Proficient Billing Specialists

Why Us?

 

 

 

Eligibility Verification:

 

Eligibility Verification is the most efficient way to eliminate denials. As soon as our team gets the list of scheduled patients they get right to work.

Verification team access payer’s website/portals, AVR systems and also speaks to the Insurance Company’s reps to get the required information.

Our team runs through a standard list of verification questions to confirm the patient’s eligibility and coverage for the services to be provided. This includes coverage limits, effective dates, Co-pays, deductibles, Out of pocket expenses, Referrals & Authorizations.

 

Medical Coding:

 

Our Medical Coding Services provide cost effective, practical procedural and diagnostic coding. Our Coding process results in cleaner claims, fewer denials and enhanced revenue. Correct coding is essential in enhancing revenue and decreasing compliance risk

 

Our team of well experienced professionals strictly follow the guidelines of: 

 

•    National Correct coding initiatives

•    Local coverage decision & Medical Policies
•    Local Medical Review Policies

 

 Our Professionals are well experienced in: 

 

•    CPT, ICD and HCPCS coding

•    Payer specific coding requirements
•    Insurance and governmental regulatory requirements

 

Our Tools: 

 

•    Medical Coding Books

•    On-line Software
•    Desktop Coding Software
•    Continuous on-line Training programs

 

Demographics Registrations: 

 

Our experienced team registers all patients’ information with high accuracy.

•    We ensure to choose the correct Insurance codes from the Insurance master list
•    We choose the correct guarantor information
•    We capture specific information based on the software and specialty
•    We have the ability to make accurate entries looking at scanned images.
•    We also verify and update existing patient demographics information available in the software.

 

Charge Claim Entries:

 

Our team has the ability to do manual charge entry and to auto generate claims from EMR/EHRs after review.

•    We pick the correct number of units, modifiers and Codes.
•    We process charges based on specialty and client specific rules
•    Our posters ensure to link the correct diagnosis to each individual CPT codes for accurate reimbursements.

•    We run internal quality reviews before the claim submission
•    Charge Entry rules are regularly reviewed to minimize rejections and denials

 

Our Cash/Payment Posting:

 

Our Cash/Payment posters have the ability to: 

 

•    Auto Posting from ERAs (Electronic Remittance Advice)

•    Manual Posting from EOBs (Explanation of Benefits)

 

Our Work Flow: 

 

•    Accurate posting of remittances, matching and accounting for every penny:

•    Submission of Secondary Claims
•    Generating Patient Statements
•    Denials Capture
•    Batch Status report to clients

 

Accounts Receivables Management: 

 

Our Accounts Receivable Management accelerates revenue cycles, improves cash flow, reduces receivables and increases collection rates.

 

Proficient Billling Specialists Company’s certified resources ensure effective follow-up with both patients and Insurances. Our working methodology ensures all claims are paid within targeted time frame allotted per payer or by payer category