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Vision Infonet provides comprehensive reimbursement services.
Our services span the entire revenue cycle that include physician
billing, insurance claims filing, patient collections, accounting,
and data analysis. We use the Internet and other state-of-the-art
technologies and resources to shorten collection cycles.
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| As
soon as the client decides to start utilizing our services…(click
here) |
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| View
Billing Cycle… (click
here) |
| Our
reimbursement services cover the following functions: |
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Demographics Entry |
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Verification |
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Pre-Certification
Processing |
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Superbill Analysis
and Charge Entry |
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Faster Claim submission |
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Secondary Carrier
Billing |
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Claim Editing and
Auditing |
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Payment Posting |
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Quality Process |
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Denial Posting |
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Insurance Follow
up and Appeals |
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Practice Analysis |
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Activity and Insurance
Reports |
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| Demographics
Entry |
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Individual
patient details are cataloged in billing software. The entries
done consist of Patient Demographics, Insurance, Employment
and sponsor details update if necessary. |
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| Verification |
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Pre
consultation and pre surgery verification process with the
carriers and verifies the patient demographic details, benefits
and service procedures to be rendered by the providers, to
understand the covered and non-covered services and reimbursement
patterns. |
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| Pre-Certification
Processing |
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| We
verify and/or initiate the pre-certification process as required
by the insurance carrier before services are rendered. |
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| Superbill
Analysis and Charge Entry |
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If
the super bills are prepared by the physician, the codes will
be cross checked, especially for the missing 4th digit or
5th digit of ICD codes, payable diagnosis, modifiers, bundling
and unbundling of procedure codes, which are the common error
found in the super bills prepared by the physicians.
Alternatively we will prepare super bills from the physician
notes and transcriptions that are available in their system.
We take utmost care while coding. We follow HIPAA compliance
and we update our knowledge regularly by attending seminars
conducted by AAPC local chapters and journals etc. CPT, ICD-9,
and HCPCS coding and assigning of appropriate modifiers and
related information into the Billing Software will be done
accurately.
Steps in preparing the super bill and generation of claim
consists of:
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Coding
of the Diagnosis and the Procedure. |
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Checking the compatibility
of the diagnosis with the procedure code. |
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Checking for the
modifiers in relation to the procedure. |
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Quality checking
before the generation of the claim. |
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| Faster
Claim submission |
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Claims
will be submitted the next day of service; either electronic
or paper claim submission. This results in faster inflow of
revenues.
We process electronically for all carriers that currently
accept electronic submission. Electronic claims are generally
paid faster (usually within 15-30 days as opposed to 60-90
days). With electronic billing there is immediate notification
of errors or missing information, thus reducing turn around
time for payment.
Claims for providers who do not accept electronic submission
we submit claims via paper. |
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| Secondary
Carrier Billing |
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will automatically process secondary carrier claims upon receipt
of the primary carrier. |
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| Claim
Editing and Auditing |
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Stringent
edits and audits are done before the claims are transmitted
to ensure submission of complete and clean claims.
We have 2 stages of checks for claim processing. This reduces
underpayments and denials of claims substantially and provides
prompt and accurate settlement of claims.
Stage 1: Our quality assurance
team does complete checkup of each and every entry of demographic
and charges fields in Billing software. We audit each and
every field in demographic and charges.
Stage 2: In this stage of quality
audit entries are randomly checked for errors. The fields
and the entries such as patient name, DOB, insurance ID and
others are verified for Demographic accuracy. Charges Entry
checkup includes fields such as CPT codes, ICD codes, modifiers,
Service provider and referring physician. Claims are then
submitted electronically to the insurance company. |
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| Payment
Posting |
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We
maintain accurate and up to date Accounts.
Our posting service includes primary and secondary insurance
payment posting, adjustments and transferring to co-insurance
to secondary insurance (if available) or patient, Personal
Payment (self pay) posting. Posting of secondary insurance
payment is also done. |
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| Quality
process |
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Our
quality assurance team does complete checkup of entire process
of cash posting. Checks are done to validate the fields such
as check number, co-insurance transfer and adjustment. Denial
and re-submission of claims posting service is very important
as it involves a specific time period within which claim has
to be re-submitted. Our quality team assures that all denial
and re-submission of claims posting is done within time and
without missing any record including all supporting documents
and information. |
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| Denial
analysis and Processing |
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Claims
needing resubmission that is claims denied by insurance are
checked for all necessary documents like Medical Necessity
records, Referral, Pre-existing information etc. and resubmitted.
Denials will be thoroughly analyzed to prevent them in the future and processing them for payment.
All the No-pay letters and other correspondence from the insurance
companies is downloaded and printed at our end. If correct
reason for denial is not mentioned, we will call the insurance
company and enquire about the correct reason for denial and
work as per their clarification.
When Claim needs Medical Necessity notes, Pre Existing information,
Place of service or type of service etc., the notes will be
collected from the client’s server. If any of the information
is not available, client will be called and requested to scan
the required information from the patient charts. Once the
required documentation is collected, it will be mailed to
insurance company along with the copy of no-pay EOB.
Duplicate Claims: Due to charge
posting error or payment applied to incorrect visit or line
item and insurance processing errors etc., patient may see
more than one doctor. For these, we call insurance and check
the correct reason for denial. |
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| Insurance
Follow up and Appeals: |
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We
will follow up via telephone (or letter if necessary) on all
claims that have gone unpaid beyond 30 days. If an unpaid
or underpaid claim requires an appeal we will process all
of the required paperwork and handle all necessary follow
up. |
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| Practice
Analysis: |
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Practice
analysis will be prepared and submitted to the client. The
type of Claims being rejected, why rejected and what can be
done to minimize the same will be discussed and the following
reports will be provided. |
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| Activity
and Insurance Reports: |
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Financial
Class Activity Report
Charge Type Analysis Report
Daily Posting Summary Report
Procedure Mix Activity Report
Practice Analysis Report
Other reports that may be of interest to clients and which can
be generated on a customized basis include:
Accounts Receivable Aged Trial Balance & Financial Class
Charges of Physician Report
Payor Mix Report
Quarterly Comparison Summary
Revenue Analysis Report
Top Referring Physician Report |
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| As
soon as the client decides to start utilizing our services: |
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Signing
the Business Associate Agreement, as required by HIPAA. |
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Checking/arranging
the basic necessities at the clients end, which includes: |
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High Speed internet
connection |
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High Speed Scanner |
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Collecting
the data from the previous service provider and its compatibility
with our Billing and Practice management software. |
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Establishment
of VPN or any other secure way of accessing the client’s
network |
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Once
the above is fulfilled, we provide online guidance to the
client to scan and save all the billing related papers in
the server to which we have access, if they are new to this
process. |
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Request
the client to scan all the patient demographics so that we can
have access to it. |
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The
Process:
Client scans all the billing related documents which includes
Super bills, EOBs, Insurance correspondence and hospital documents.
Client also scans all the records of payments received from
any source by any means like co-pays and self-pays received
in the form of cash, check or credit card within two business
days of receipt, to enable us to process and submit claims
in a timely manner, and follow-up on their account receivables.
Client gives us permission in writing to access their network,
to contact insurance providers, patients, referring doctors,
hospitals, nursing homes and any other party deemed necessary,
and to obtain the information necessary to perform the billing
function on their behalf. |
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