Quite a significant number of claims fails to satisfy the eligibility verification criteria and as a result, the patients are put to inconvenience. The experts at REQS painstakingly verify data relating to the patient eligibility and ensure a totally patient friendly procedure towards processing of claims. Patient eligibility verification is one of the most important and prime steps leading towards the clearing of claims. Lack of proper eligibility and benefits verification leads to delayed payments, increased errors, non-payment of claims thus by leading to patient dissatisfaction. At REQS, we effectively tackle this problem through the remotely hosted solution for eligibility verification at hospitals and at medical practice centers. REQS deploys expert staff accessible via toll-free numbers, working towards the objective of delivering high-quality cost effective patient insurance eligibility verification and related services.
Methodology of Eligibility Verification Services:
- We check patient coverage with insurance company websites and internet payer portals.
- Verify coverage on all the Primary and Secondary Payers receiving Schedule.
- We just don’t stop with the eligibility or coverage confirmation, take it to next level and fetch kind of coverage the patient has, what their deductible is, and how much has been applied.
- Web Interactive to process Eligibility Verification.
- We take the responsibility to re-check eligibility status and the date of service.
- Establish affable communication with the patients for procuring additional information (only if required).
Efficient eligibility verification services lead to increase in account receivable cycles, reduced account receivable period, and increased number of zero error claims and an overall increase in revenue by reduction of write-offs and denials.
REQS follows highly standard issued medical billing-coding process through a structured methodology which has been proved successful for several large US clients. Our coding services will offer assistance to our clients in experiencing an increase in returns and reduction in the number of denials.
As professionals we ensure adherence to highest standards of ethical coding.
- We run a full-time, hands-on medical coding and regulatory compliance program.
- We monitor, track and review each medical claim which helps us identify errors and escalate to the payers attention.
- Cleave to highest of standards in medical coding forms part of the work culture of REQS.
- Quality Assurance Team to perform daily coding quality assurance reviews under the supervision of the QA Manager.
- Our coding specialists are well experienced who excel in industry standards of excellence providing high quality within the given turnaround time.
- Data given by the client is monitored, analyzed and improved upon for documentation and coding thereof ,resulting in effectively managed denials and increased payment velocity.
- Based on the clinical information provided by the health providers/professionals, our coders determine the codes and pass on the information to the client.
- Our coding specialists review the patient’s medical records and details so that they can use the proper codes to bill patients and process claims for insurance companies.
- Our Coding specialists have the capability to analyze patient reports and information contained in a scientific whereby the data is processed with the correct code.
Every information in Patient Demographics sheet is important hence REQS ensures accurate and quality entry of basic demographic information about an individual or patient which will directly impact physician’s monthly revenue.
[Capturing information like Patient’s Name, Patient Information, Patient Employer Information, Patient Guarantor Information, Physician Information, Insurance Information, Account #, Patient details such as Sex, Patient Date of Birth, Marital Status, Patient Address, Patient phone number etc]
To reduce the chance of claim rejection we ensure that every claim is verified to check Date of service, Billing Provider, Rendering provider, Physician, Place of Service, Type of Service, Admission date, CPT Codes, ICD codes, Modifiers, Authorization or Referral Details and Co-pay Details. We do this with manual check & random quality audit in order to ensure accuracy.
Our Expertise is aware of all nuances of payer communication when handling a payment posting account.
EOB / enter the allowed amount, paid amount, Analysis of EOBs for Under-Payment or Over-Payment and patient information like Patient Name, Date of Service, Procedure Code, then calculating the contractual adjustments which will make the follow up easier with the insurance companies.
Our experts will systematically follow up on accounts receivable, claims and all the pending claims, An in-depth analysis of rejections denials is carried out and our systematic accounts receivable projects can efficiently detect and identify different medical billing scenarios which result in non-payment of dues; and help resolve those problems to effect increase in the number of claims paid.
Process claims are submitted automatically while claims presented conventionally are also processed. This follows thorough quality check by senior billing specialists, even rejection reports received from clearing house is analysed, necessary changes are made if any and resubmitted.
At REQS denial management is one of the core activities to ensure client satisfaction and is carried out by senior medical billing specialists [ Our scope includes Payers, Patient, Providers, facilities and any other participants are called to follow-up on denied, underpaid, pending and any other improperly processed claims and the action is documented in the system.] If authorized by the provider we also have facility to call up patients [to obtain information from the patient needed for billing such as ID# and to update the COB (Co-ordination of benefits) with their insurance companies. Secondary paper claims are processed and sent to the client office for submission].
Our experts are always available for an immediate support to you and your staff no matter what the issue or problem is.
Medical Billing – Quality Check :
Quality is the key to performance and at REQS we check for all types of errors starting from [typo, billing error, specification and system errors] along with Shadow Processing and Random Auditing to ensure compliance with quality controls.
Every team is provided with a weekly quality report and the performance of each billing staff is continuously monitored and periodically appraised for better outcomes.
Quality Control :
REQS realizes the significance of quality, and to fulfill our goal we have efficient quality control at every step, by a team of quality resources personnel, all entered demographic changes are duly verified. Further, a representative sample of all demographic changes and payment effected that have preliminarily undergone by quality resources personnel are once again verified by senior quality personnel.
Call quality monitoring, which is a quality measurement process to evaluate and establish the quality of voice delivery for patient and insurance follow-up.
Compliance monitoring, which checks for adherence to legal and statutory compliance and conformance to client-specified policies and procedures.
Why Prefer REQS billing services ?
- Experience a hassle-free medical billing service by REQS.
- Our experts are well-trained staff who have the knowledge and resources to facilitate clean, accurate claims.
- A well-established company with a transparent functional set up, HIPAA and 100% secure medical billing processes. We endear to give you a sense of control over your finances that you have never experienced before.
- One of our special capability is that our medical billing experts are well-versed with the sweeping regulations, thereby they can handle the coding changes brought in by ICD 10 with ease.
- Our hybrid approaches to practice management and revenue cycle management typically ensure an increase in collections with accurate coding across all specialties.
- HIPPAA compliance ensures secure information and data flow between REQS and our partners enabled through reliable hardware and software which includes secured virtual private networks and virtual sites.
- Our staffs are trained to ensure effective business continuity and to handle surges in volume.