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Core Competency Presentation Transcription BillingCoding.

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Presentation on theme: "Core Competency Presentation Transcription BillingCoding."— Presentation transcript:

1 Core Competency Presentation Transcription BillingCoding

2 To Provide Healthcare Solutions that are comprehensive, flexible and cost effective, for Physicians, Clinics and Hospitals MissionMission

3 Who We Are RapidCare BPO has associated with Rapid Medical services  Rapid medical services is a 9 - year old healthcare solution provider catering to small, medium and large practices throughout the USA  currently serves 400+ Physicians across all specialties  has a 600+ intellectual resource pool comprising of CMT Certified Transcriptionists, CPC Certified Coders and CMRS Certified Reimbursement Specialists  strictly adheres to HIPAA, HL7 and BS7799 Compliance Standards  operates out of State –of- the --Art facilities with redundancies in power, data, resource and location.

4 Management Hierarchy

5 MT Receive Voice Files from Client Receive Voice Files from Client Transcribe to Text and QC Transcribe to Text and QC Upload to client Cc to MC department Upload to client Cc to MC department MC Receive Transcribed Text Receive Transcribed Text Code the Charts and QC Code the Charts and QC Upload to client Cc to MB department Upload to client Cc to MB department MB Create & Bill Encounter to the Payor Create & Bill Encounter to the Payor Receive payment and reconcile Receive payment and reconcile AR follow-up and Denial Management AR follow-up and Denial Management What We Do

6 Transcription Process  Initial setup of Toll free number / Dictaphone at client location  Client uploads Voice files to dedicated FTP server  Download the files and transcribe  QC on transcribed text by Editors  Copy of completed text files uploaded to client  Another copy is forwarded to the coding department

7 Coding Process  Segregation of the files to the respective coders  Coding is done using CPT, ICD-9 from the transcribed charts  Two tier QC a) Manual QC by Sr. Coders to check for under /over coding b) QC through software to check i) Compatibility of CPT and Dx. codes ii) If code will be Reimbursed iii) Whether the codes are bundled  Procedure Code Analysis done on a monthly basis to check the validity and reimbursement levels of the codes used  The charts are forwarded to the billing department

8 Coding Metrics -Sample Account Manager MARK SAWYERS Team Leader Name Joseph Department / Client TPT Resource Name Document ID/Name HighMediumLow Justin9568-9668001 Max9669-9769102 Peter9770-9870010 Jason9871-9971000

9 Billing Process  The coded charts and demographics are entered into the billing software  A claim is created and transmitted electronically to the Insurance company  Payments are received by the physicians, while the ERA/EOB are scanned to us.  The accounts are reconciled, Secondary Claims generated and Patient statements dispatched  Denied/Unpaid claims are followed up via phone till the payment is received  Monthly Financial summary reports are generated as per the clients requirements

10 Billing Quality Standards  Our 3-tier QA process ensures 99.9% accuracy a) Level -1 : 100% QC check by specialized QC team a) Level -1 : 100% QC check by specialized QC team b) Level -2 : 100% Validation Check by software b) Level -2 : 100% Validation Check by software c) Level -3 : 100% Validation check by clearing House software c) Level -3 : 100% Validation check by clearing House software i) L1 Report – Generated 30 minutes after transmission, which does a validation check before forwarding to the insurance company. i) L1 Report – Generated 30 minutes after transmission, which does a validation check before forwarding to the insurance company. ii) L2 Report – Generated 24 hours after transmission, which serves as an acknowledgement, that the claims have reached the insurance company. ii) L2 Report – Generated 24 hours after transmission, which serves as an acknowledgement, that the claims have reached the insurance company.  We adhere to strict work flow management process, that makes sure there is absolutely no drop in quality standards  We exceed the performance standard guidelines set by http://www.physiciansnews.com/business/1101.html for evaluating the performance of medical billing company. http://www.physiciansnews.com/business/1101.html

11 AR Benchmark Statistics Aging BucketShould Not Exceed 0-3070% 31-6015% 61-9010% 91-1205% Client -IClient-II Actual Acceptable AR%Actual AR Acceptable AR% AR Avg Chg YTD Per Month$183,982.00 $74,312.00 Current$121,016.53$128,787.406.42$33,995.07$52,018.4053 31-60 days$27,223.30$27,597.301.37$5,464.80$11,146.80104 61-90 days$17,839.05$18,398.203.13$3,571.96$7,431.20108 91-120 days$10,217.74$12,878.7426.04$2,537.68$5,201.84105 $176,296.62$187,661.646.45$45,569.51$75,798.2466

12 Ancillary Healthcare Services Eligibility Verification Referral Request Prescription (Rx) Refills Credentialing Appointment Scheduling

13 InfrastructureInfrastructure Training Facilities to train and retain resource pool Well spaced out cabins for distraction free environment State of the Art facility

14 Thank You Eric Ennis: 248-346-3972 Mike Ennis: 248-670-3767 Rajive Saranathan: 586-745-0416 Email: info@rapidcarebpo.com For further Information contact:


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