Medical Billing and Collections
ECMCI provides end-to-end medical billing and collection services for Medical Facilities and Hospitals from preparation and submission of claims to government agencies, commercial insurance companies and family of the patients, to payment application and reconciliation, to follow-up and collection of problem claims until payment is collected.
We have the required experience, the necessary technology and resources, plus the economy of scales to perform the billing and collection functions for your facilities effectively and efficiently at a fraction of your in-house cost.
Our experienced Medical Billers review patient demographics and treatment records to ensure billing accuracy; translate the associated charges into the custom billing format required by the respective payers and transmit the claims electronically to the payers to expedite billings; closely monitor the payment status of submitted claims and promptly analyze, correct and resubmit rejected claims to maximize collection. ECMCI’s medical billing and collection outsourcing services maximize our client’s revenue, lower their billing costs, improve their cash flow and allow our clients to focus on providing the best medical services to their patients.
Patient information and treatment records can be scanned and sent to ECMCI’s processing center through email or upload to our billing system directly through EDI.
Our billing specialists review patient demographics, summary of treatment and medical charts to ensure all proper documentations are in place and to determine the optimum level of service to bill the payers to maximize revenues.
Once the procedure and diagnosis codes are determined, our billing specialists translate the services into billable codes, such as Current Procedural Terminology and ICD-9-CM codes, as per Government or Private Insurance requirements for claims processing and transmit the claim to the payers electronically either directly through Electronic Data Interchange or via a clearinghouse to maximize billing speed and minimize errors.
We cross-check all census data on government websites and verify with medical claim adjusters from insurance company on treatment authorization to ensure patient eligibility.
We recognize the importance of preventing mistakes before they happen in order to prevent insurance claims from getting held up or denied. We practice extreme caution and diligence, through multiple levels of review by our experienced billers, in detecting and eliminating errors before a claim is submitted to minimize rejection.
We diligently monitor the payment status of submitted claims; meticulously apply and reconcile payments received; promptly follow up on problem claims to ensure all billings and appeals are completed within specified period of time before the claims are disqualified; and work closely with collection agencies to maximize collection.
We provide regulation education to our staff and set clear guidelines for our billing and collection operation to ensure compliance with all government regulations.
All records are hosted on secured and synergistic servers and are available for review by authorized facility personnel on demand anytime anywhere.
We provide regular AR and Cash Flow reports to our clients and communicate constantly with them on the status of any billing and collection issues.
i. A Step-by-Step Billing Procedure
ECMCI offer SaaS or On-Premise solution that ensures the efficient processing of Medical Billing. We work with individual client and make it easy to integrate the best-practice billing procedure to our solutions. Our billing specialists benefit from end-to-end capabilities for receiving, entering and tracking medical claims, reconciliation, posting, work task routing for approvals and detailed reporting.
1. Scanning – Paper documents needed for medical billing are transformed into the electronic form via the use of industry standard scanner devices.
2. Transfer – The electronic documents are then transferred via secure connection (fax/email/ftp/https etc.) to our processing center.
3. Routing – The documents are then subject to the first level of review. Using the combination of image recognition technology and well-trained specialists, the documents are inspected for accuracy and relevancy before being routed to the appropriate department. Any discrepancy that may arise during this process will be reported and verify with the client.
4. Verification – The second level of review involves the examination of information in the documents and the comparison with the existing database to ensure accuracy and integrity of the data. Any discrepancy that occurs in this level is subjected to specialist’s review. The specialist will need to contact the client, the payer source, the insurance agency etc. to verify the data. The results shall be reported to client and attached to original documents.
5. Archive – Electronic documents are classified and indexed for easy search and retrieve functions. At this stage, the documents stored in the system are ready for the medical billing process.
Medical Billing Process
1. Insurance Verification
Our medical billing specialists call up the insurance company or electronically verify the accuracy and eligibility of each patient. Pre-certification is done for specific lab tests, diagnostic tests and surgeries.
2. Patient Demographic Entry
The medical billing specialists enter patient demographic details such as name, date of birth, address, insurance details, medical history, guarantor, etc. into the system. For established patients, we validate these details and necessary changes, if any, are done to the patient records on the practice management system.
3. CPT and ICD-9 Coding
Our clinical and financial systems are fully integrated; hence, users share one point of data entry for all census and resident demographic information, and clinical information such as CPT and ICD-9 Coding. This structure results in consistent and accurate records that only need to be edited once if changes are necessary. Medicare RUGS information also flows seamlessly from the clinical application, ensuring accurate payer billing.
4. Charge Entry
The fee schedules are pre-loaded into the practice management system. CPT and ICD-9 codes are entered into the system. The billing specialists ensure that all details have been provided in the claim and ready to be filed.
5. Claims Submission
Claims are submitted electronically via the practice management system. However, we have the ability to process paper claims as well. At this stage, a thorough triple-check is done by a senior billing specialist prior to the submission. The triple-check report contains the charge, resident demographic and physician information, along with clinical and MDS status information. The rejection report received from the clearing house, if any, is analyzed and the necessary changes are made. These claims are then resubmitted.
6. Payment Posting
Electronic remittance advice and checks are uploaded to the system. All payments are entered and posted in the system. The reconciliation is performed on a daily basis. A daily log is updated with these data.
7. Account Receivables Follow-up
All claims in the system are examined and priorities are set by the filing limits of the claims, and then worked down from the age of the claim. Periodic follow-ups via telephone, email and/or online are done for inquiries of the status of each claim submitted to the insurance company.
8. Denial Management
Analysis of denials and partial payments is done by our senior medical billing specialists. Payers, patients, providers, facilities and any other participants are contacted to follow up on denied, underpaid, pending and any other improperly processed claims, and the action is documented in the system.
Reports can be customized and provided as per your requirements.