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We believe in innovations and learning new technologies to meet the ever changing market dynamics. We perform as trusted partners to our clients in their endeavor to find the right operating model to leverage the offshore-based Process Outsourcing advantage with a promise to deliver the best in industry service at competitive terms.

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physician s office or emergency room
Physician’s Office Or Emergency Room
  • Physician writes an order
    • To admit patient
    • To observe patient
    • For tests, procedures, lab, radiology, etc
    • For surgery
      • SDS
      • Inpatient surgery
scheduling
Scheduling
  • Referrals
  • Authorizations
    • Pre-cert or pre-auth must be obtained from insurance prior to treatment
    • Pre-cert or pre-auth number must be included on claim
  • Notifications
    • Some insurances do not require authorization.
    • Some insurance request to be notified.
pre registration
Pre-Registration
  • Verify Insurance Coverage
  • Verify Authorization
  • Verify Patient Demographics
  • Determine Patient Responsibility
    • Co-pays, deductibles
    • Co-insurance
  • Obtain Patient Responsibility up front
  • Collect deposits
financial counseling
Financial Counseling
  • Meet with patients to review their financial obligations
    • Scheduling / Pre-registration process
    • Registration
    • Prior to discharge – inpatients
    • During discharge process – in and out patients
  • Once they are out the door the

chances of collecting diminish

dramatically

registration s turn
Registration’s Turn
  • Verify any missing data
  • Verify Identity
  • Scan Insurance Cards and documentation
  • Obtain co-pays & patient responsibility $$$
  • Patient Signs required documents
    • Permission to treat, guaranty of payment, assignment of benefits
    • Other consent forms
and more
And More ……
  • Advance Directives
  • Notice of Financial Responsibility
  • MSP Questionnaire
  • Rights as a Medicare patient
  • ABNs
  • HIPAA – Privacy Notice
  • Red Flag Regulations
  • Etc.
bed management
Bed Management
  • Bed Accommodation
    • Private
    • Semiprivate
  • Verified at Midnight
  • Charged at Midnight
  • Patients holding in ED for a bed
case management
Case Management
  • See every observation or inpatient
  • Case management monitors inpatient and observation patients’ care to ensure admission meets admission criteria
    • Interqual
    • Milliman Care Standards - used by insurances
  • Works with physicians to discharge the patient in the appropriate amount of time or ensure patient still meets inpatient criteria.
  • Monitors and works on delays to recovery.
  • Review patients status:
    • Medicare and Medicaid – every 3 days
    • All others - daily
discharge planning
Discharge Planning
  • Performed by case management.
  • Begins when patient is admitted.
  • Goal is to only keep patient in house as long as is medically necessary to provide excellent quality of care while maximizing reimbursement.
  • Discharge to appropriate community resource
    • May arrange transfer to SNF, Home Health, contact family, etc.
    • Work with physician and family
    • Consider what insurance will pay for
charges are entered
Charges are Entered
  • Charges are maintained in the charge master (CDM)
  • A unique charge code identifies each service and test performed or supply provided
  • Many charges have CPT-4 or HCPCS codes attached, required for billing
  • Charges connect to Revenue Codes, required for billing
  • Charges are billed on UB04 and HCFA 1500 claim forms
services are documented
Services are Documented
  • Documentation must exist in the Medical Record to support all procedures performed and supplies used.
  • Physician and Clinical staff signatures are critical
  • Verbal orders must be signed
  • Documentation must be complete and legible
electronic medical record
Electronic Medical Record
  • Automate as much of the medical record as possible.
  • Eliminates filing issues
  • Allows for instantaneous access to medical record
  • Reduces storage space
  • Much of our medical record is electronic
patient is discharged
Patient is Discharged
  • Financial Counseling
    • Outstanding balances, co-pays, co-insurance, deductibles, bad debt, non-covered services
  • Discharge Planning
  • Discharge disposition – can affect reimbursement
    • Another facility
    • SNF
    • Home
    • Home health
medical records him
Medical Records – “HIM”
  • Manages the medical record
    • Scans and files loose documentation
    • Verifies electronic records
  • Ensure physician, nurses and clinical staff have signed where necessary
  • Monitors, reports and obtains chart deficiencies
  • Coding and abstracting
  • DNFB management
medical records coding
Medical Records Coding
  • Medical records chart reviewed by certified coder
  • Physician, nursing and ancillary documentation is critical
  • ICD- 9 codes: diagnoses, procedures
  • CPT-4 codes: procedures performed
  • Greatly impacts reimbursement
  • Heavily regulated
insurance processes claim
Insurance Processes Claim
  • Pays claim
  • Denies claim
    • Immediately
    • After processing
  • Line item denials
  • Pends claim
    • Doesn’t notify hospital
    • Timely filing
contact us
Contact Us

Futuristic Gigatech

46/4, Novel Tech Park,GarvebhaviPalya , Kudlu Gate,Hosur Main Road, Bangalore, Karnataka – 56 00 68.

E-mail : [email protected] Office: 0091 80 4093 4093India Mobile: 0091 903 500 4530

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