RCM (Revenue Cycle Management)

Medical Coding

Having an experienced AAPC Certified Medical Coding Team for Coding and Audits ….

AccuBills is one of the best leading coding company. AccuBills is well aware about the importance of Medical Coding in RCM system and for submission of clean claims. Accurate Medical Coding will help in reduced denials and also a fast flow of revenue for our clients.

Medical Coding is one of the main reason for Denials. So as understanding the importance of Medical Coding and to reduce the coding errors in starting itself we have AAPC (American Academy of Professional Coders) certified medical coders, to maintain the highest level of accuracy and quality of work. AccuBills believes in meeting and exceeding the industry standards without compromising on quality for our clients.

We have ICD-9-CM, CPT-4, HCPCS coding, ICD-10-CM and ICD-10-AM medical coding experienced staff.
  • Chart Audits and Code Reviews
  • Offshore coding audits
  • Payer specific coding requirements
  • Our Coding team accomplishes Medical coding process with perfection to ensure error free claim submission to insurance carriers. A separate sub group of experienced coders handles the HCC medical coding and their audits. A separate audit team audits all the coding done before the claims are processed.
    We conduct professional; trainings for our coding team to make them aware about the latest changes and updates in the process.

    Provider Credentialing

    Credentialing is the first step to validating that a physician meets the standards for delivering clinical care. Physicians/Providers must credential themselves to get enrolled with the Payer’s network and be authorized to provide services to patients who are members of the Payer’s plans. Credentialing can be a tedious and confusing task for medical providers. Our experienced team can streamline these processes for you and give you peace of mind that all paperwork has been completed accurately and timely. The credentialing process validates that a physician meets standards for delivering clinical care, wherein the Payer verifies the physician’s education, license, experience, certifications, affiliations, malpractice, adverse clinical occurrences, and training.

  • New Registrations/Re-credentialing of an Individual or Group Provider.
  • Provider Data Maintenance - Re-credentialing team maintains the provider’s practice information up to date.
  • Systems Contracting Creation and Maintenance CAQH Attestation.
  • Expirations and Renewals Tracking and Analytics.
  • Provider credentialing is the important part for any provider as to get paid provider need to be credentialed with the payers. If provider is not credentialed, he will not get paid by insurances.

    AccuBills have experienced staff to help new providers in credentialing. Credentialing team have good experience in new provider credentialing and also in resolving old credentialing issues.

    Patient Scheduling & Appointment Management Services

    Our Appointments Scheduling team goes through the provider’s online portal resulting in a smooth pre-registration process and Collection of patient demographics for eligibility and prior authorization requirement.

  • Fixing the schedule based on the provider’s Availability.
  • Direct communication with physicians and patients through the messaging system. Informing patients about the appointment and seeking confirmation.
  • Sending automated reminders to the patient and provider.
  • Insurance Eligibility & Verification

    Receiving patient demographic information from referral sources such as hospital or clinic or from the patient directly.

    Verifying patient information with the carrier.

  • This service includes verification of payable benefits.
  • Co-pays/co-insurances/deductibles.
  • Effective date type of plan and coverage details plan exclusions.
  • Specific coverage.
  • Claims mailing address.
  • Referrals and pre-authorizations.
  • Verifying patients’ coverage on all primary and secondary payers.
  • Updating patient accounts.
  • Communicating with patients and completing paperwork.
  • Demographic Entry

    Patient demographics include identifying information such as name, date of birth, and address, along with insurance information. Patient demographics streamline the medical billing process, improve healthcare quality, enhance communication, and bolster cultural competency. Our data entry team creates an account for the patients in software and enters all the Patient information with precision. While we enter existing patient information team updates the insurance and guarantor information accurately.

    Charges Entry

    Charge entry is the process of assigning to the patient account an appropriate value as per the chosen medical codes and corresponding fee schedule. The reimbursements for the healthcare provider's services are dependent on the charges entered for the medical services performed. Our team has well-developed experience in handling charge entries for different specialties. The charge entry team enters the charge into the client's medical billing system based on specific rules. The team captures all related information from superbills, like locations, authorizations, places of service, ICD codes, modifiers, etc. Well-trained medical billing professionals can send these claims to payers in a timely manner. Our systematic entry process eliminates rejections and reduces denials. That is why outsourcing medical billing ensures greater precision and cost savings for medical billing companies. The pending document will be sent to clients on a daily basis for query clarification. The final charges are audited by the quality team, and clean claims are sent to insurance companies.

    Billing & Rejections

    Denied claims are defined as claims that were received and processed by the payer and a negative determination was made and the rejected medical claim usually contains one or more errors that were found before the claim was ever processed or accepted by the payer. Our Billing experts are knowledgeable about preparing invoices. Our billing experts consider themselves responsible for the submission of claims to insurance companies and also ensure that the payments for medical services are received in a timely manner.

  • Our Billing team Management track and analyze trends in payer denials and rejections. Categorize these denials and rejections and work on how to fix these issues at full tilt.
  • We train billing staff to handle rejections swiftly and provide training on handling denials.
  • Quality experts schedule routine chart audits for documenting quality to identify problems and trends before claims submission.
  • Payment Posting

    Payment posting is one of the most vital steps in the medical billing process, and it is also a crucial component of revenue cycle management. Payment posting allows medical practices to receive full payment in the most expeditious manner possible.

  • Our payment posting team gets a clear insight into insurance payments through EOBs (Explanation of Benefits), Insurance checks through ERAs (Electronic Remittance Advice), and payments from patients. With a large number of payments to be posted every day, an efficient posting process provides a better understanding of the day-to-day financial status. It helps in better flow of cash.
  • Our Payment posting team is closely associated with the denial management team so that any rework/rebilling happen significantly.
  • Account Receivable Follow-up

    Our accounts receivable follow-up team is responsible for looking after denied claims and reprocessing them to receive maximum reimbursement from the insurance companies. There is a massive amount of work to be done before the physician can claim an amount from the insurance firm. So, we have divided an A/R team comprised of two departments -

    A/R Analytics

    A/R Follow up

  • The A/R analytics team is responsible for studying and analyzing denied claims as well as partial payments. Also, if any claim is found to have a coding error, the A/R team corrects it and resubmits the claim.
  • The A/R follow-up team, on the other hand, constantly communicates with patients, healthcare service providers, and insurance firms and takes necessary actions based on their feedback or responses.
  • Denial Analysis & Management

    Managing denials is one of the most important components of the health revenue cycle. When insurance companies are denying an average of 9% of claims submitted, in order to ensure a healthy cash flow, healthcare organizations need to focus mainly on the root cause and denial prevention. A good approach is to understand the different types of medical billing denials, pinpoint the most common billing problems and take steps to avoid them.

    We have the best denial management team that resolves the issue and send the claim for reprocessing. They establish a tendency between the individual payer Codes and common denial reason codes. This trend monitoring helps to uncover weaknesses in the billing, enrollment, and medical coding process that are then corrected to reduce future refusals.

    No-Fault & Worker Compensation

    Our Process:

    We have experienced AR staff to track cases of Motor Vehicle Accidents (MVA) and workers' compensation. They follow up with the claim specialist/adjusters to analyze the status of the bill submitted. They also work on the medical documentation submission and claim to refill. In addition, follow up with the patient are also done to obtain any additional details related to their injury/accident.

    Patient Follow-up & Statements

    We have the best AR follow-up patient calling specialist reaching out to the patients with the mode of soft calling for patient responsibilities, self-pay payments, and insurance verification.

    We generate patient statements and send them to the patients as per the information required by the patient. We follow up and track all the records if they are received by the patient or not.