Systematized revenue cycle management in healthcare is the key to smooth administration for medical practices and hospitals. M.S. Solutions the leading Healthcare BPO Service company delivers comprehensive Healthcare and Medical Revenue Cycle Management Outsourcing Services. Our services range from pre-registration and scheduling of appointments to coding and billing. We also ensure the safety and security of patient information and maximize the efficiency of our clients’ operations. M.S. Solutions have considerable expertise in delivering outsourced healthcare revenue cycle management and guarantees quick reimbursement and well organized administrative processes as a guaranteed outcome.
Our comprehensive range of revenue cycle management services for the healthcare industry include:
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
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.
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.
The coding team of MSS is certified, experienced coders from AHIMA and AAPC, and well versed in HIPAA ethics.
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
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.
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
All the claims were posted and created in 8 hours
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.
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
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
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
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
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
What our denial professionals do
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
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
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
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
M.S.Solutions provide comprehensive medical credentialing for all healthcare providers who are eligible for credentialing with Medicare, Medicaid, or commercial insurance carriers. The health care provider will have a dedicated medical credentialing coordinator who will ensure that all necessary documentation is collected and processed in accordance with each payer. Medical credentialing enables healthcare providers to utilize the patient’s insurance to pay for medical services performed. Hence it is important for healthcare providers to credentialed with most payers depending upon the geographical area. Failing medical credentials results in losing patients to other healthcare providers.
Here are the information needed
MSS’s Provider Credentialing Process
Our Provider Enrollment services enable practices to enroll for the services they provide by ensuring that health insurance payers have the data they need to process the claims for the services provided. We constantly monitor the payers to ensure applications are received and processed on time. We work diligently to identify and resolve potential administrative issues before they impact your provider reimbursements.
Claims Enrollment – Electronic Data Interchange (EDI)
EDI enrollment is required to submit patient claims electronically to payers through a clearinghouse. Our provider enrollment specialists collect the EDI data such as submitter ID, submitter name, etc, and instruction manual specific to the insurance payers requirements from the practice specific clearinghouse. Our enrollment team prepares the documents and completes the EDI enrollments. EDI enrollments are completed in 2-3 business days.
Electronic Remittance Advice (ERA/835)
Enrolling the healthcare provider for ERA transactions is cumbersome because there are several moving targets involved such as clearinghouse, insurance companies, third-party vendors such as CAQH EnrollHub, Instamed, Payspan, Zelis, PNC, ECHO, etc. Our provider enrollment specialists will enroll the healthcare providers in the clearinghouse, insurance, and third-party vendors for ERA transactions which will help the practice by receiving payments faster. We make sure the paper EOBs are stopped within 30 days from the ERA enrollment date which helps the practice to reduce 99% of paper EOBs.
Electronic Fund Transfer (EFT)
Receiving payments in paper checks is medieval. It is time-consuming and creates unnecessary complications to the practice. Our provider enrollment specialists make sure all insurances deposit the money directly in the practice’s bank account. Here is the process to implement EFT.