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RLS Modus Operandi
Healthcare facilities face a lot of hassles when it comes to settling payments with regardsto insurance. Payments are considered settled when patients submit insurance details at the front desk of the hospital. But the hospital or healthcare facility does not receive the final payment till the insurance agency settlesthe claim. Our medical billing services allow the practitioners to take the back-seat through the various steps involved in the process.
In order to simplify the medical billing process and minimize the daily hassles
encountered by healthcare facilities, RLS follows a framework of clearly defined steps.
Patient's Data Receiving
Medical records of patients contain vital demographic information such as a summary of diagnoses, the medical history and regular updates on visits with physicians. The clients forward mandatory patient data i.e. patient medical records, charge-sheets, insurance verification, a copy of the insurance card and any other patient information. This is then scanned and uploaded onto a secure FTP server to be accessed by our qualified medical billing staff.
Retrieval and checking of medical claims
Ourstaff will then retrieve the information from the FTP server and look for any illegible or missing information in the documents. If there are any errors, the healthcare facility is immediately notified and asked to re-send the documents.
Medical Coding
An important step in claims processing, medical coding fixes the procedure and diagnoses codes for each patient based on CPT (Current Procedural Terminology) and ICD-10 (International classification of Diseases) standards. The ‘level of Service’ determines the 5-digit procedure code and the diagnoses code as the name suggests, is based on the medical diagnoses made by the doctor.
Charge Creation
Once documents are checked and verified and the coding is completed, our medical billing team creates medical claims while adhering to rules pertaining to the specific carriers and locations. Claims are usually created within a 24 hour period.
Medical Claims Audit
The claims are then put through a rigorous auditing session which involves extensive checking at multiple levels. The completed claims are once again checked for valid and complete information, correct procedures and diagnoses codes. The single most common cause for rejection of claims is the submission of incomplete / incorrect information. The efficient medical billing process at RLS completely eliminatessuch chances.
Medical Claims Transmission
The claims are then filed and sent for a final follow-up check before being sent to the claims transmission department along with all necessary information and supporting documents for each claim.
Claims Submission
The final audited and recorded medical claims are sent to the respective insurance agencies with relevant information and the necessary supporting documentation required for the final settlement.
Follow-Up And Settlement
This is the final and most important step in the medical billing process. Healthcare facilities no longer have to chase insurance agencies for settlement of payments. We’ll ensure that we follow-up persistently till the job gets done and the final settlements are made.
