Claim#, Date of Service, Procedure, Units, Charges to be identified before posting Application of Payment, Deductible, Co-insurance, Adjustments, Write offs, etc in the Cash Posting After Cash Posting, Claim#, Patient Name and Value to be checked for tallying data with the EOB If any incorrect details found or any details missing, follow up to be done with Insurance Log to be updated with Total Checks, Total Value, Posted details, Pending details, etc