Medical Billing Process
Hospitals and healthcare facilities face a lot of hassles when it comes to settling payments with regards to insurance. Payments are considered settled when patients submit insurance details at the front desk of the hospital. But the hospital or healthcare facility does not receive the final payment till the insurance agency settles the claim. Our medical billing services allow hospitals to take the back-seat through the various steps involved in the process.
In order to simplify the medical billing process and minimize the daily hassles encountered by hospitals and other healthcare facilities, Flatworld Solutions follows a framework of clearly defined steps:
Patient Demographic Entry
CPT & ICD-10 Coding
1. Transmission of claims to Flatworld
Medical records of patients contain vital demographic information such as a summary of diagnoses, the medical history and regular updates on visits with physicians. The hospital forwards medical claims to our billing team via courier or scanned documents, supported by patient medical records, charge-sheets, insurance verification data, a copy of the insurance card and any other patient information. This is then scanned and uploaded onto a secure FTP server to be accessed by our qualified medical billing staff.
2. Retrieval and checking of medical claims
Our staff will then retrieve the information from the FTP server and look for any illegible or missing information in the documents. If there are any errors, the hospital or healthcare facility is immediately notified and asked to re-send the documents.
3. Medical coding
An important step in claims processing, medical coding fixes the procedure and diagnoses codes for each patient based on CPT (Current Procedural Terminology) and ICD-10 (International classification of Diseases) standards. The 'level of service' determines the 5 digit procedure code and the diagnoses code as the name suggests, is based on the medical diagnoses made by the doctor.
4. Charge creation
Once documents are checked and verified and the coding is completed, our medical billing team creates medical claims while adhering to rules pertaining to the specific carriers and locations. Claims are usually created within a 24 hour period.
5. Medical claims audit
The claims are then put through a rigorous auditing session which involves extensive checking at multiple levels. The completed claims are once again checked for valid and complete information, correct procedures and diagnoses codes. The single most common cause for rejection of claims is the submission of incomplete/incorrect information. The efficient medical billing process at Flatworld Solutions completely eliminates such chances.
6. Medical claims transmission
The claims are then filed and sent for a final follow-up check before being sent to the claims transmission department along with all necessary information and supporting documents for each claim.
7. Claims submission
The final audited and recorded medical claims are printed and sent to the respective insurance agencies and government departments along with relevant information and the necessary supporting documentation required for the final settlement.
8. Follow-up and settlement
This is the final and most important step in the medical billing process. Hospitals and healthcare facilities no longer have to chase insurance agencies for settlement of payments. We'll ensure that we follow-up persistently till the job gets done and the final settlements are made.
Benefits offered at Flatworld Solutions
With over 20 years of providing medical billing services to a host of medical billing companies, healthcare providers and insurance companies in the U.S and U.K, our services are comprehensive and cover all loop-holes associated with outsourcing medical billing services. The following are some of the advantages that we offer to customers:
- Medical claims audit
- Strict adherence to quality control standards
- Quality assurance reviews
- Monthly billing reviews
- Email, fax and voice communication
- Streamlined medical billing process via templates and protocols
- All electronic documents are preserved for 120 days unless otherwise specified
- Restricted employee access to files and folders
- Secure FTP servers
- A systematic data back-up of all patient visits
- Internal data and communication back-up
- HIPAA compliant
- Employees are well-trained in regulations regarding Medicare, Medicaid, managed care, third party liability, workers compensation, preferred provider organizations and indemnity insurers
- Adherence to standards such as CPT, HCPCS and ICD-10
- Proficiency in Medical Coding Levels 1, 2 and 3
Concerns in outsourcing medical billing services
There have been incidents in the past that have led to valid concerns and fears regarding outsourcing medical billing services. The most common ones are:
- Healthcare fraud
- Non-adherence to federal, state and payer regulations
- Inaccurate submission of claims
- Lack of familiarity with U.S medical billing laws
At Flatworld Solutions, we provide adequate training and give our employees access to a reservoir of knowledge on the latest in the medical billing domain, thereby eliminating all possibilities of inaccuracy and errors caused by lack of familiarity with relevant laws. We have been in the business of providing medical billing services for almost a decade and possess the expertise and capability to provide cost-effective solutions for your medical billing requirements.
Contact us to outsource medical billing services.
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