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Medical Billing - Services

Let's agree to that fact that medical billing is much more than data entry for medical practitioners, Without a proper medical billing and coding foundation, the entire medical system can collapse. Given the current medical and legal environment, the constantly changing healthcare regulations and the increasing complexities of insurance reimbursement, the importance of these services cannot be undermined.

ICEGEN's Medical Billing services provide the highest rate of returns on your claims at a competitive price so you can focus on your medical practice, patient care and support. ICEGEN is skilled in every aspect of Billing and the staff expertise includes Medicare, Medicaid and Workers compensation to name a few. ICEGEN has experience in working with various Practice Management Software packages such as Medical Manager, Medics, Lytec, Misys, IDX and Medisoft.

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Process

Patient Demographics

All the relevant documents for processing are first assimilated by the ICEGEN Pre-Verification Team.

Patient verification
Basic information about the patient made easily accessible/retrievable by capturing identity details of the patient on the basis of

  • Appointment Date
  • Name
  • Date of Birth
  • Social Security Number
  • Insurance details
  • Employment details etc

Charge Entry

Incorporate Procedure codes, Diagnosis codes, Modifiers and other related information into the Billing Software.

Coding

ICEGEN has a sophisticated billing management system that ensures accurate coding using ICD9CM and CPT Books, following AMA and LMRP guidelines.

All Coded Charts are audited for adherence to coding rules and regulations. All the operations adhere to standards set by the HIPAA regulations and done according to the AAPC ethics.

Payment Posting

To ensure accurate application of data received from the insurance companies on receipt of payments, ICEGEN uses advanced recording facilities. ICEGEN also analyzes post payments/partial payments and undertake corrective action. This extends to:

Insurance payment posting

  • Cash posting for primary insurance payments/ adjustments/ transfer co-insurance to secondary insurance (if available) or patient.
  • Posting of secondary insurance payment.


Self-Paid posting
Direct payments by the patients to the healthcare provider.

Denial posting
Checking Claims/re-submission of documents like medical records, authorization etc. for claims denied.
Paid claims are received from Insurance companies as EOB (Explanation of Benefits) along with payment details, which are verified and posted in respective patient accounts. The associate then proceeds to nullify every patient account with the payment details, thus, balancing the ledger for the physician.

Claims Processing

  • To reduce claims rejection and ensure speedy reimbursement, data is entered electronically and submitted as a claim either electronically or on paper (HCFA/CMS 1530).
  • Correspondence/denied claims are processed on a day-to-day basis.
  • Unpaid claims are typically sorted by financial class order and ICEGEN follows-up with the appropriate insurance companies/self-pay patients if requested, to resolve any non-payment issues.

Note: Account Receivables analysis also includes the review of unpaid balances due from patients for services that have been rendered. When charges are collected the AR service becomes nullified.

Account Receivables

Inefficient account receivables can impend cash flows and deplete revenues. ICEGEN provides services to follow-up on your receipts by identifying patient accounts that require tracking, analyze possibilities for delay, address insurance issues and rectify the same.

Assessment
Running through daily insurance aging reports/claims analysis to identify: Unpaid /Low-paid/ Denied/Rejected Claims apart from Claims that have not been entered in the records.

Analysis

  • Ensuring availability of necessary documents like medical records/referrals/authorizations towards claims re-submission.
  • Appealing for consideration in case of low reimbursement/timely filing of cases.
  • Separating the claims denied.
  • Issuing instructions to the callers for follow-ups and status reports.

Auditing

ICEGEN's Data Validation team checks all the information for data errors/outdated entries and validity before uploading it to ensure 100% accuracy. This reduces underpayments/claims denial to ensure prompt and accurate settlements.

The Auditing Process involves:

  • Quality Assurance wherein the entire database is validated and each and every entry in the patient demographics and charges are checked
  • Quality audit entries wherein random checks are conducted to identify errors in patient information.
  • Charges Entry checkups that run through the CPT/ ICD codes, modifiers, service providers and referring physicians

Reports

ICEGEN provides complete reports on:

  • Transaction volume (Number of Patients and Claims) generated daily/ weekly/ fortnightly/ monthly as requested by the customer.
  • Incomprehensible files/ charts/ patient information -recorded in log for client clarification and instructions.

Call Center

ICEGEN offers 24x7 help-line with trained callers who can:

  • Identify patient accounts that require follow-up.
  • Analyze possibilities for delay.
  • Follow-up with the insurance providers for speedy reimbursements.
  • Rectify problems/answer queries.

Advantages

  • Error free data capture.
  • Improved staff efficiency and productivity.
  • Reduced general and administration expenses to the client.
  • Cash flow insured from staff turnover and personnel issues.
  • Knowledgeable staff
  • Compliance help line
  • Grievance resolutions
  • Comprehensive management reports
  • Data backup and software upgrades
  • Improved coverage of unpaid accounts
  • Improved physician satisfaction
  • Reduced staffing issues and training time

Compliance

Compliance means following necessary laws and regulations. The purpose of corporate compliance is to promote practices for prevention, detection, and resolution of instances of conduct that do not conform to federal and state laws, payer's requirements and hospital policies.

ICEGEN maintains one of the Industry's leading compliance programs, Information security is strictly followed as per HIPAA and violations of any of these rules are considered as a serious offence and the Compliance Committee takes immediate corrective and preventive action.

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Team

ICEGEN employees are AAHAM /AAPC certified professionals. They are proficient in:

  • CPT, ICD-9CM, and HCPCS coding across various specialties.
  • Coders are certified under AAPC and strictly follow the ethics of coding, thus, assuring clean claims being processed.
  • All employees possess in-depth knowledge of:
  • Healthcare, Insurances and their practices and processes.
  • Insurance and governmental regulatory requirements.
  • Payer-specific coding requirements.
  • ICEGEN makes it a point that every professional undergoes a through and a rigorous training program and upon successful completion and evaluation, candidates are inducted on live projects.
  • On-going training/weekly refreshers and periodic workshops are also conducted to improve the knowledge base of the associates.

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