Medical Coding is the process of assigning standardized codes to specific services, procedures and medications provided to a patient as part of an outpatient or inpatient treatment upon our reviewing the Doctor narration and supportive documentation.
Bringing expertise in to claim submissions drive efficiency and financial results. Health systems benefit from a lower cost and can begin optimizing efficiency and profit from the beginning
Our Resubmission team is experts in rejection review who is having extensive experience in Medical, Billing, Administration and insurance related Guidelines and Policies. The payer rejection through RA will review properly and will apply correct action to justifying the claim and resubmit to the payer and follow-up
Our goal of a prospective audit is to catch any billing or coding errors before the claim is submitted like Medical review, Administration audit, Adjudication review, Policy review and Documentation review.
Medical necessity is based on “evidence based clinical standards of care”. This means that there is evidence to support a course of treatment based on a set of symptoms or other diagnostic results. Not all diagnosis for all procedures is considered medically necessary.
Our expert team will review the denial will engage for an effective communication to the stakeholders
This process will help the facility to map the payment in the system, and the proper remittance Allocation against the claim.
RCM level training to be provided to the new joiners. The training including Insurance details, billing processing, documentation, guidelines, and policies which will help the person to act effectively on the assigned work.
Detailed reporting Data will be provided to the facility in a timely manner. Also customized Dashboard is provided with graphical representation of the report statistics.
A strong and effective CDI program helps ensure that physician documentation accurately paints the patients' clinical picture and thus reflects the integrity of the financial, clinical, and quality outcomes.
Regular training will be provided to the facility staffs including Doctors, nursing and billing and authorization based on our review and Updated Guidelines.
Regular follow-ups made with Payer regarding rejection and payment related issues.
At the time of external audit, whether is a Government Audit, Tasneef Audit or even recover audits from insurance we are there to support the Facility.