Medical coding is a crucial part of revenue cycle management which should be precise in all aspects of a patient’s healthcare information. It is a transcription of patient healthcare services such as procedures, diagnosis, and equipment into standardized universal acceptable alphanumeric codes. Medical codes translate the medical service documentation as follows

1. Patient’s diagnosis and injury as ICD-10 codes
2. Medical services, treatments, and procedures as CPT codes
3. An unexpected medical condition or distinct procedure can be distinguished by updating Modifiers

Medical coders review the patient’s clinical documentation from providers which illustrates the patient’s past medical history, diagnosis, prescription, plan, and treatment given is transformed to the set of qualified codes. Coders ensure that the codes used are standardized as each insurance payer has its own guideline for coding. Each code describes the patient’s medical condition and services provided, so the accuracy of coding is essential as it affects the status of the claim. MSS employees certified medical coders who interpret the patient’s charts. Some of our employees are double certified coders. MSS’s medical coding professionals have wide knowledge in scrutinizing the patient’s medical records and assigning appropriate codes. Moreover, MSS’s medical coders will recognize private payer policies and government regulations for accurate and compliant coding. We have successfully coded vascular access centers, anesthesia, interventional cardiology, general surgery, urgent care, emergency medicine, etc.

Leadership
The leadership of the Medical Coding & Scribing operations team of MSS has a combined experience of 17 man-years and are themselves certified coders from AAPC and AHIMA. The coding management team has a diverse and rich experience in initiation, transition and on boarding of a variety of projects from various coding specialties.

Coding executives
The coding team of MSS is certified, experienced coders from AHIMA and AAPC, and well versed in HIPAA ethics.

Coding/Scribing specialties
MSS coding team specializes in Diagnostic Radiology, Interventional Radiology and Cardiology, E/M coding (Inpatient, outpatient, ED), General Surgery, Ambulatory Surgery, Pathology & Laboratory, Anesthesia coding for providers and HCC coding for payers.

WHY MSS CODING & SCRIBING SERVICES
QUALITY:

1. MSS employs a team of certified auditors who do a quality check on up to 8% of the total coding/scribing output from the coders/transcriptionists.
2. TAT (Turn-around Times): MSS has a proven track record of abiding by the Turn-around Times for coding output as per the SLA reached with the clients
3. CDI (Clinical Documentation Integrity): We also provide timely feedback, as appropriate, to Providers on improving clinical documentation for optimal reimbursement and HIPAA compliance

Charge capture plays a crucial role in Medical billing. Charge capture or charge entry is a process of creating a claim for a service rendered by the provider to the patient. A claim is the most important aspect for getting reimbursements. Even a minor mistake in charge capture impacts the entire outcome. MSS gives high importance for accurate charge posting in order to submit clean claims.

MSS’s goal is to get paid at the very first submission and the team relentlessly pushes harder to achieve a higher first–pass rate of claims. We are experienced in various Practice Management Systems and various medical specialties. We have predefined rules in charge entry for different medical specialties, which reduces the room for errors and contributes to clean claims.

1. Charges entry includes the following
2. Charge or Superbill files posting
3. Patient demographics entry and verification
4. Patient eligibility verification
5. Claims creation
6. Missing charges reminders

Charge entry file downloads

MSS will download the charge entry files from several file sharing applications such as Dropbox, Google Drive, PMS, FTP, Email, Fax etc. If the client prefers MSS will train them to upload the files in their own practice management system.

Patient demo entry, data and eligibility verification

1. All new patients information such as patient, guarantor, Insurance information are entered
2. All existing patient information is verified and updated
3. All non-office patients, demographics verified by logging into hospital or facilities portal
4. MSS verifies patients insurance ID, name, address of the insurance, group name, group number, effective date, termination date, the name of the insured, date of birth and the relationship of the insured to the patient
5. MSS verifies coverage for primary, secondary and tertiary payers by utilizing payer websites, automated voice response systems and calling
6. All self-pay and indigent patients are checked for Medicaid and other possible insurances eligibility

Claims creation
All the claims were posted and created in 8 hours

1. Charges are entered in PMS based on specialty specific CPTs and ICD 10 rules
2. Handwritten diagnosis and procedures are analyzed to find the appropriate ICD-10 and CPTs
3. Handwritten hospital patients’ diagnosis are cross checked with the patients progress notes by logging into the hospital portal for accuracy
4. Using appropriate modifiers, mapping, linking CPT and ICD 10 codes etc., to avoid denials
5. Educating providers of any obsolete or deleted CPT’s
6. Precertification numbers for non-office patients are requested through fax and calling the facility before the claim is created
7. Email request to the practices regarding missing Diagnosis, CPTs, DOS, etc.

Missing charges reminder
It is very important to submit claims to the insurance within the filing time limit period. Delay in the charge entry directly impacts the reimbursements.

1. Weekly reminders to the provider regarding missing charges
2. Weekly reminders to providers on incomplete office progress notes.

All charges entered by the charge entry team are checked by the checking team for errors. Checking team collects data on common errors and fixes systemic problems that affect payment delays and bad debt. This long term perspective improves the collection rate and helps to protect future cash flows by fixing problems that affect the patient-provider relationship. Most of the claims error happens in the charge entry phase. MSS’s checking team service is unique because we strive to eliminate problems before they happen. All claims are reviewed for errors and risk of denial before claim submission.

Maintain a review log for billing claims
The most common rejection reasons are logged. The accumulated rejection reason logs help us to track rejection trends. MSS monitors and evaluates these trends in order to resolve the problems that are causing the medical claim denials and rejections. This way practices get increased revenue through reimbursements and reduce the risk of future claims rejections.

Eligibility, Referral and Pre-cert Verification

1. Patient’s insurance coverage are verified for primary and secondary payers
2. Verifications are done by call and online portal
3. Referral required patients are identified before the appointment and alert is created in PMS to alarm the front office on the appointment day
4. Weekly report and remainders on referral missing patients
5. Precertification and Pre-Auth are obtained by calling, faxing and emailing hospital, facility and insurance portals
6. Missing precertification claims are followed up every week
7. Weekly Email reminders sent for prior authorization missing claims

MSS submits all claims electronically within eight hours from the encounters or charges received. Electronic claim submission speeds up claim processing in medical billing. The clearinghouse provides a confirmation that the claims have reached the payer on time. Electronic claim submission reduces rejections and denials drastically. MSS submits claims electronically to almost all clearinghouses and is familiar with the clearinghouse portals. Many payers have very strict claim filing time limits. Electronic claim filing helps to stay on time and enhance cash flow. Before the claims are submitted the following checks are made

1. Appropriate modifiers are added to the CPTs
2. High specificity diagnosis are added by cross-checking the progress note
3. Reminders sent to providers before electronic claim submission if the claims are created without the completion of progress note

Clearinghouse Rejections and Batch Checking

Clearinghouse generates payer acknowledgment and rejection reports for every claim batch submitted. These reports are analyzed line by line and erroneous claims are fixed and resubmitted. These reports help us to improve operational efficiency. Electronic claims submitted are commonly scrubbed for the payer, specialty, and coding rules. MSS works on rejected claims immediately and resubmits them with required corrections. After submitting the claims electronically batches are checked in the clearinghouse portal to confirm if the claims are accepted by the payer and clearinghouse.

Medical records request and submission

1. Medical records requested by the payer are downloaded directly from the hospital portal rather than relying on the practice
2. Medical records are submitted directly through the insurance portal to save time
3. All worker compensation claims are submitted with medical records in the first submission
4. Separate invoices are created for attorney offices requesting medical records. Medical records are sent after the payment received from the attorney offices
5. Weekly reminder sent to the provider to complete unsigned medical records

Accuracy in payment posting in medical billing is imperative for an optimized revenue cycle. Once payments are posted to patient accounts each denial is addressed separately. Rejected claims, late payments, and untimely patient statement submission can eventually lead to a huge loss for healthcare practices. MSS handles the payment posting in medical billing according to client-specific rules that would indicate the cut-off levels to make adjustments, write-offs, refund rules, etc.

ERA and paper EOB posting

Electronic remittances typically contain a high volume of payment transactions. The processing of ERA batches involves loading the files into the practice management system, processing exceptions from the batch run by making corrections using the functionality available. Payment data from scanned images of the Explanation of Benefit (EOB) document are captured line by line and posted to the respective patient accounts. MSS develops practice/physician specific business rules to ensure accurate payments, adjustments, write-offs, and balance transfers are posted correctly. Here are our salient features

1. ERAs are posted on the same day it is received
2. Sequestration and MIPS penalty are posted in separate adjustment code
3. 835 files are directly downloaded from Payspan, PNC, Zelis, Echo, Redcard, JP Morgan, Optum, etc into PMS for small insurances such as USAA, Aetna continental, etc
4. EOBs are posted in 8 hours
5. Paper checks cashing details are verified with providers and Insurances
6. Downloading paper EOB files from Dropbox, PMS, FTP, Fax, Email, etc
7. Practice employees are trained to upload paper EOBs and Medical records
8. MSS does electronic payment posting into the medical billing software and handles the exceptions (fallouts) manually to make sure no payment is missed. Missing ERA’s are traced
9. MSS certified coders analyze the Medical records for claims which are down coded due to lack of documentation and suggest appropriate codes to the providers
10. Continuous monitoring of payee address in ERA’s/EOBs
11. Uncashed checks or checks sent to incorrect addresses are rectified
12. Every year fee schedules are updated depending upon Medicare, Medicaid, Commercial and Self-pay allowed fee schedule to reduce contractual adjustments
13. Every week missing paper EOB reminders sent to the providers
14. Refund letters are analyzed and emailed to the provider to mail the check to the payer
15. Educating the providers frequently regarding obsolete ICDs, CPTs, Insurance reimbursement policies, etc
16. Payments deposited in the bank are reconciled for discrepancies
17. Weekly charges and payments report are texted to the providers
18. Monthly payment reports Emailed to the providers
19. Custom year-end reports send to the practice to inform the practice production, collection, and outstanding account receivable
20. Payer paid amount is compared with accountable care organizations (ACO) fee schedule to make sure the provider is paid according to the ACO/payer contract
21. Adjustments and denials are adjudicated properly which helps patients understand their responsibility​

Denial management is a vital component in the medical billing process. Denial management in medical billing is to investigate every unpaid claim and appeal the rejected claims. It demands extensive knowledge and timely execution. MSS have a well-experienced team of denial management professionals trained to identify the root cause of expensive denials. MSS can handle denial efficiently and in a timely manner to minimize denials reimbursements. MSS corrects and resubmits the claims and files an appeal towards deemed medically not necessary claims. The appeal letter is sent to retreat the payer for their mistakes and make them clarify why the original processing of the claim was incorrect. Systematic tracking of denials will collect data back to the billing process to prevent future denials of the same nature, thus ensuring first submission acceptance and payment of claims. The Denial Management team helps you to take control of your denials and accelerate reimbursements.

Denials occur because of

1. Inaccurate or Incomplete Insurance information
2. Absence of Pre-Authorization number
3. Filing claims after the allowed time frame
4. Credentialing and non-enrollment errors of the provider
5. Medically necessity of patient

What our denial professionals do

1. Examining the volume of denials and analyse them
2. Reckon denials not meeting the deadlines and claim age
3. Statistically estimating denials based on payers, CPT codes and ICD 10 standards/HIPAA regulations
4. Grouping the denials by coding and CPT/HCPCS
5. Preparation of a comprehensive denial management report
6. Systematic approach of tracking and managing claims denials
7. Reduce denial backlogs and apply best practices to reduce denials overtime
8. Work with payers to revise or eliminate contract requirements that lead to denials and appeal
9. Prevent future claims denial by reconciling missing patient information with existing records
10. Denied claims are appealed to reverse the payer decision such as fee schedule, no pre-authorization & pre-cert (extenuating circumstances), filing time limit, Medically necessity denial, etc
11. Focus on appealing claims that bring the highest amount of revenue than the provider adjustment
12. Claims-related alerts activation to inform particular denials. Creating awareness to the health care providers by sharing information about unpaid denial issues

Any payments due from payers, or other guarantors are considered AR in medical billing. It is crucial for healthcare providers and private practices to track the claims they submit to insurance companies to optimize revenue recovery and increase the revenue. The goal of AR in medical billing is to achieve the shortest collection period possible.

MSS follow-up on the claims in 30 working days from the claim submission date

1. Claims never go missing
2. Minimize time for outstanding accounts
3. Shrink account receivables by 45 – 60 days
4. Claim denials can be followed up
5. Helps in recovering overdue payments
6. Recovering claims kept pending for information

AR Follow-up and analysis process
Account receivable team regularly follows-up with the insurance company to know the claim status on the 30th day from the claim submitted date

1. Claim inquiries are done efficiently by live chat, secure email, Insurance calling and secure message on insurance portal
2. Claims needed resubmission are checked for all necessary documents such as Medical records, referral, prior authorization etc.
3. Unpaid VA claims are followed up by submitting medical records and resubmission every 45 days
4. MSS conducts frequent AR analysis to compile all claim details to initiate corrective actions for non-payments
5. Insurance claims pending because of COB, Pre-existing conditions etc are followed up aggressively, every week
6. Every week Account receivable aging reports are compared with previous weeks to identify:

• Unpaid Claims
• Low Paid Claims
• Denied Claims
• Rejected Claims
• Claims not on file

Reports

Medical billing reports can help healthcare providers to understand the health of the practice. MSS’s reports are customized depending upon the practices requirements. The reports are shared with the health care provider daily, weekly, monthly and yearly. Reports can help to understand how the practice is performing based on several revenue metrics. MSS offers a number of customized reports, including, but not limited to

1. Charges and payments summary – This report will help the healthcare provider to understand if there is any increase or decrease in payments
2. Insurance collection report – This report will help the healthcare provider to find in which insurance bucket the practice have maximum number of patients
3. Patient collection report – This report will help to find how much the practice collected from the patients
4. CPT Production report – This report will help the healthcare providers to analyse the services completed by number of units and compare it with each facility or provider
5. Visit comparison report – Healthcare providers can identify number of new patients visits and compare it with previous month or with other facilities
6. Account receivable aging report – The practice/healthcare provider can identify how much money is out there in the pipeline grouped by each insurance and patients
7. Provider/Payer/Facility/CPT wise AR report – This report will help the practice to identify how much the insurance account receivable grouped by provider, payer, facility, CPT etc
8. Coding analysis report – This report analyses the number of office visits, hospital visits and other CPTs.
9. Dialysis visit comparison report – This is specific to Nephrology practice which helps the healthcare providers to identify the dialysis visit count and compare it with previous month or with each dialysis facilities
10. Payer mix summary report – This report shows the payer mix by their volume over a period of time (charge, payment and patient count)
11. Adjustment detail report – The healthcare provider can see how much amount is contractually adjusted and written off
12. Payerwise payment comparison report – This report will help the healthcare provider to find which insurance pays the maximum of payments.
13. Incomplete progress notes report – This report will remind the healthcare provider to complete the progress notes on time
14. Preauth/Referral claims report – This report will remind the healthcare provider to obtain the precertification/authorization and referrals from other facilities and practices

Most of the healthcare practices fail to maintain the correct patient balance. Patient statement service is a crucial part of a practice. Here are the services we offer to keep the patient account receivable low

1. Most of the patient balances past due need a simple reminder to collect the balance
2. Almost 56% of patients delay paying their Medical Bills. MSS calls each patient to remind about the balance
3. MSS’s patient statement team finds the correct address for all patient statements which are “return to sender” and resent them on time
4. MSS check’s retroactive insurance every month for uninsured/self-pay patients to check if the patient got Medicaid or any other insurances to cover the service rendered
5. MSS’s patient statement team send statements immediately after posting insurance payments and handles inbound patient calls clarifying billing questions
6. MSS engages patients in digital channels by sending eBills which helps the practice to receive the payments faster
7. MSS collects payments from patients by web, phone, paper checks, etc