The following details provides the workflow of Medical billing process.
2. In Billing
office, Scanning department retrieves the files and prints them and
ties up with the control log for number of files and pages.
4. Illegible /missing documents are identified and a mail is sent to the Billing office for rescanning.
6.Coding
and pre-coding of the super bill/charge sheet and demographics for
insurance, doctors, modifiers, CPT and diagnosis are done wherever
required.
7. The
claims data entry operator creates a charge, according to the billing
rules pertaining to the specific carriers and locations .All charges are
accomplished within the agreed turnaround time with the client.
8. Charges are verified by audit department for accuracy and compliance with rules.
8. Charges are verified by audit department for accuracy and compliance with rules.
9. Claims are filed and information sent to the Transmission department.
10. Transmission
department prepares a list of claims that go out on paper and through
the electronic media. Once claims are transmitted electronically,
confirmation reports are obtained from clearing house and filed after
verification. Paper claims are printed and attachments done if required and put into envelopes and sent to the US for postage and mailing.
11. Clearing house transmission rejections/errors are analyzed and take corrective action and again transmit the claims to clearing house
12. Once recieve the EOB( Expalnation of Benefits-Payments), Cash
applied team receives the cash files and post the payment in the
respective accounts. This would helps to reconcile the deposits at the
end of each month. while psoting the EOBS, Overpayments are immediately
identified and sene the information to Dr office to refund the amount
into the respective insurances.
13. All
rejected/denied claims, research the reason for denial with remark
codes in the EOB’s or Explanation of Benefits received and take
appropriate action to resolving the issue.
14. AR
analysts are the key to any group. They record the processing time of
each insurance companies and identify all claims falling above the
processing time. Then the claims are researched for completeness and
accuracy and insurance carriers are called if required. AR analysts are
responsible for the cash collection and resolving all problems to enable
the account to have clean AR.
15. Insurance
Calling team, calls to the insurance companies to identify the reasons
for non-payment of the claims.Calling details are passed on to the AR
Analysts for resolution. Calling team works during the American Time
zones.
16. Patient
calling team calls up the patients to confirm receipt of bill and when
they are going to pay. Based on client’s approvals budget plans and
discounts for immediate payments are also undertaken.
A Note on Methodology
The size of a billing organization can range from a few staff to hundreds of employees, with employees added as the number of claims processed grows.
Cost factors include the number of claims, average number of pages per claim, average processing time per claim, average payroll costs, and the percentage of claims that must be processed in paper or hardcopy format, including those received electronically but printed for compilation. All of these variables and more have been taken into account in our study.
Savings percentages are derived from Laserfiche’s 20-year history and experience with over 25,000 installations worldwide. In this white paper, we present results for the following types of organizations as represented by our customers:
•Single-facility billing departments: 75,000 claims processed annually.
•Multi-facility billing departments: 225,000 claims processed annually.
•Third-party billing organizations: 750,000+ claims processed annually.
An ROI calculator is available upon request. With this tool, you can plug in your own variables and calculate the savings your organization will realize by implementing digital document management technology.
A number of steps are required to generate and file a medical claim from a patient encounter, including documentation compilation, quality control, financial verification, coding, billing input and claim processing.
Often, these steps involve one or more staff members, and this simple list belies the complexity and effort involved in each of these steps. The work processes involved in generating and filing a claim can be dramatically streamlined with document management. These benefits are further enhanced by implementing an electronic document workflow process to automatically guide the file through the required stages.
Claim Processing Efficiencies
Source documentation can vary from a single encounter form to a multi-page file of supporting records. Portions arrive at different times and in a variety of formats that include paper, electronic documents and electronic data files.
And documents may be received in a variety of ways, including physical delivery, fax, e-mail, CDs and FTP site uploads. In fact, without a digital document management system, the most effective way to compile and review the disparate documentation is often to print everything received electronically, which wastes time and resources.
Providers that have implemented an EMR/EHR application can send an electronic data file, which in effect transfers the printing and paper costs to the billing organization. The mail room becomes the initial record assembly area, where documentation is sorted into patient batches and folders are created and labeled.
Documents are then routed to the first step or staff in the workflow process, which is typically quality control. Too often, duplicate files are received, which doesn’t just double the cost of compilation, but also requires staff to identify them as duplicates and then delete them.
Defining Workflow
Workflow, a term that originated in the mid-eighties, has many definitions. For this study, we define workflow as a computer-assisted (or automated) organizational process. An organizational process is a collection of activities related to a specific commitment, adding value to a product or service of the organization.
Workflow is often used synonymously with reengineering, but workflow automation and business process reengineering are not the same thing. Workflow automation is a software technology that provides a means of automating a business process. Reengineering is the act of analyzing the business processes of a company or practice and changing them with the goal of improvement.
Thus, business organizations can automate business processes using workflow software without reengineering them. Likewise, businesses can reengineer business processes without work- flow automation.
Workflow is also not the same as workflow automation.
Any application that can route a document so that it flows (like e-mail) from one user to another can claim to be workflow. True workflow automation includes an array of essential features that go far beyond the simple routing of documents and depends on two critical factors, (1) automating manual process steps and (2) distributing information to the workgroup, in this case, to the physician and his or her staff.
An automated workflow system has the following characteristics:
• Tasks These are activities that must be completed to achieve a business goal. The CPR (computer-based patient record) and workflow system in this study are task-based.
• People Tasks are performed in a specific order by specific people (i.e., nurses, physicians) based on business roles.
• Roles Roles are defined independent of the people or the processes that fill them; for example, the CPR defines a nurse’s role as different from a physician’s role in the physician’s office.
• Processes Processes are the sequences of steps to be performed based on business conditions. Workflow automation may mirror existing processes or call for redesigning processes to eliminate redundancies and bottlenecks and to account for simultaneity.
Since redesigning processes involves an examination of why people do what they do and often requires changing the way people do their work, it may foster fear, uncertainty, politics, and resistance to change.
• Practices Practices are what actually happen in organizations. Only by capturing the practices is it possible to truly automate businesses.
• Policies Policies are formal written statements of how certain processes are handled. In most physician practices, policies are unwritten and must be remembered by the person assigned to the task.
A Note on Methodology
The size of a billing organization can range from a few staff to hundreds of employees, with employees added as the number of claims processed grows.
Cost factors include the number of claims, average number of pages per claim, average processing time per claim, average payroll costs, and the percentage of claims that must be processed in paper or hardcopy format, including those received electronically but printed for compilation. All of these variables and more have been taken into account in our study.
Savings percentages are derived from Laserfiche’s 20-year history and experience with over 25,000 installations worldwide. In this white paper, we present results for the following types of organizations as represented by our customers:
•Single-facility billing departments: 75,000 claims processed annually.
•Multi-facility billing departments: 225,000 claims processed annually.
•Third-party billing organizations: 750,000+ claims processed annually.
An ROI calculator is available upon request. With this tool, you can plug in your own variables and calculate the savings your organization will realize by implementing digital document management technology.
A number of steps are required to generate and file a medical claim from a patient encounter, including documentation compilation, quality control, financial verification, coding, billing input and claim processing.
Often, these steps involve one or more staff members, and this simple list belies the complexity and effort involved in each of these steps. The work processes involved in generating and filing a claim can be dramatically streamlined with document management. These benefits are further enhanced by implementing an electronic document workflow process to automatically guide the file through the required stages.
Claim Processing Efficiencies
Source documentation can vary from a single encounter form to a multi-page file of supporting records. Portions arrive at different times and in a variety of formats that include paper, electronic documents and electronic data files.
And documents may be received in a variety of ways, including physical delivery, fax, e-mail, CDs and FTP site uploads. In fact, without a digital document management system, the most effective way to compile and review the disparate documentation is often to print everything received electronically, which wastes time and resources.
Providers that have implemented an EMR/EHR application can send an electronic data file, which in effect transfers the printing and paper costs to the billing organization. The mail room becomes the initial record assembly area, where documentation is sorted into patient batches and folders are created and labeled.
Documents are then routed to the first step or staff in the workflow process, which is typically quality control. Too often, duplicate files are received, which doesn’t just double the cost of compilation, but also requires staff to identify them as duplicates and then delete them.
Defining Workflow
Workflow, a term that originated in the mid-eighties, has many definitions. For this study, we define workflow as a computer-assisted (or automated) organizational process. An organizational process is a collection of activities related to a specific commitment, adding value to a product or service of the organization.
Workflow is often used synonymously with reengineering, but workflow automation and business process reengineering are not the same thing. Workflow automation is a software technology that provides a means of automating a business process. Reengineering is the act of analyzing the business processes of a company or practice and changing them with the goal of improvement.
Thus, business organizations can automate business processes using workflow software without reengineering them. Likewise, businesses can reengineer business processes without work- flow automation.
Workflow is also not the same as workflow automation.
Any application that can route a document so that it flows (like e-mail) from one user to another can claim to be workflow. True workflow automation includes an array of essential features that go far beyond the simple routing of documents and depends on two critical factors, (1) automating manual process steps and (2) distributing information to the workgroup, in this case, to the physician and his or her staff.
An automated workflow system has the following characteristics:
• Tasks These are activities that must be completed to achieve a business goal. The CPR (computer-based patient record) and workflow system in this study are task-based.
• People Tasks are performed in a specific order by specific people (i.e., nurses, physicians) based on business roles.
• Roles Roles are defined independent of the people or the processes that fill them; for example, the CPR defines a nurse’s role as different from a physician’s role in the physician’s office.
• Processes Processes are the sequences of steps to be performed based on business conditions. Workflow automation may mirror existing processes or call for redesigning processes to eliminate redundancies and bottlenecks and to account for simultaneity.
Since redesigning processes involves an examination of why people do what they do and often requires changing the way people do their work, it may foster fear, uncertainty, politics, and resistance to change.
• Practices Practices are what actually happen in organizations. Only by capturing the practices is it possible to truly automate businesses.
• Policies Policies are formal written statements of how certain processes are handled. In most physician practices, policies are unwritten and must be remembered by the person assigned to the task.
The process of medical billing is complex and consist of several sub processes like patient admission and charge entry, claim process management, payment posting etc. The process of Medical Billing Services must be performed in a proper way to get payment faster.
ReplyDeleteA medical billing service consists of preparing claims and submitting them to insurance providers. This makes sure that the provider is reimbursed the correct amount for the service(s) rendered to patients.
DeleteMedical offices and facilities are paid from private insurances providers and a number of healthcare programs such as Medicare and Medicaid, which are financed by the U.S. Government, through medical billing processes. Being paid the appropriate funds allows the medical provider to remain open and function. With lower than projected reimbursements, it’s virtually impossible for them to offer top-notch healthcare to patients.
ReplyDelete