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R evenue C ycle M anagement S ystem How we do It How we do It Insurance companies aim to benefit more by slowing down the process at the physicians expense!

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Presentation on theme: "R evenue C ycle M anagement S ystem How we do It How we do It Insurance companies aim to benefit more by slowing down the process at the physicians expense!"— Presentation transcript:

1 R evenue C ycle M anagement S ystem How we do It How we do It Insurance companies aim to benefit more by slowing down the process at the physicians expense! We aim to get you what is rightfully yours!! We approach professionally to overcome the tactics being used to hold your money by insurance companies !!! DOCTUS is your catalyst, cutting down receivables and accelerating your cash flow

2 R evenue C ycle M anagement S ystem How we do It How we do It Profile Driven by People, Process and Technology, Doctus USA consistently provides quality motivated solutions and compounding value to our clients through outsourced Healthcare Administrative Support Services. The Doctus Team of trained and experienced professionals has actively serviced the North American medical markets for more than 7 years and is highly specialized in Medical Billing, Receivables Management, Indexing, Transcription and Digitization Services. With North American based Management and world class domain knowledge in healthcare, enabled support services, software development and application delivery, Doctus are the trusted partner to several North American clients.

3 R evenue C ycle M anagement S ystem How we do It How we do It Our team Our employees are our key players. They understand our clients demands and expectations and this allow us to guarantee service levels which is unmatched in the industry. Our billing team consists of- - Professional Coders certified by American Academy for Professional Coders (AAPC) - Billing Specialists with experience in handling diverse specialties. - Experienced AR Analysts and Denial Management Specialists

4 R evenue C ycle M anagement S ystem How we do It How we do It Patient Scheduling & Insurance Eligibility Verification Medical Coding Medical Billing Patient Registration Charge Posting Claims Transmission Payment Posting Statement Processing Denial Management Accounts Receivable Insurance follow-up Patient follow-up What we do

5 R evenue C ycle M anagement S ystem How we do It How we do It Hospital /Docs office generates Super bills Hospital /Docs office generates Super bills Insurance Company Releasing payments Insurance Company Releasing payments Clearing Houses For Electronic Clearance Clearing Houses For Electronic Clearance Demo Entries Charge entries Medical Coding EOBs Payment Postings Denials Claims Submission A/R Analysis Follow ups Insurance Calling Patients Statement Patient Calling Customer Care Demo Entries Charge entries Medical Coding EOBs Payment Postings Denials Claims Submission A/R Analysis Follow ups Insurance Calling Patients Statement Patient Calling Customer Care Claims

6 R evenue C ycle M anagement S ystem How we do It How we do It ACCESSSING SOFTWARE PATIENT DEMOGRAPHICS ENTRY CHARGE ENTRY REPORTS TO CLIENT QUALITY AUDIT GENERATION OF REPORTS ACTION ON DENIALS / REJECTIONS TRANSMISSION OF CLAIMS THRU CLEARING HOUSES CASH APPLICATION AR ANALYSIS / CALLING CASH TALLYING CLIENT IN US SCANNING TO INDIA CODING Paid Claims for cash application Unpaid Claims For corrective action

7 R evenue C ycle M anagement S ystem How we do It How we do It Mail to India on Scan date, File name and directory path. 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 In the FTP Site, Files would be placed in the common path which can be accessible by India Scanning Documents to India Medical Coding Log to be maintained with File name, Total charges, Specialty details, etc before Coding. Coding of Diagnosis to the utmost specificity using ICD-9 CM Manual. Coding of Procedures by referring to CPT / HCPCS. Coding of Procedures by referring to CPT / HCPCS. After Coding, files to be handed over to Charges Department for processing.

8 R evenue C ycle M anagement S ystem How we do It How we do It Patient #, Name(LFM), Address, SSN, Sex, Employer, Home Ph, Work Ph, Guarantor, Marital Status, Subscriber details, Doctor#, Insurance information etc to be entered in the system After entering, printouts to be taken and data to be checked Log to be maintained with Total Patients, Patients entered, Pending details, etc. Patient Account Numbering to be done, if system does not generate automatically Documents to be sorted Patient wise before entering into the system If any clarification is required, send mail to US office Demographics entry

9 R evenue C ycle M anagement S ystem How we do It How we do It Charge Entry Patient Demographics and Coding to be done before entering Charges Charge File to be sorted by Patient / Date of Service Patient #, Doctor #, Place of Service, Type of Service, Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Referral, Prior Authorization, On Bill comments, etc. to be entered in the system After entering data, file to be given to Quality Audit for checking After checking and corrections, Claims to be transmitted. After Transmission, Charges completion details to be sent to US office. If any clarification required, send mail to US office. If any incorrect details found, Charges department to be informed

10 R evenue C ycle M anagement S ystem How we do It How we do It Quality Audit for Patient Demographics and Charges before sending batch wise update to client After Quality Audit, files to be given to Supervisor / Manager for sending Batch Update to client. If any incorrect details found, Charges Team to be informed of the same and correction done Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Place of Service, Type of Service, Referral, Prior Authorization, On bill comments, Location, etc to be checked in Charges File Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph, Guarantor, Subscriber details, Employer, etc to be checked in Patient Demographic File Log to be updated with patients checked, charges checked, correction details, etc Quality Check

11 R evenue C ycle M anagement S ystem How we do It How we do It After Quality Check is through, List of Electronic Claims to be separated Transmission processes to be accurately followed to avoid rejection Claims to be transmitted electronically through different clearing houses After transmission, log to be updated with patient #, claim#, total claims transmitted, pending claims, etc. Send mail to Charges department after completion of Transmission If any incorrect details found, Charges department to be informed Claim Transmission Electronic/Paper

12 R evenue C ycle M anagement S ystem How we do It How we do It If any incorrect details found or any details missing, follow up to be done with Insurance Log to be updated with Total Checks, Total Value, Posted details, Pending details, etc After Cash Posting, Claim#, Patient Name and Value to be checked for tallying data with the EOB Application of Payment, Deductible, Co-insurance, Adjustments, Write offs, etc in the Cash Posting In the EOB Copy, Claim#, Date of Service, Procedure, Units, Charges to be identified before posting Insurance Name, Check #, Total Check Value to be cross verified with the Check and EOB Copies Checks and EOB(Explanation of Benefits) to be arranged before doing Cash Posting Cash Posting

13 R evenue C ycle M anagement S ystem How we do It How we do It -Within 24 Hours on receipt of EOB Denied claims are worked on, rectified and resubmitted. -EOB is posted on the same day and All Denials which require additional documentation, are sent to the Doctors office. - we are well versed with using correct appeal procedures in knowing Healthcare Laws and we specialize in working on old Account Receivables. Denial management -Our A\R and Denial Management Specialists receive extensive training in AR follow-up. -Aggressive follow-up starts 21 days after claim submission. - - Our Specialists are chosen for their analytical skills and are provided with access to all the documentation required to make sure that the claim is paid on the first call.E.g. When the Insurance rep says that the claim lacks authorization number, our Specialists are taught to immediately retrieve the authorization number from our database and fax it while they are still on the call.

14 R evenue C ycle M anagement S ystem How we do It How we do It Skill set Software Medic (Misys PM / Tiger) MDS Excalibur Medical Manager Med plexus Medisoft PMC Lytec Sequel Med Geysers Kareo Vericle NextGen IDX Healthmatics Ntierprize Office ally We expertise in most of the billing softwares. However, its is defined by our clients. We also use remote desktop applications or web based softwares. Specialties Radiation Therapy Obstetrics Ambulatory Surgical Centre Orthopaedics Pathology ENT Family Practice Paediatrics Gastroenterology Podiatry General Surgery Gynaecology Radiology Infectious Disease Internal Medicine Cardiology..Neurology Physical Therapy

15 R evenue C ycle M anagement S ystem How we do It How we do It Phone : Fax : For further information, please contact-


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