claims processing.pdf

8/14/2019 claims processing.pdf

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TRINITYMAGTRINITYMAGTRINITYMAGTRINITYMAG GLOBAL SERVICESGLOBAL SERVICESGLOBAL SERVICESGLOBAL SERVICES

MEDICAL BILLING SERVICESMEDICAL BILLING SERVICESMEDICAL BILLING SERVICESMEDICAL BILLING SERVICES

TrinityMagTrinityMag Global ServicesGlobal Services

BREAKING BARRIERS IN BPOBREAKING BARRIERS IN BPOBREAKING BARRIERS IN BPOBREAKING BARRIERS IN BPO

THROUGH INNOVATIONSTHROUGH INNOVATIONSTHROUGH INNOVATIONSTHROUGH INNOVATIONS


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Welcome to TGS Professional Medical BillingWelcome to TGS Professional Medical Billing TGS is a full service billing center specializing in electronic filing of insurance

claims, patient balance billing, and collection of old receivables. Located inNew Delhi.

TGS PMBTGS PMB

Core Services These services represent the bulk of our daily tasks and are the ones that

provide you with your cash flow. They encompass everything needed tocompletely bill a claim; from the initial superbill to getting your paymentsposted.

Practice Management

These services are comprised mainly of the reporting that is generated fromthe Core Services. They allow you to optimize your collections andultimately increase your cash flow.


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TGS Medical Billing ServicesTGS Medical Billing Services

Medical Transcription

Scheduling

Coding

Fee Schedule

Credentialing of Providers

emograp c uper n ry

Transmission of Electronic & Paper Claims

Payment Posting

Denials Management

AR follow-up on unpaid claims

Follow up Electronic Claims(10 days), Paper Claims(30 days)

Appeal on low payment

Patient Bills

Weekly Reports Top 10 carriers)

Monthly Reports Financial Report)


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Why Outsource to TGSWhy Outsource to TGS

Have You Considered Outsourcing your Medical Billing to TGS Experts?

Outsourcing your medical billing claims can be very profitable for Physicians because iteliminates all the daily expenses associated with Keeping medical billing In-House. It isAceteras responsibility to relinquish these expenses from your

practice enabling you to receive greater profitability.

What Are Some Of The Benefits Of Outsourcing

Shortened insurance payment cycles of 10-14 days

Increased cash flow

Reduced outstanding accounts receivable

Customized reports analyzing your practice Patient Account Management by a highly qualified professional

No need to invest thousands into a new system

No need to train your staff on a new and sometimes complicated system

You save money and time!

Access your patient account information via your own computer

The Expertise

Our Execution Strategy

People Power


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Hourly , Daily

Collect OngoingPerformance Data

Communicate Results

Set Strategic Goal

Collect Performance DataCondition for

Performance Gap

Quality In TGSQuality In TGS

Cycle

Generate Competence /Performance Gap

Track Results

Analyze Performance

Develop KeyPerformance Indicator

Set Performance Target


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INDUSTRY BENCH MARKSINDUSTRY BENCH MARKS

Account Receivables Days > 60 Days

Total Account Receivables - -> 2.5 times of monthlyCharges

Collections - -> 40% of monthly Charges


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Pre-Analysis Analysis Transition Management Ongoing Operations

Key ActivitiesUnderstand clientbusiness needsIdentifyoutsource

Gather documentationIdentify solution andcostingConfirm and validate with

Adapt process planEmulate client processConfirm performancerequirements

Operations acceptsserviceresponsibilityQuality plan put

TGS Forging Ahead

opportunitiesAssessrequirementsReviewenvironmentConfirm viability

clientPrepare processimplementation plan

Customer acceptance into effectSLA acceptance

Location Offshore Offshore Offshore Offshore

Timeline 2 weeks 2 weeks 3-4 weeks Ongoingengagement

ResponsibilityClient functionalmanagersAceteraFunctional

specialists

Client functional managersAcetera analysis team

Client functionalmanagersAcetera transition team

Client operationsteamAcetera servicedelivery head


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TGS has experience of 5 plus years in the Front Office / BackOffice Medical Billing / Practice Management Industry.

The staff at TGS have worked with most of the states along theeastern as well as the western coast of the US.

CAPABILITIES

Keeping abreast of the changes in guidelines for billingvarious carriers through participation in Medical BillingForums, subscribing to Manuals and Bulletins from InsuranceCompanies.

TGS has a comprehensive training schedule for bothexperienced as well as fresh candidates. We always maintaina bench strength so that the day to day routine of the clientsdo not suffer at any point.


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Specialties

Radiation Therapy Obstetrics

Ambulatory Surgical Centre Orthopaedics

Pathology ENTFamily Practice Pediatrics

Gastroenterology Podiatry

General Surgery Psychiatry

SKILL SETS

ynaeco ogy a o ogy

Infectious Disease Internal Medicine

Cardiology Neurology

Oncology & Hematology Physical Therapy

Software

Medic (Misys PM / Tiger) EMDS Excalibur

Medical Manager Medplexus Medisoft

PMC Lytec SequelMed

Geysers Kareo Vericle

NextGen


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EXPERIENCEEXPERIENCE

We have staff who have physical hands on offsite experienceof working with group practices in various states for morethan 5 years.

,

Internal Medicine clients in the State of Maryland.

We have onsite experience in the following domains

Scheduling of Appointments

Front OfficeAll the processes in Medical Coding / BillingLiaisoning with Software CompaniesData Migration from one software to another


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Modules in Medical BillingModules in Medical Billing

Flow chart of Medical Billing Process of Medical Billing

Scanning Department

Coding dept

a en emograp cs

Superbill / Charge dept

Quality dept

Transmission dept

Payment posting dept

Insurance Follow up / Analysis

Patient Analysis

Month End Reports


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FLOW CHART OF MEDICAL BILLING


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ACCESSSING SOFTWARE

PATIENT DEMOGRAPHICS ENTRY

CHARGE ENTRY

QUALITY AUDIT

PROCESS - MEDICAL BILLING

Un aid

CLIENT IN US

SCANNING TO INDIA

CODING

REPORTS TO CLIENT

MIS / GENERATION OF REPORTS

ACTION ON DENIALS / REJECTIONS

TRANSMISSION OF CLAIMS THRU CLEARINGHOUSESPaid Claims forcashapplication

ClaimsForcorrectiveaction

CASH APPLICATION AR ANALYSIS / CALLING

CASH TALLYING


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US Office scans Patient Demographics,Charge Sheets, Insurance Card Copies, etc.

Scanned copies would be saved as *.TIF(Tagged Image Format) file and placed in FTP

Site

SCANNING DOCUMENTS TO INDIA

Mail to India on Scan date, File name anddirectory path.

In the FTP Site, Files would be placed in thecommon path which can be accessible by India


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MEDICAL CODING

Log to be maintained with File name, Totalcharges, Specialty details, etc beforeCoding.

Coding of Diagnosis to the utmosts ecificit usin ICD-9 CM Manual.

Coding of Procedures by referring toCPT / HCPCS / ASI Manuals

After Coding, files to be handed over toCharges Department for processing.


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PATIENT DEMOGRAPHICS

Patient Account Numbering to be done, ifsystem does not generate automatically

Documents to be sorted Patient wise beforeentering into the system

, , , , ,

Employer, Home Ph, Work Ph, Guarantor,Marital Status, Subscriber details, Doctor#,Insurance information etc to be entered inthe system

After entering, printouts to be taken anddata to be checked

Log to be maintained with Total Patients,Patients entered, Pending details, etc.

any c ar cat on s

required, send mail to USoffice


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CHARGE ENTRYPatient Demographics and Coding tobe done before entering Charges

Charge File to be sorted by Patient/ Date of Service

Patient #, Doctor # , Place of Service, Type ofService, Date of Service, Procedure Code,Diagnosis Code, Modifier, Units, Value, Referral ,Prior Authorization, On Bill comments, etc. to beentered in the system

If any clarificationrequired, send mail to USoffice.

After entering data, file to be given toQuality Audit for checking

After checking and corrections, Claims tobe transmitted.

After Transmission, Charges completion

details to be sent to US office.

If any incorrect details

found, Charges departmentto be informed


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QUALITY AUDIT

Quality Audit for Patient Demographics andCharges before sending batch wise update toclient

Patient #, Name, Address, SSN, DOB, Home Ph,Work Ph, Guarantor, Subscriber details,Employer, etc to be checked in PatientDemographic File

After Quality Audit, files to be given toSupervisor / Manager for sending Batch Updateto client.

If any incorrect detailsfound, Charges Team to beinformed of the same andcorrection done

Date of Service, Procedure Code, DiagnosisCode, Modifier, Units, Value, Place of Service,Type of Service, Referral, Prior Authorization,On bill comments, Location, etc to be checked inCharges File

Log to be updated with patients checked, charges

checked, correction details, etc


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TRANSMISSION

Electronic / Paper

After Quality Check is through, Listof Electronic Claims to be separated

Transmission processes to beaccurately followed to avoidrejection

Claims to be transmittedelectronically through Fast claim,

Envoy, Halley, Navicure , Emdeon,Availityetc.

After transmission, log to be updated

with patient #, claim#, total claimstransmitted, pending claims, etc.

Send mail to Charges departmentafter completion of Transmission

If any incorrect details

found, Charges departmentto be informed


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INSURANCE FOLLOW UP

TREATMENTELIGIBILITY

COVERAGEINFORMATION

CONTRACTINFORMATION

DENIALREASONS

INSURANCEFOLLOW UP

CARRIER FEESCHEDULE

CLAIM STATUS

PAYMENTDETAILS

PROVIDERINFORMATION


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INSURANCE ANALYSIS

Claims pendingfor additionaldetails required

Claims not inthe Insurancesystem

Claims rejectedby Insurance

Claims deniedby Insurance

Claims pendingafter 30 days

Log to be updated with details ofPatient#, Name, Claim#, Value,Insurance reasons etc

Analysis and actions to be carriedout for resubmitting the claims

Claims to beprinted againand sent toinsurance

Claims to becorrected forrejections andresent to Carrier

Claims to becorrected fordenials andresent to Carrier

AR to follow upwith insuranceand get theclaim status

Information tobe faxed or sentthrough courierto the insurance


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PATIENT FOLLOW UP

TREA

TMEN

T

ORM

ATION

COVERAG

E

INFORM

ATII

PAYMENT

INFO

RMATION

PERS

ONA

L

INFO

RMA

TION

PATIENT


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PATIENT ANALYSIS

Bills returned due toincorrect address

No correspondencefrom patient

Patients givingwrong information

Patient Bills would be sentmonthly once and three times tothe patient.

Log to be updated with details ofPatient#, Name, Balance, Bills sentdetails

AR will follow up with thePatient for getting payment from

him

If Patient does not pay or respondproperly even after 90 days, hisaccount would be moved toCollection Agency.


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Doctor

AuditRecap

Patient

MONTH END REPORTS

Month-end

FinancialReports

nanc a

ServiceAnalysisReports

Financial

Aged AR


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REQUEST FOR INFORMATIONREQUEST FOR INFORMATION

We request to answer the following questions so that we can plan

our transition / migration and business process.

1. Volume of Business

2. Current AR

3. Total # of Providers in the Group4. Payer Mix

5. Software being used

6. Specialty

7. State in which the practice is located

8. MIS Reports of Last Month End and Year End

9. Clearinghouse being used

10. Access to your system for viewing Master Data


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Looking forward for a long termassociation with you.

San Francisco Bay Area

3940 Freedom Circle.

Santa Clara, CA -95054

Phone No : 408-200-7468

Los Angeles Area

200 Continental Blvd.

El Segundo, CA 90245

TrinityMag Global Services

E-74, 1st Floor, Bharat Nagar

New Friends Colony, New Delhi-110025

(646) 810 1148

E-mail: [email protected]

claims processing.pdf

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