Charge Team: In this department, we have reliable individuals who first enter the patient personal information from the demographic sheets. They then check for the relationship of the Diagnosis and CPT code. Then they create a charge, according to the billing rules pertaining to the specific carriers and locations. All charges are accomplished within our agreement with the client.
Audit: The daily charge entry then needs to be audited to double check the accuracy of this entry, in other words, this is the check and balance to make certain the billing rule is being followed accurately. Also, this department verifies the accuracy of the claims based on carrier requirements to be sure we have a clean claim.
Claims Submission: The transmission department prepares a list of claims that go out on paper or through electronic media. Once claims are transmitted electronically, clearing house reports are reviewed in 24 to 48 hours for any transmission rejections and appropriate corrective action is taken right away. Paper claims are printed, and attachments are done, and put into envelopes and sent to the US postal service for mailing.
Carrier Adjudication: The carrier Utilization Review department would then review the claim. Once the review is completed, the claim would then be adjudicated and processed for payment. Then the EFT and ERA is sent electronically.
Review of EOB’S/ERA’S: From our aging report if any inaccuracies are detected we will research, correct, resubmit unpaid or denied claims. When applicable we immediately call the health care payer or appeals for reconsideration of the unpaid or denied claims.
Patient Billing: After the payment received have been applied, the patients are billed for deductible, co-pay, and co-insurance or for any non-covered service. If payment is not received after 3 statements, we refer the patients account to our collection agency.