Medical coding is the process of application of universal alphanumeric codes to the healthcare services rendered i.e., medical diagnosis, procedures, services, and equipment provided. A patient’s medical record i.e., documents such as physician’s notes, laboratory reports, and services lists, are used by a medical coder to ascribe the diagnosis and procedure codes. The process of medical coding involves abstraction of the medical information from the available documentation, assigning the right diagnosis & procedure codes, and enabling the process of creation of a claim to be submitted to payers.

Payers can understand the following information from the standardized codes:

• Patient diagnosis
• Medical necessity for treatments, services, or supplies the patient received

Charge entry is the process of assigning to the patient account an appropriate $ value as per the chosen medical codes and corresponding fee schedule. The reimbursements for the healthcare provider’s services are dependent on the charges entered for the medical services performed.

Steps in the Charge Entry process
Our process involves the following steps.

• Receipt of documents – superbills, charge tickets, and associated clinical documentation via an FTP server, EHR, or document management system
• Recording the patient demographic information, date of service, billing provider, referring healthcare provider, Point of Service, data and time of admission, ICD/CPT codes, number of units, and modifiers.
• Workflow automation to provide daily reporting to the customers and facilitate collaboration to ensure compliance to timely filing norms
• Review of imported charges for accuracy before billing
• SQC (Statistical Quality Control) to review the quality of the process through a random audit
• Adherence to pre-defined provider-specific rules for different specialities and services rendered
• Review of any pending or held documents with the client daily to reduce any backlog
• We also perform charge audit services to identify any missed charges, instances of over-billing, and medical coding errors

The payment posting process, in many ways, provides a view of the effectiveness of your revenue cycle. It allows you to understand trends in reimbursements and perform analytics. Accurate payment posting offers clarity on the state of your revenue cycle, and, therefore, you must choose a highly efficient team to process payments.

Our Payment Posting Process
We process different types of remittances received with a high degree of accuracy, improved responsiveness, and follow the procedures defined by our clients. We perform the following services:

Patient Payments. We receive information on the point of service payments made by patients from our clients. These payments are made via cash/check/credit cards and could be on account of co-pays, deductibles, or non-covered services. Our team reviews the information received and adjusted the same against each patient account.

Insurance Posting: We process Insurance Payments in the following formats

Electronic Remittance Advisory.

We receive high volume ERAs from payers and process them in batches by importing them into the client’s practice management system. Each batch run throws exceptions that fall out, and we correct the same along with verification of batch totals.

Manual Posting:

Our clients often send us scanned EOBs. Each EOB batch is accessed via secure FTPs or through the EHR system and processed in line with the client’s business rules for adjustments, write-offs, and balance transfer to secondary insurance companies or the patients.

Denial Posting. Posting of claim denials is essential to get an accurate understanding of the customer’s A/R cycle. Denied claims are sent back by the payers in the form of ANSI codes for denials and sometimes with payer-specific medical coding guidelines. We understand the payer-specific denial codes for most payers and have expertise in understanding ANSI standard denial codes. We record each claim denial in the practice management system and take actions to re-bill to the secondary insurance company, transfer the balance to the patient, write-off the amount, or send the claim for reprocessing.