Transcript Document

Revenue Cycle Management System
How we do It
Insurance companies aim to benefit more by slowing down the
process at the physician’s expense!
We aim to get you what is rightfully yours!!
DOCTUS is your catalyst, cutting down receivables and accelerating
your cash flow
We approach professionally to overcome the tactics being
used to hold your money by insurance companies !!!
Revenue Cycle Management System
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.
Revenue Cycle Management System
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
Revenue Cycle Management System
How we do It
What we do
 Patient Scheduling
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
Insurance
Revenue Cycle Management System
How we do It
Clearing Houses
For
Electronic Clearance
Hospital
/Doc’s
office
generates
Super bills
•Demo Entries
•Charge entries
•Medical Coding
•EOB’s
•Payment Postings
•Denials
•Claims Submission
•A/R Analysis
•Follow up’s
•Insurance Calling
•Patients Statement
•Patient Calling
•Customer Care
Claims
Insurance
Company
Releasing
payments
Revenue Cycle Management System
How we do It
SCANNING TO INDIA
CLIENT IN US
CODING
ACCESSSING SOFTWARE
PATIENT DEMOGRAPHICS ENTRY
CHARGE ENTRY
QUALITY AUDIT
Paid Claims for
cash application
TRANSMISSION OF CLAIMS THRU CLEARING HOUSES
CASH APPLICATION
Unpaid Claims
For corrective action
AR ANALYSIS / CALLING
CASH TALLYING
ACTION ON DENIALS / REJECTIONS
GENERATION OF REPORTS
REPORTS TO CLIENT
Revenue Cycle Management System
How we do It
Scanning Documents to India
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
Mail to India on Scan date, File name and
directory path.
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.
After Coding, files to be handed over to
Charges Department for processing.
Revenue Cycle Management System
How we do It
Demographics entry
Documents to be sorted Patient wise before entering into
the system
Patient Account Numbering to be done, if system does not
generate automatically
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.
If any clarification is required, send
mail to US office
Revenue Cycle Management System
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
If any clarification required, send
mail to US office.
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 incorrect details found, Charges
department to be informed
Revenue Cycle Management System
How we do It
Quality Check
Quality Audit for Patient Demographics and Charges before
sending batch wise update to client
Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph,
Guarantor, Subscriber details, Employer, etc to be checked
in Patient Demographic File
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
After Quality Audit, files to be given to Supervisor / Manager
for sending Batch Update to client.
Log to be updated with patients checked, charges checked,
correction details, etc
If any incorrect details found,
Charges Team to be informed of
the same and correction done
Revenue Cycle Management System
How we do It
Claim Transmission
Electronic/Paper
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
Revenue Cycle Management System
How we do It
Cash Posting
Checks and EOB(Explanation of Benefits) to be
arranged before doing Cash Posting
Insurance Name, Check #, Total Check Value to
be cross verified with the Check and EOB Copies
In the EOB Copy, Claim#, Date of Service,
Procedure , Units, Charges to be identified
before posting
Application of Payment, Deductible, Co-insurance,
Adjustments, Write offs, etc in the Cash Posting
After Cash Posting, Claim#, Patient Name and Value
to be checked for tallying data with the EOB
Log to be updated with Total Checks, Total
Value, Posted details, Pending details, etc
If any incorrect details found or any details
missing, follow up to be done with
Insurance
Revenue Cycle Management System
How we do It
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.
-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
Doctor’s office.
- we are well versed with using correct appeal procedures in knowing Healthcare Laws and we specialize in
working on old Account Receivables.
Revenue Cycle Management System
How we do It
Skill set
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
Software
•Ambulatory Surgical Centre
•Medic (Misys PM / Tiger)
•Orthopaedics
•MDS
•Pathology
•Excalibur
•ENT
•Medical Manager
•Family Practice
•Med plexus Medisoft
•Paediatrics
•PMC
•Gastroenterology
•Lytec
•Podiatry
•Sequel Med
•General Surgery
•Geysers
•Gynaecology
•Kareo
•Radiology
•Vericle
•Infectious Disease
•NextGen
•Internal Medicine
•Cardiology
.Neurology
•Physical Therapy
.
•IDX
•Healthmatics Ntierprize
•Office ally
Revenue Cycle Management System
How we do It
For further information, please contactPhone : 1-408-625-7222
Fax
: 1-406625-7006
E-mail: [email protected]