Medical Billing


Changing healthcare reforms by the government to eventually improve the quality of healthcare is currently causing havoc to various healthcare practitioners’ revenue management with new challenges like - increase in denials and operating costs, reduced reimbursements, reduced amount of time spent on patient care due to increased administrative tasks and more intricate coding.


With various medical reforms to be effective very soon like the Affordable Care Organization Concept, the Sustainable Growth Rate (SGR), the mandatory transition to exhaustive ICD-10 and HIPAA 5010 medical coding and reporting compliance, the revised ABN (Advanced Beneficiary Notice of Non-coverage), Form CMS-R-131 and so on – An experienced billing service will definitely help provide your healthcare practice a competitive edge!


Patient Registration


Maggnessa provides customized patient scheduling and registration process that works the way you want it to work by providing:

    Personalized schedule templates and appointment types:
  1. User-defined schedule views – by appointment type, location or provider

  2. Customizable welcome email for new patients

  3. Automated phone and email appointment reminders and confirmations


Insurance Eligibility Verification


Insurance information of every new patient sent to us is verified and updated as follows:

  1. Receive patient schedules from the hospital via fax, email or EDI

  2. Verify patients’ insurance coverage.

  3. Contact patients for additional information.

  4. Update the billing system with eligibility and verification details including member ID, group ID, co-pay information, coverage start and end dates, and so on.

Medical Coding


Maggnessa has put in place an expert team of highly credentialed and experienced coders. All our coders are AAPC certified, have a minimum of five years of experience and are continually working to stay on top of latest changes in the industry. Leveraging this vast repository of expertise:

  1. Offshore coding audits
  2. HCC medical coding
  3. HCPCS, ICD-9 and ICD-10 coding including ICD-10-CM, ICD-10-AM, ICD-9-CM and CPT-4 medical coding
  4. Payer specific coding services
  5. Chart Audits and Code Reviews

  6. Charge Creation


    Once the insurance verification process is completed and respective codes for diagnosis are assigned, our healthcare billing team moves to the next phase of creating medical claims that adhere to rules pertaining to specific carriers and locations. Claims are usually created within a period of 24 hours.


    Medical Claims Audit


    The claims are then put through a series of rigorous auditing sessions, which involves extensive testing at various levels. The completed claims then go through the second round of examination for validation of information, including correctness of procedures and diagnoses codes. Only those claims that are error-free go to the next step.


    Claim Transmission And Working On Clearing House Rejections


    Once the charges are created and their correctness is established, they are filed with the payer electronically. At the clearing houses, the accuracy of information contained in the claims is validated and a report is sent back within 24 hours in case of any inconsistencies. Once we get the report, the inaccuracies in the claims will be rectified and within next 24 hours error-free claims will be resubmitted to the insurance company.


    Payment Posting


    Our experienced team of medical billing and coding experts can carry out all payment posting processes including:

    1. Payment Posting from Explanation of Benefits (EOBs) to Patient Account
    2. Indexing of EOBs to patient account
    3. Analysis of EOBs for under-payment or over-payment
    4. Reconciliation to Match Payment Posting to Actual Deposits

    Denial Management


    We track every claim that is denied and present it in a manner that allows fast identification of trends. With this kind of powerful intelligence in hand, we can dramatically drive up the first-time claim acceptance rate and stop the torrent of claim denials.


    Some of the key functions of our denial management process are as follows:

    1. Identifying the root cause of denials – We identify and interpret patterns to quantify the causes of each denials
    2. Supporting accurate workflow priorities – We collect every piece of information related to denied claims, including status, escalation and correspondence with payers, which will be very helpful in streamlining the recovery process
    3. Providing timely and accurate statistics – We provide accurate analytics and reports that can go a long way in preventing future denials
    4. Tracking, prioritizing and appealing denials – We generate appeal letters that adhere to state/ federal rules and provide case citations in favor of the clients appeal, Avoiding out-of-timely filing, Analyzing the effectiveness of the resolutions and Identifying business process improvements to avoid future denials

    Account Receivable Recovery


    Here our team of AR management experts rigorously tracks all unpaid insurance claims that pass the 30 days bucket and ensure that they are collected, thereby greatly reducing accounts receivable (AR) days. They also ensure that all underpaid claims are processed and paid correctly by the insurance payer, while making sure that all the denied claims are appealed in time.


    Patient Follow-Up/Patient Statements


    We approach patients regarding pending balances that are due after the claim is processed. Those that receive no responses are moved to collections and the client is notified to take further action.


    Collections


    This is the final and most important step in the medical billing cycle, wherein we persistently follow-up with insurance agencies for final settlement of payments and get the job done within the shortest possible time.