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Billing/Claims
- Old A/R Clean Up
- Coding Specialties
- Process Flow
- Reports
- FAQs

EMR
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  Services - Billing & Coding
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Old Accounts Receivable Clean Up
"Old A/R", are loosely categorized as claims over 90 days old. These cause a significant backlog and burden the manpower of most medical practices.

Many healthcare providers find their practice to be generating reasonable monthly charges but the actual net collections are not being realized. Within a six month duration, it is common to find a provider with excessive amounts in A/R that are older than 180 days outstanding.

Our billing specialists utilize a real-time A/R management program, which literally allows them to work on unpaid claims. Usually the volume of outstanding claims and the time it takes to research, correct, appeal, and re-file the claims will take much longer than expected. A limited number of staff devoted to this task will not be able to accomplish the goal, which is to substantially reduce and eliminate the outstanding A/R and collect as much money as possible in a short period of time.

To overcome on all these problems a thorough, detailed follow-up done by our insurance specialists. We pursue these accounts by assigning a full team of individuals to solve them.

Specialties:
Vennar’s expertise and specialized manpower renders Billing/Claims services to Specialties including:
• Cardiology
• Urology
• Nephrology
• Orthopedics
• Radiology
• Obstetrics and Gynecology
• Surgery
• Oncology
• Ophthalmology
• Internal Medicine
• Gastroenterology
• Genitourinary

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Billing & Coding Process Flow
Vennar developed a diligent process flow to ensure the following:
• Optimizing the billing & revenue Cycle
• Ensuring adherence to the Billing Guidelines for each specialty
• Recovery of Payments in the Shortest Possible Time frame
• Updating all information to the Hospital/Practice

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Connectivity Process
Documentation at the Front Desk
The patient hands over his insurance card. On the card copy the office manager needs to verify if a referral or pre-authorization needs to be obtained and then contact the respective Primary care physician (gatekeeper) and get this documentation.

Scanning
Demographics, super bills/charge sheets, insurance verification data and a copy of the insurance card i.e. all the information pertaining to the patient, is sent to the billing office.

Billing office scans the source documents and saves the image file to an FTP site or on to their server under pre-determined directory paths. The Scanning department retrieves the files.

Files are sent to the appropriate departments with the control log for number of files and pages received. Illegible/missing documents are identified and a mail is sent to the Billing office for rescanning.

Pre-Coding
Pre-coders then enter the key-in codes for insurance companies, doctors and modifiers.
Pre-coders also add insurance companies, referring doctors, modifiers, diagnosis codes and procedure codes that are not already in the system.]

Coding
Coding team assigns the Numerical codes for CPT (Current Procedural Terminology) and the Diagnosis Code based on the description given by the provider.

Charge Team
This department would first enter the patient personal information from the Demographic sheets. The relationship of the Diagnosis code and CPT is also checked. Then a charge is created according to the billing rules pertaining to the specific carriers and locations. All charges are accomplished within the agreed turnaround time with the client, which is generally 24 hours.

Audit
The daily charge entry then needs to be audited to cross-check the accuracy of this entry to ensure the billing rules are being accurately and meticulously followed. Also this department verifies for accuracy of the claims based on carrier requirements to ascertain a clean claim.

Cash Application
Cash Applications team receives the cash files (Check copy & EOB) and applies the payments in the billing software against the appropriate patient account. During cash application, overpayments are immediately identified and necessary refund requests are generated for obtaining approvals. Also underpayments/denials are passed on to the Analysts.

Analysis
AR analysts are the key to any group. The claims are researched for completeness, thoroughness and accuracy and work orders are set up for the call center to make calls. AR analysts are responsible for the cash collections and resolving all problems to enable the account to have clean AR.

They also research the claims denied by the carriers, rejections received from the clearing house, Low payment by the carriers and appropriate actions are taken. Analyst reviews for global patterns and bulk problems are solved at one instance.

Calling
This is the hub of activity around which Medical Billing operates, where the caller would call up Insurance and verify if the claim is with the carrier and what is the current status of it. Whether it is being processed for payment or denial, based on his inputs the analyst goes to work, and gets the required pre-requisites needed, in case of payment he would compile a list of payment details or if denied then corrective action needs to be initiated.

Calling team receives work orders from the analysts and initiate calls to the insurance companies to establish reasons for non-payment of the claims. All reasons are passed on to the Analysts for resolution.

Claims Transmission
Claims are filed and information sent to the Transmission department. 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 and filed after verification.

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Reports

Why Reports?
• Numbers make a tangible difference
• Facilitate interpretations and to arrive at conclusions
• Credibility to work done
• Forecasting Future Collections
• Directing work towards areas of specialization

Insurance Follow-up Summary Reports
These reports tailored to the Client requirements helps us make a summarized presentation of number of claims addressed during the assigned time period, track claims where Client action is pending etc.

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Features and Benefits
The purpose of our medical billing services is to maximize the cash flow & profits of your practice. Our medical billing solutions are the single most powerful tool you have in accelerating the cash flow, reducing the expenses & increasing the profits of your practice. Our main features include:
• All data transfers through FORTIGATE Firewall with dedicated VPN connections
• Latest Anti-Virus Softwares
• High speed internet of 2 MBPS bandwidth with redundancy from 2-different service   providers – One with Optical Fiber and the other with RF
• Connectivity through two different gateways – to ensure 100% connectivity
• Separate ISDN connection for backup
• Quick adoption to existing Client Billing Softwares

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Benefits
• Error Free Data Entry
• Quick Turn Around Times
• Shortened Time for Receivables
• Accelerated Account Receivable Turnover
• Elimination of Aged Claims
• Cash flow protected from Staff turnover & other Personnel Issues
• Accelerated Revenue Cycle

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Our Commitment
Our commitment to serving your health care operation mandates that – regardless of the costs we incur – we invest in any additional resources to ensure that each and every claim is followed up thoroughly. The following services are included in our fees and are provided to you at no additional charges
• Toll free numbers & patient help line
• Toll free fax numbers
• Patient eligibility verification
• Electronic & paper claim filing
• Secondary & tertiary claim filing
• Payment posting
• Rejected claim resolution
• Aged claim reconciliation
vSoft collections on outstanding patient balances
• Comprehensive management reports

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Rates
We serve clients throughout the country in all specialties. Although we charge most of our client's around 8, we do consider a prospective client's claim volume, average reimbursement and specialty prior to making a proposal.

We apply our fee to monies posted on a monthly basis. Our fees apply only to those carrier and patient payments collected as a result of our billing activities. In other words, we will not apply our fee to those monies (co pays & cash patients) paid by the patient at the time of their appointment.

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Billing & Coding - FAQ

1.What is Medical Billing?
2. What is the Medical Billing Process?
3. What about the Payment?
4. What about the Billing Quality?
5. What are the Medical Billing mistakes you should avoid?
6. How can I see that my collections have increased?
7. How fast is your billing turnaround?
8. How can I benefit from your service?

1. What is Medical Billing?
Medical Billing is the process of submitting and following up on claims to insurance companies in order to receive payments for medical services rendered by a health care provider.

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2. What is the Medical Billing Process?
The Medical Billing process is an interaction between the healthcare provider and the Insurance Company. After examining the patient, the doctor maintains a medical record. This Record includes the patients' symptoms, clinical findings, and diagnosis and treatment details. Following these details a medical coder or a billing specialist provides a medical code for this record. This billing code is then submitted to the Insurance Company. The Insurance Company then proceeds with the claim.

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3. What about the Payment?
Based on the amount negotiated by the doctor and the insurance company, the original charge is reduced.

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4. What about the Billing Quality?
Billing Quality is measured in terms of timeliness and completeness of payment. The shape of the distribution curve of Accounts Receivable illustrates billing quality. For several decades, medical billing was done almost entirely on paper. However, with the advent of computers it has become possible to efficiently manage large amounts of claims. Many software companies have arisen to provide medical billing software to this particularly lucrative segment of the market.

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5. What are the Medical Billing mistakes you should avoid?
Physicians believing that their billing professional cares a lot and will not be doing any mistakes at the head of the list. Take a copy of patients’ Insurance card. Also a second ID. Secure sign advanced Beneficiary notice when indicated.

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6. How can I see that my collections have increased?
We provide easy-to-read, detailed reports daily, monthly and as needed. Our managers are always available to discuss progress toward our mutual goal of increased collections. Clients have praised our aggressive approach to accounts receivable because of our professional attitude, dedication to reliability and customer service

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7. How fast is your billing turnaround?
The timeliness of our process is unparalleled. We have the manpower to enter your charges into the system and get the resulting claim or bill out the door within four to 24 hours of receiving your complete information

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8. How can I benefit from your service?
Our medical billing experts will take the burden of insurance processing and replace it with improved cash flow and more time for the care of your patients.

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