Professional Medical Billing Care Solutions

Services

Billing Care Solutions offers a wide range of services that assist

medical practices and facilities for an optimized practice performance.

Medical-Billing-&-Coding

Medical Billing & Coding

It is not an easy task to handle the demands of business and practice simultaneously. Hard work is required to make sure everything is running smoothly from practice to delivery of quality patient care, increased cash-flow to higher productivity, and compliance with continuously changing regulations and payer guidelines.

Don’t worry! We are here to help you with a customized Medical Billing process and best medical billing solutions. We have a full spectrum of practice management solutions for all healthcare providers that will help you in the best possible way. Our full suite practice management and billing solutions help you in the elimination of all charge entry, claim submission, payment posting and follow-ups.

We provide complete management and billing solutions including:

  • Claim submission and help in tracking to ensure payment on time
  • Remittance advice posting and Payment verification
  • Development of new payer rule in order to monitor changes and to keep payment on track
  • Clearing claim in advance for clean claims
  • Continuous follow-up process so nothing gets delayed or left behind
  • Can handle Web-based billing software that is easy to use and offers the best system to streamline, manage and track financial and administrative processes.
  • Availability of completely customizable reports in real-time that provides detailed visibility into practice performance and denial trends.
  • Information regarding insurance packages to ensure appropriate payer enrollment
  • Need-based account reviews to examine payer success and avenues for improvement

Revenue Cycle Management (RCM)

Billing Care Solution is here to provide an excellent service in Revenue Cycle Management (RCM) system. Our Healthcare Revenue Cycle Management process facilities to manage the administrative and clinical functions that are associated with patient appointment, scheduling, patient visit, and care services, patient eligibility and benefit verification, prior authorization and referral, chart review and clinical documentation, HCPS coding, charge capture and charge entry, billing and claim submission, claim rejections, self-pay collections, patient payments and patient statements. It also includes insurance payment, and insurance refunds, payment posting and reconciliation, Account Receivable and Denial Management, claim appeal and follow up, write off and closing account procedures. Our dedicated Revenue cycle management professional staff will present you with a real-time assistance program to reduce the administration cost and save time through automation.

Our Revenue Recovery Specialists will provide you comprehensive business consultancy in medical billing and custom Revenue Cycle Management Solutions with digital processes that will reduce manual work and improve your business revenue workflow through the automation process. This approach constantly enhances overall operational efficiency and allows the business to expand its best services to Patient Care.

Revenue-Cycle-Management-(RCM)

Billing Care Solutions provides best Revenue Cycle Management Services:

  • Implementing an End-To-End Revenue Cycle Management Solution and racking a claim through its entire cycle
  • Improve revenue by effectively managing your insurance follow-up and claims denial processes
  • Design Strategies for a High-Performance Revenue Cycle through Standardized Quality Training Program
  • Design models to reduce Account Receivable and real-time reporting and analytics
  • Monitor revenue goals and visualize areas for improvement
  • Improve the Patient Financial Experience through Streamline Patient billing
Account-Receivable-Management

We are among fastest growing Revenue Cycle Management Companies and we tailor our services according to your practice and business needs. We drive your business in new directions of Financial growth.

  • Investigate, Classify, Organize, Monitor, Prevent Account Receivable financials
  • A/R categorized by financial payer’s and Patient Financial Services
  • In-depth knowledge on insurance rejections & denials management
  • Identify Health plan products, Administrative policies, and Network adequacy
  • Identification and diagnoses of the issues in order to fix them to get faster reimbursements
  • Regular and consistent follow up of practice aging reports

    Account Receivable Management

    Billing Care Solutions is here to assist you with your AR Management through our well- organized process where our AR department reviews and categorize the denial reports, rejection Code, Reason Code, containing information on denials and write-offs Trends. The audit team investigate and analyzes previous denials trends and pass the correct instructions to the billing department in order to reduce the error rate in future billing. Then analyze the denial issues log and review the trends in insurance denials that had been identified in order to determine whether the actions taken were effective enough to reduce similar denial in future.

    Our Audit department investigates and prepares AR trends reports and their top priority to resolve your account receivable issues such as demographic and claim entry errors, inconsistency in Billing, Coding and modifiers errors,  Claim Adjustment Group Code, Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), provider credentialing and enrollment contract negotiation matters, Investigate claim on file submission status through Electronic Data Interchange (EDI) 837 professional and institutional or EDI file. They also get the confirmation of receiving data in the HIPAA compliant Accredited Standards Committee (ASC) X12N 835 file format knows as Electronic Remittance Advice (ERA) and also reconcile the Insurance/payer payment into Bank deposited through Electronic Fund Transferred (EFT). The Claim Department also get in touch with Centers for Medicare & Medicaid Services (CMS), MACs like Noridian Healthcare Solutions, LLC, CGS Administrators, National Government Services, Inc. Novitas Solutions, Inc. Palmetto GBA, LLC. Wisconsin Physicians Service Government Health Administrators and Clearinghouses.

    Provider Enrollment & Credentialing

    Credentialing Services:

    In the absence of proper medical credentialing, the healthcare providers (hospital, physician office, dental practice, or surgery center and more) cannot work in any place and cannot partner with health insurance legally. As a result, reimbursement for medical services can also be denied or delayed and facility will have to face loss in revenues. Medical Credentialing is very crucial for both the patient and the healthcare providers because it ensures that service providers are competent to do the best and possible standers job.

    Do you want to give your patients the best care possible and the credibility of your business do not put your patients at risk?

    Billing Care Solutions credentialing processes offer organizational efficiency by reducing the burden on all stakeholders and positively impacting quality. We always ensure real-time credentialing requirements and assist our client’s inquiries about credentialing matters for each specialty, (Medical, Dental, Behavioral Health etc.).

    We evaluate through qualifications examining, reviewing and verifying that a candidate’s professional licenses or certifications, specialty certificates, education, work experience, competence, and malpractice and other variables are in compliance with credentialing guidelines and standards implemented by the National Committee for Quality Assurance (NCQA).

    100% satisfaction is guaranteed on all of your provider enrollment and credentialing matters.

    Provider-Enrollment-&-Credentialing

    We aim to:

    • Increases Physician and Patient Trust
    • Improve reimbursement and prevents lost revenue
    • Reduces error risk factors
    • Improves reputation and credibility
    • Protects against potential lawsuits
    • Understand State Regulations
    • Assign a Credentialing specialist
    • Maintain credentialing tracking grids
    • Weekly application follows up
    • fulfill expectations of business needs
    Eligibility-&-Benefit

    Our staff Check member eligibility with insurance card and also View detailed benefits information. We also confirm all details such as Group Number, Group Name Plan/Product, Current Effective Dates, Co-payment Co-insurance, Deductible (original and remaining amounts), Out-of-pocket Limitations/Maximums Preauthorization indicators and contacts.

    • Search benefits by category, including vision
    • Get a copy of the digital ID card
    • Check coverage limits and therapy accumulators
    • Verify the care provider’s network and tier status for the member’s plan
    • View cost share amounts and balances
    • Learn more about Eligibility and Benefits
    • Member ID Cards Verification
    • Identify Member’s Primary Care Provider (PCP)
    • View, Add Notes or Comment on Member’s Plan of Care
    • Access / Acknowledge Member Health Assessment
    • Access Member Health Risk Assessment
    • View Risk Stratification Assessment

    Eligibility & Benefit

    According to the survey report mostly practice revenue burns due to insurance-coverage and member benefits.  A lot of claims denied because eligibility and benefit not verified or the patient or service not covered by the plan or providers. A huge revenue can save if the practice establishes an insurance verification process in the office or get the services from a professional organization. Our eligibility and verification team can reduce these types of denials, making medical billing practices more efficient and raising your overall bottom line revenue. Patient benefit and insurance eligibility should be verified before clinical services are provided and should never be a task the medical billing staff handles on the back end. Our trained and experienced

    Our trained and experienced special team will guide and assist you on patient eligibility and benefits services with custom designed sheets. We took the patient eligibility and benefit according to the client’s demands.

    We highly recommend and encourage all healthcare providers to use the Availity, Navi-Net Provider Portal or their preferred vendor for eligibility and benefit verifications tools and get benefit information from the member services help line via phone or IVR.

    Authorization and Referral Services

    The healthcare realm is facing, most common denial in medical billing reimbursement rates as Pre-Authorization, Prior Authorization, Pre-Certification, and Notification. Authorization is the process of getting a medical service(s) authorized from the insurance carrier. Providers or Medical billing companies have to contact insurers in advance and obtain a certification number in order to be reimbursed properly. The process of obtain Referrals from a primary care physician before seeing a specialist. These processes result in an authorization and referral number and provider’s/billing companies must use on claims submitted for payment.

    Our Authorization and Referral Process:

    Billing Care Solutions is well aware of the Authorization and Referral process. We consider and manage it as a special project in Medical Billing Cycle because of the time and costs associated with it. Our Authorization Specialists have wide-range knowledge of functionalities and compliance with payer contractual requirements. We identify, verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements through in all paperwork and research relevant to each case from the payer carriers. We Obtained prior authorizations and referrals from various payer carriers by submitting clinical information via fax and online payers web portals or by speaking directly to a case management representative. We ensure end to end, timely, and accurate submission of prior and retro authorization and referral requests to the payers. it is our pledge to make everyone aware of any changes or implementations that may potentially impact you financially growth.

    Authorization-and-Referral-Services

    Submission of Pre-Authorization and Referral Request:

    We require following information:

    • Demographic information of the patient
    • Patient Full Name
    • Date of Birth
    • Insurance ID
    • Tax ID number
    • Tax ID number
    • National Provider Identifier (NPI) number
    • Address where services are being provided
    • Phone and fax number
    • CPT/HCPCS codes
    • Diagnosis Code
    • Location where the service will be performed
    • PCP Information
    • Specialist Information
    Business-Intelligence-Reporting-Services

    Billing Care Solutions

    always suggest analysing your business before we talk about solutions. It gives us the best basis to make a difference for your business. Every week, our reporting team prepare all clients a practice health presentation to facilitate the client to understand current financial growth improvement trends chart-flow and guide them what factors are improved and what are facing problems to gain monthly practice estimated payment target. We provide you fast and accurate Comprehensive Revenue Management Cycle Reporting features.

    • Valuable business insights and competitive analysis
    • Increased client satisfaction and better data quality
    • Increased operational efficiency by Identifying market trends
    • Improved, accurate decisions with competitive analysis
    • Increased revenue by fast and accurate reporting
    • Improved visibility through actionable Information
    • Measurement of the performance of business metrics by our reporting team

    Business Intelligence Reporting Services

    For healthcare industry, it is a requirement to analyze the data from the operations to collect, transform, and report from various data sources and present it in a visual manner to become informed by data through business intelligence strategy. Medical Billing Reporting solution brings powerful enhancement to management decision-making processes on which services need more focus on developing. It also helps out in practice financial information, Aging and Account Receivable, Charges and Payment, Submission and rejections denials, monitor key performance indicators (KPIs), and generate accurate reports.

    Billing Care Solutions

    will give you a unique direction and keep an eye on your practice health data through their Business Intelligence Reporting System. We analyse historical practice data as Payment to Charge ratios (PC%) Patent aging, Appointment Reminders, most common CPT & DX code combinations by payment and information that let them understand business performance at a glance, identify emerging risks and important trends early, and detect and investigate problems as they arise Business Intelligent organizations have better control over their processes and standard operating procedures.  The visibility of these functions is improved by a Revenue Cycle Management Reporting system as it delivers fast and accurate information to decision-makers using a variety of data sources without assistance from a Software vendor to run complex reports. Our Business Intelligence reporting team extract the data by using different reports and tools and make it presentable through designs and show them in dashboard summary for the better position of the business.  All of these things come together to create a comprehensive view of a business strategic initiatives to help a business make sound and actionable decisions.

    Patient Support

    Healthcare is a customer service industry based on the quality of care provided and the daily interactions between staff and patients, health insurance companies, and medical billing companies to assist the patient inquiry. Improving patient care has become a priority for all health care providers with the overall objective of achieving a high degree of patient satisfaction. The fact that the patient is the most important person in a medical care system must be recognized the importance of all those who work in the system.

    If you’re wondering how to assist your patient-related inquiry about the medical bill and patient statements, eligibility and benefit, network participation, and front-end best services, look no further.

    Billing Care Solutions is very classified to manage patient customer services over emails and phone calls. At their most they can also perform more advanced services, such as patient management and payment processing, medical bills and patient statements, eligibility and benefit, network participation. In addition, if you need a partner to ensure your customers receive the care they expect from your company, Billing Care Solutions is the right company for you. We take care of patient calls with comprehensive approach to patient care and guide through every stage of your medical journey, including recovery, therapy, support and education.

    Patient-Support

    According to our 15 years of experience the strongest doctor-patient relationships starts with customer service. As business reputation develops from excellent or poor customer services and it is critical in determining whether potential patients seek your services in the future.

    • Caring and empathetic staff
    • Providing appointment confirmation
    • Professionalism and confidence efficient processes
    • Collect and facilities patient payment process
    • Inquire if the patient has any questions
    • Minimizing wait times to talk to a scheduling agent
    • Reducing the time necessary to capture patient data
    • Collect and facilities patient payment process
    • Assist in Billing and Insurance Claims Inquires
    • Provide contact instructions for future engagements