Patient Demographic
Demographics & Charge Capture or Claim creation the process starts with Demographics entry and insurance verification. Either through scanning documents to our billing team or having it shipped in packages we collect all the information necessary to generate an encounter: demographics, insurance information, and ICD/CPT codes.
Once the information is retrieved the claim can be created using two methods :
Manual Claim entry: Claims are created directly into the PM system from a route slip or super bill. Before any claim is generated verification is done for patient’s insurance eligibility. At the time of ICD/CPT entry various online tools will be used to insure correct coding is done with modifiers, units, and charges.
Auto generation: Claims are automatically created directly from the appointment scheduler. ICD/CPT codes, modifiers, and units are entered into individual patient appointments along with Demographic information and patient insurance details. If any copayments are posted into the appointment details they are directly transferred into the encounter. At the end of the auto generation process auditing of the newly created claims can still be done before submission
Prior Eligibility
"Prevention is better than cure" the famous phrase that asks us to be prepared than to lament about it afterwards.
A medical survey has shown that 6% insured individuals forget to renew their health insurance coverage annually and as a result they have to pay for the services from their pocket that account for almost 30% of their annual insurance premium.
This can be disadvantageous for the provider as well, in case the patient becomes reluctant about their coverage and don’t pay the bills. To bring down these figures, Unitech performs insurance verification of every patient that comes in for an appointment a day or two before. In case the patient doesn’t have an active coverage he is informed about the same.
Advantages of Insurance Verification
Increase point of service collections (Co-pays, Out Of Pocket, etc.)
Improves efficiency of revenue cycle
Decrease claim denials due to no coverage
Reduce risk factors
Enhanced patients experience
Simplifies workflow
Reduced rework of claims
Decreased account receivables days
Alerts about self-pay patients
How will we do it?
Unitech executives will access the patient’s insurance information from the appointment schedule of next day or the practice can choose to email it in secure file format.
Depending on the insurance payer, we will verify benefits and eligibility through websites, Automated Voice Response System and calling the Customer support center.
We also verify specific benefits or details listed below as and when requested by the provider.
The detailed information will be punched in the individual patient’s account in form of notes.
In case the coverage is terminated or the service is not covered, the patient is called and informed about the same, and asked for any alternative insurance coverage.
A detailed daily report is also sent to the practice manager with notes of all the patient’s verified.
We can verify more or less from these information while verifying insurance depending on the specialty of the provider:
Payable benefits
Co-insurance
Patient policy status
Type of plan and coverage details
Referrals & pre-authorizations
Lifetime medical insurance
Patient co-pays
Plan deductibles
Effective policy date
Plan exclusions or exceptions
Mailing address for filing medical insurance claims
Referral/ Authorization
Eligibility checking is the single most effective way of preventing insurance claim denials. Our service begins with retrieving a list of scheduled appointments and verifying insurance coverage for the patients. Once the verification is done the coverage details are put directly into the appointment scheduler for the office staff’s notification.
There are thee methods to check eligibility:
Online - Using various Insurance company websites and internet payer portals we check patient coverage.
Automated Voice system (IVR) – By calling Insurance companies directly an interactive voice response system will give the eligibility status.
Insurance Company Representative Call- If necessary calling an Insurance company representative will give us a more detailed benefits summary for certain payers when not available from either websites or Automated phone systems.
Medical coding/ Billing / Scrubbing
For healthcare providers that offer critical care services, optimizing the medical billing process is a primary focus area to ensure sustained, long-term operations. From streamlining the complex collections process to overcoming continual declines in reimbursements and satisfying HIPAA requirements, there are a number of tasks that constitute the medical billing process and lead to the successful close of a revenue generation cycle. UNITECH, a leading Medical Billing Services company, will enable your healthcare business to accelerate the pace of revenue generation, reduce operational expenses and increase the efficiency delivered by the system.
UNITECH is an expert provider of HIPAA compliant Medical Billing Services. We provide end-to-end medical billing services and act as a mediator between insurance companies and hospitals or healthcare providers. Healthcare organizations are faced with the possibility of losing large quantities of money every year due to under-pricing, coding errors, non-reimbursed claims and missed charges. When you outsource medical billing services to UNITECH, we provide output of the highest quality and accuracy, and eliminate the occurrence of these losses.
END-TO-END MEDICAL BILLING SERVICES
Eligibility Verification/Pre-Insurance Verification: Before the patient’s visit to the provider, we perform pre-insurance verification to check eligibility regarding the particular insurance, requirement for any pre-authorization or referral, whether any copayment has to be collected, if the patient has met the deductible, the amount of co-insurance the patient shares, and whether the patient’s insurance covers the service sought from the provider. This step is important because many insurance providers do not provide retro-authorization.
Medical Coding: We access the superbills and detailed patient information from the physician’s office through a secure network. The medical documents are verified and their validation is communicated to the client. The healthcare documents are then sent to the medical coding department to assign CPT and ICD codes. The coded documents are subjected to proof-reading and cross-checked by the medical coding manager. The coded documents are then forwarded to the charge entry team. We also validate the code entered by the clients. UNITECH is getting ready for the ICD 10 change.
Charge Entry: The charges from the coded documents are entered into the particular patient account. If the patient is new and an account number does not exist as yet, then the patient account is created by entering all the demographic details from the patient registration form. Before transmitting the claims to the insurance payer through the clearing house, the entered charges are audited by the Quality Assurance (QA) team to ensure a ‘clean claim’ is submitted.
Claims Transmission: Once the charges are entered and audited, the claims are then filed with the payer electronically. We also have the capability to process paper claims. Usually at clearing houses, the claims go through some type of cursory filtering software to ensure that they are accurate and all information is contained within the document. Within 24 hours, a paper report is sent back with errors that have been caught. Once we have the report, the incorrect claims are rectified with the necessary information within 24 hours and the claims are resubmitted to the insurance company.
Payment Posting: When our team of experienced medical billing professionals receives scanned EOBs (Explanation of Benefits) and checks, these payments are entered into the system. As part of this task, we also charge appropriate patient accounts and initiate the process for denied claims in case actual claim is far below the expected one. Reconciliation takes place on a daily basis.
Accounts Receivable Follow-Up / Insurance Follow-Up: Once the claims are submitted to the payer for processing, our expert medical billing BPO follow-up team resolutely pursues all unpaid insurance claims that have crossed the 30 days bucket in order to reduce the accounts receivable (AR) days of the claim. Sometimes, the claims are underpaid by the insurance payer, and in this case, we ensure that the underpaid claims are processed and paid correctly. The denied claims are appealed by our AR team.
Denial Management: The denied claims are addressed on priority basis – our billers and coders find the missing puzzle pieces fast, and re-file or appeal the denial. We have Denial Analysts on board who fix the issue and send the claim for reprocessing. If the claim needs more information from the provider, then these gaps are filled promptly; if the claim is denied and the patient is responsible, the claim is billed to patient.
Patient Follow-Up/Patient Statements: We follow up with patients for any pending balance due after the insurance claim is processed A patient statement is generated and filed on a weekly or monthly basis, as per your business requirement. Follow-up is done through phone calls. If no response is received from the patient, we move those balances to collections, generate a report for it and send it to you for further action.
Reports: Our reporting package contains monthly customized reports, including insurance aging reports and Key Performance Indicators (KPI) report, offering a detailed picture of your practice’s financial health and the length of your claim payment cycle.
Credit Balances: As part of our medical billing services, we can perform credit balance processing of the payer or patient, after verifying that it is a case of overpayment. This ensures correct and timely refunds to the appropriate entity.
Provider Enrolment and Credentialing: We offer a comprehensive range of medical billing and healthcare BPO services. We complete all applications and necessary paperwork on your behalf with the chosen payer networks and government entities. We follow all payer contracts through to contract load date and provide copies of fully executed contract and fee schedules to your practice or billing company. We also maintain and update CAQH profile.
Claim Submission/ Claim Analytics
Primary & Medicare Secondary Electronic:
Primary & Secondary Medicare electronic claims are submitted directly to Medicare connecting through the Client's PMS system from the central billing location.
Care-First and various other commercial Insurance claims are submitted through a clearing house.
EDI claim acknowledgment reports are retrieved and analyzed to trace any rejected claims within 24 hours from transmission.
All rejected claims are resolved by taking corrective and re-submitted on the same day
Paper Claims: Paper claims are queued on the client’s practice management system so that they are printed on aCMS 1500 form at the client’s office and mailed to various insurance companies accordingly.
AR & Denial Management
Denial / Rejection and appeal workup
Our expertise includes managing denials for the following reasons:
Authorization Issues
Medical Necessity and Medical Records requests
Terminated Insurance
Wrong Diagnosis
Partial Payments
EDI Rejections
No status and No claim on File
PIP cases
Referral Issues
Non-Participation with Insurance Network
Coordination of benefits
Inclusive Procedures
Out-of-network claim status and deductibles
Letter of Protection from Attorney cases
Worker's Compensation
Patient Billing/Patient Statement
Patient statements help you reduce your costs and save time by billing your patients quickly and efficiently. With patient statements, you can create a fully electronic billing and payment experience for your patients and leverage traditional print and mail statement workflow. You can print and mail your own patient statements or outsource the printing and mailing to Unitech. By automating your patient billing process you can accelerate cash flow, lower your costs, and save precious time, while providing greater convenience to your patients.
Due to high insurance premiums, employers nowadays are providing health insurance policies to their employees with higher deductibles, more co-insurance, larger co-pays, and many services that are just plain not covered. This leaves more patients with balances that need to be paid to your practice. Capture’s services include billing patients for these balances. We generate easy to understand patient statements weekly on a 30-day cycle. This creates a continuous flow of revenue. Patients send payment directly to your practice. We do not touch your money. Our direct phone number appears on the statement so that patients will call Capture Billing directly with all of their billing questions and concerns – no more time-consuming phone calls for your practice. We provide your patients with the best possible customer service to answer their questions, interpret their EOBs, and work with their insurance companies to get their claims resolved.
Capture Billing is not a collection agency but we make every effort to collect your money. We try to help your patients pay their bills. We will send out three patient statements, a demand letter and follow up with phone calls. Based on your criteria, we will work with patients to set up payment plans if needed and monitor these payments. If the patient balance remains outstanding after these efforts, we recommend that the account be turned over to a collection agency or an attorney for collections upon your approval.
Worker Comp/NF Forms/Billing
Filing the Claim
Employees who are injured on the job typically file a claim through their employer’s workers’ comp carrier. The employer’s Human Resources Department normally handles the claim, which is usually the extent of the employer’s involvement in the claims process. However, some companies also administer their workers’ compensation policies.
The employee then receives a claim number after the claim is filed, which serves as an ID number when receiving reimbursement for the treatment. The workers’ comp carrier will also assign an adjuster, who will authorize the employee’s treatment, review the employee’s recovery and coordinate the claims process. In some cases, the adjuster also authorizes the employee’s primary care provider to provide treatment or direct the employee to obtain treatment from the carrier’s provider network.
Patient Treatment
An employee becomes the healthcare provider’s patient once the adjuster authorizes the treatment. Services covered by workers’ comp aren’t billed to the employee’s private health insurance, although unrelated services provided in conjunction with the authorized services are billed to the employee’s own insurance. The provider also works with the adjuster to develop a comprehensive treatment plan intended to restore employees to their full pre-injury function.
Employees use the CMS-1500 claim form to submit workers’ comp claims, as is the case with other healthcare claims. However, workers’ comp claims don’t typically have a format that would allow for electronic submission. This is because a worker’s comp claim must be submitted with a copy of the healthcare provider’s notes documenting the treatment indicated by the claim. Medical billers must also fill in the fields on the CMS-1500 to indicate that the employee’s condition is work-related, including the date of injury. They will use the workers’ comp claim number instead of an insurance ID number to ensure the correct injury was appropriately treated. Workers’ comp claims made to government or commercial healthcare plans must also be placed on hold until the carrier can determine if workers’ comp will cover the treatment cost.
Processing the Claim
The adjuster reviews the charges on the CMS-1500 and the attached progress notes to ensure the provided services are related to the work-related injury and authorized under the treatment plan. Payment for unrelated and unauthorized services will be denied, but the employee can’t be held liable for those expenses. Furthermore, the healthcare provider can’t bill those charges to the employee’s personal insurance since they’re under the jurisdiction of the workers’ comp plan.
The adjuster revises appropriate charges according to the carrier’s fee schedule. Like other forms of healthcare, providers aren’t allowed to bill patients for any remaining balance on workers’ comp claims. Providers also agree to accept the fee schedule rates as payment in full, since workers’ comp doesn’t typically include co-insurance or co-payments.
