Billing & Claims :
Metaphrase has been providing these services for small and large Physician Groups, and single Physician Practices. Our dedicated teams for Coding and Billing are continuously trained and updated with the latest industry standard practices. These services are delivered through our HIPAA Certified back office in Vijayawada, India to accrue the best cost-benefits system.
The Metaphrase Edge
• Experienced Team with hands on experience of dealing with U.S based clients, Insurance Companies and patients
• Customized Reports on the Realization, Disparities in Billing and other reports as requested
• Working closely with patients to assist them with payment schedules and friendly reminders on delayed payments
• HIPAA Trained and Certified Staff & Facility
• Customer-Team Construct: Each Team caters to one major Customer
• A Designated Account Executive for each Client separately to render personalized services
• Optional Integration with your existing Billing Software, Hospital Information System (HIS) and Electronic Medical Record (EMR) tools
• Unique Process Flow to minimize revenue loss to the Practices
Medical Billing and Claims
Medical Billing and Claims Management is the process of submission of bills to the Insurance Company for services rendered by a Medical Practitioner on a patient and ensuring the collection of revenues without any revenue loss. In this connection, Metaphrase has been offering various services that will not only increase the administrative efficiency of the Practice, but will value-add to increase their patient satisfaction.
The services offered are listed below:
• Coding
• Patient Demographic and Charge Entry
• Claims Transmission – Paper & Electronic
• Cash Posting
• Claims Follow up – Insurance & Patients
• Processing of Unpaid claims – Insurance & Patient
• Reports Generation and updates to Physicians / Hospital
• The manpower is trained in each of the above activities and has hands-on experience with US based clients, Insurance companies and patients.
Metaphrase realizes that about 20-25% of the revenue is lost or never recovered by the Hospitals / Clinical Practices as a result of unclaimed bills, no follow up and wrong coding. This is a hard, yet widely acknowledged fact in the Health Care Industry. In such a scenario, it is imperative that appropriate steps are taken to curb this kind of unwanted damage to the revenues. Metaphrase has set up a unique process flow that prevents this kind of revenue loss to the practices. Some important features of the process at Metaphrase are listed below:
Coding: Experienced professionals to handle and verify the CPT, ICD-9 and modifier coding to ensure proper billing.
Patient Assistance: Closely work with your patients and assist them with their payment schedules and friendly reminders on delayed payments.
Database: Build a personal database of all your patients and their billing cycles and update regularly.
Follow up: Follow up with the insurance agencies to help the practice realize the money faster.
Verification: Claim status verification within 24 hours of submission of claims and take appropriate steps to re-submit if required.
Reporting: Send you fortnightly / monthly reports on the realizations and disparities in billing etc.
Security: Keep all the patient related information confidential in line with HIPAA regulations.
Advantage: Maximize the administrative efficacies of the practice while minimizing the expenses.
Personal service: A designated Account Executive for each Client to render personalized service.
Metaphrase ensures that the Practices maximize their revenue & administrative efficiency while minimizing the time loss.
Old Accounts Receivable Clean Up
"Old A/R", are loosely categorized as claims over 90 days old. These cause a significant backlog and burden the manpower of most medical practices.
Many healthcare providers find their practice to be generating reasonable monthly charges but the actual net collections are not being realized. Within a six month duration, it is common to find a provider with excessive amounts in A/R that are older than 180 days outstanding.
Our billing specialists utilize a real-time A/R management program, which literally allows them to work on unpaid claims. Usually the volume of outstanding claims and the time it takes to research, correct, appeal, and re-file the claims will take much longer than expected. A limited number of staff devoted to this task will not be able to accomplish the goal, which is to substantially reduce and eliminate the outstanding A/R and collect as much money as possible in a short period of time.
To overcome on all these problems a thorough, detailed follow-up done by our insurance specialists. We pursue these accounts by assigning a full team of individuals to solve them.
Specialties:
Metaphrase�s expertise and specialized manpower renders Billing/Claims services to Specialties including:
� Cardiology
� Urology
� Nephrology
� Orthopedics
� Radiology
� Obstetrics and Gynecology
� Surgery
� Oncology
� Ophthalmology
� Internal Medicine
� Gastroenterology
� Genitourinary.
Billing & Coding Process Flow
Metaphrase developed a diligent process flow to ensure the following:
� Optimizing the billing & revenue Cycle
� Ensuring adherence to the Billing Guidelines for each specialty
� Recovery of Payments in the Shortest Possible Time frame
� Updating all information to the Hospital/Practice.
Conectivity Process
Documentation at the Front Desk
The patient hands over his insurance card. On the card copy the office manager needs to verify if a referral or pre-authorization needs to be obtained and then contact the respective Primary care physician (gatekeeper) and get this documentation.
Scanning
Demographics, super bills/charge sheets, insurance verification data and a copy of the insurance card i.e. all the information pertaining to the patient, is sent to the billing office.
Billing office scans the source documents and saves the image file to an FTP site or on to their server under pre-determined directory paths. The Scanning department retrieves the files.
Files are sent to the appropriate departments with the control log for number of files and pages received. Illegible/missing documents are identified and a mail is sent to the Billing office for rescanning.
Pre-Coding
Pre-coders then enter the key-in codes for insurance companies, doctors and modifiers. Pre-coders also add insurance companies, referring doctors, modifiers, diagnosis codes and procedure codes that are not already in the system.
Coding
Coding team assigns the Numerical codes for CPT (Current Procedural Terminology) and the Diagnosis Code based on the description given by the provider.
Charge Team
This department would first enter the patient personal information from the Demographic sheets. The relationship of the Diagnosis code and CPT is also checked. Then a charge is created according to the billing rules pertaining to the specific carriers and locations. All charges are accomplished within the agreed turnaround time with the client, which is generally 24 hours.
Audit
The daily charge entry then needs to be audited to cross-check the accuracy of this entry to ensure the billing rules are being accurately and meticulously followed. Also this department verifies for accuracy of the claims based on carrier requirements to ascertain a clean claim.
Cash Application
Cash Applications team receives the cash files (Check copy & EOB) and applies the payments in the billing software against the appropriate patient account. During cash application, overpayments are immediately identified and necessary refund requests are generated for obtaining approvals. Also underpayments/denials are passed on to the Analysts.
Analysis
AR analysts are the key to any group. The claims are researched for completeness, thoroughness and accuracy and work orders are set up for the call center to make calls. AR analysts are responsible for the cash collections and resolving all problems to enable the account to have clean AR.
They also research the claims denied by the carriers, rejections received from the clearing house, Low payment by the carriers and appropriate actions are taken. Analyst reviews for global patterns and bulk problems are solved at one instance.
Calling
This is the hub of activity around which Medical Billing operates, where the caller would call up Insurance and verify if the claim is with the carrier and what is the current status of it. Whether it is being processed for payment or denial, based on his inputs the analyst goes to work, and gets the required pre-requisites needed, in case of payment he would compile a list of payment details or if denied then corrective action needs to be initiated.
Calling team receives work orders from the analysts and initiate calls to the insurance companies to establish reasons for non-payment of the claims. All reasons are passed on to the Analysts for resolution.
Claims Transmission
Claims are filed and information sent to the Transmission department. Transmission department prepares a list of claims that go out on paper and through the electronic media. Once claims are transmitted electronically, confirmation reports are obtained and filed after verification.
Reports
Why Reports?
� Numbers make a tangible difference
� Facilitate interpretations and to arrive at conclusions
� Credibility to work done
� Forecasting Future Collections
� Directing work towards areas of specialization
Insurance Follow-up Summary Reports
These reports tailored to the Client requirements helps us make a summarized presentation of number of claims addressed during the assigned time period, track claims where Client action is pending etc.
Features and Benefits
The purpose of our medical billing services is to maximize the cash flow & profits of your practice. Our medical billing solutions are the single most powerful tool you have in accelerating the cash flow, reducing the expenses & increasing the profits of your practice.
Our main features include:
� All data transfers through FORTIGATE Firewall with dedicated VPN connections
� Latest Anti-Virus Software�s
� High speed internet of 2 MBPS bandwidth with redundancy from 2-different service providers
� Connectivity through two different gateways � to ensure 100% connectivity
� Separate ISDN connection for backup
� Quick adoption to existing Client Billing Software�s.
Our Commitment
Our commitment to serving your health care operation mandates that � regardless of the costs we incur � we invest in any additional resources to ensure that each and every claim is followed up thoroughly. The following services are included in our fees and are provided to you at no additional charges.
� Toll free numbers & patient help line
� Toll free fax numbers
� Patient eligibility verification
� Electronic & paper claim filing
� Secondary & tertiary claim filing
� Payment posting
� Rejected claim resolution
� Aged claim reconciliation
� Comprehensive management reports.
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