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TRINITYMAGTRINITYMAGTRINITYMAGTRINITYMAG GLOBAL SERVICESGLOBAL SERVICESGLOBAL SERVICESGLOBAL SERVICES
MEDICAL BILLING SERVICESMEDICAL BILLING SERVICESMEDICAL BILLING SERVICESMEDICAL BILLING SERVICES
TrinityMagTrinityMag Global ServicesGlobal Services
BREAKING BARRIERS IN BPOBREAKING BARRIERS IN BPOBREAKING BARRIERS IN BPOBREAKING BARRIERS IN BPO
THROUGH INNOVATIONSTHROUGH INNOVATIONSTHROUGH INNOVATIONSTHROUGH INNOVATIONS
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Welcome to TGS Professional Medical BillingWelcome to TGS Professional Medical Billing TGS is a full service billing center specializing in electronic filing of insurance
claims, patient balance billing, and collection of old receivables. Located inNew Delhi.
TGS PMBTGS PMB
Core Services These services represent the bulk of our daily tasks and are the ones that
provide you with your cash flow. They encompass everything needed tocompletely bill a claim; from the initial superbill to getting your paymentsposted.
Practice Management
These services are comprised mainly of the reporting that is generated fromthe Core Services. They allow you to optimize your collections andultimately increase your cash flow.
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TGS Medical Billing ServicesTGS Medical Billing Services
Medical Transcription
Scheduling
Coding
Fee Schedule
Credentialing of Providers
emograp c uper n ry
Transmission of Electronic & Paper Claims
Payment Posting
Denials Management
AR follow-up on unpaid claims
Follow up Electronic Claims(10 days), Paper Claims(30 days)
Appeal on low payment
Patient Bills
Weekly Reports Top 10 carriers)
Monthly Reports Financial Report)
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Why Outsource to TGSWhy Outsource to TGS
Have You Considered Outsourcing your Medical Billing to TGS Experts?
Outsourcing your medical billing claims can be very profitable for Physicians because iteliminates all the daily expenses associated with Keeping medical billing In-House. It isAceteras responsibility to relinquish these expenses from your
practice enabling you to receive greater profitability.
What Are Some Of The Benefits Of Outsourcing
Shortened insurance payment cycles of 10-14 days
Increased cash flow
Reduced outstanding accounts receivable
Customized reports analyzing your practice Patient Account Management by a highly qualified professional
No need to invest thousands into a new system
No need to train your staff on a new and sometimes complicated system
You save money and time!
Access your patient account information via your own computer
The Expertise
Our Execution Strategy
People Power
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Hourly , Daily
Collect OngoingPerformance Data
Communicate Results
Set Strategic Goal
Collect Performance DataCondition for
Performance Gap
Quality In TGSQuality In TGS
Cycle
Generate Competence /Performance Gap
Track Results
Analyze Performance
Develop KeyPerformance Indicator
Set Performance Target
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INDUSTRY BENCH MARKSINDUSTRY BENCH MARKS
Account Receivables Days > 60 Days
Total Account Receivables - -> 2.5 times of monthlyCharges
Collections - -> 40% of monthly Charges
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Pre-Analysis Analysis Transition Management Ongoing Operations
Key ActivitiesUnderstand clientbusiness needsIdentifyoutsource
Gather documentationIdentify solution andcostingConfirm and validate with
Adapt process planEmulate client processConfirm performancerequirements
Operations acceptsserviceresponsibilityQuality plan put
TGS Forging Ahead
opportunitiesAssessrequirementsReviewenvironmentConfirm viability
clientPrepare processimplementation plan
Customer acceptance into effectSLA acceptance
Location Offshore Offshore Offshore Offshore
Timeline 2 weeks 2 weeks 3-4 weeks Ongoingengagement
ResponsibilityClient functionalmanagersAceteraFunctional
specialists
Client functional managersAcetera analysis team
Client functionalmanagersAcetera transition team
Client operationsteamAcetera servicedelivery head
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TGS has experience of 5 plus years in the Front Office / BackOffice Medical Billing / Practice Management Industry.
The staff at TGS have worked with most of the states along theeastern as well as the western coast of the US.
CAPABILITIES
Keeping abreast of the changes in guidelines for billingvarious carriers through participation in Medical BillingForums, subscribing to Manuals and Bulletins from InsuranceCompanies.
TGS has a comprehensive training schedule for bothexperienced as well as fresh candidates. We always maintaina bench strength so that the day to day routine of the clientsdo not suffer at any point.
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Specialties
Radiation Therapy Obstetrics
Ambulatory Surgical Centre Orthopaedics
Pathology ENTFamily Practice Pediatrics
Gastroenterology Podiatry
General Surgery Psychiatry
SKILL SETS
ynaeco ogy a o ogy
Infectious Disease Internal Medicine
Cardiology Neurology
Oncology & Hematology Physical Therapy
Software
Medic (Misys PM / Tiger) EMDS Excalibur
Medical Manager Medplexus Medisoft
PMC Lytec SequelMed
Geysers Kareo Vericle
NextGen
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EXPERIENCEEXPERIENCE
We have staff who have physical hands on offsite experienceof working with group practices in various states for morethan 5 years.
,
Internal Medicine clients in the State of Maryland.
We have onsite experience in the following domains
Scheduling of Appointments
Front OfficeAll the processes in Medical Coding / BillingLiaisoning with Software CompaniesData Migration from one software to another
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Modules in Medical BillingModules in Medical Billing
Flow chart of Medical Billing Process of Medical Billing
Scanning Department
Coding dept
a en emograp cs
Superbill / Charge dept
Quality dept
Transmission dept
Payment posting dept
Insurance Follow up / Analysis
Patient Analysis
Month End Reports
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FLOW CHART OF MEDICAL BILLING
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ACCESSSING SOFTWARE
PATIENT DEMOGRAPHICS ENTRY
CHARGE ENTRY
QUALITY AUDIT
PROCESS - MEDICAL BILLING
Un aid
CLIENT IN US
SCANNING TO INDIA
CODING
REPORTS TO CLIENT
MIS / GENERATION OF REPORTS
ACTION ON DENIALS / REJECTIONS
TRANSMISSION OF CLAIMS THRU CLEARINGHOUSESPaid Claims forcashapplication
ClaimsForcorrectiveaction
CASH APPLICATION AR ANALYSIS / CALLING
CASH TALLYING
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US Office scans Patient Demographics,Charge Sheets, Insurance Card Copies, etc.
Scanned copies would be saved as *.TIF(Tagged Image Format) file and placed in FTP
Site
SCANNING DOCUMENTS TO INDIA
Mail to India on Scan date, File name anddirectory path.
In the FTP Site, Files would be placed in thecommon path which can be accessible by India
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MEDICAL CODING
Log to be maintained with File name, Totalcharges, Specialty details, etc beforeCoding.
Coding of Diagnosis to the utmosts ecificit usin ICD-9 CM Manual.
Coding of Procedures by referring toCPT / HCPCS / ASI Manuals
After Coding, files to be handed over toCharges Department for processing.
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PATIENT DEMOGRAPHICS
Patient Account Numbering to be done, ifsystem does not generate automatically
Documents to be sorted Patient wise beforeentering into the system
, , , , ,
Employer, Home Ph, Work Ph, Guarantor,Marital Status, Subscriber details, Doctor#,Insurance information etc to be entered inthe system
After entering, printouts to be taken anddata to be checked
Log to be maintained with Total Patients,Patients entered, Pending details, etc.
any c ar cat on s
required, send mail to USoffice
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CHARGE ENTRYPatient Demographics and Coding tobe done before entering Charges
Charge File to be sorted by Patient/ Date of Service
Patient #, Doctor # , Place of Service, Type ofService, Date of Service, Procedure Code,Diagnosis Code, Modifier, Units, Value, Referral ,Prior Authorization, On Bill comments, etc. to beentered in the system
If any clarificationrequired, send mail to USoffice.
After entering data, file to be given toQuality Audit for checking
After checking and corrections, Claims tobe transmitted.
After Transmission, Charges completion
details to be sent to US office.
If any incorrect details
found, Charges departmentto be informed
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QUALITY AUDIT
Quality Audit for Patient Demographics andCharges before sending batch wise update toclient
Patient #, Name, Address, SSN, DOB, Home Ph,Work Ph, Guarantor, Subscriber details,Employer, etc to be checked in PatientDemographic File
After Quality Audit, files to be given toSupervisor / Manager for sending Batch Updateto client.
If any incorrect detailsfound, Charges Team to beinformed of the same andcorrection done
Date of Service, Procedure Code, DiagnosisCode, Modifier, Units, Value, Place of Service,Type of Service, Referral, Prior Authorization,On bill comments, Location, etc to be checked inCharges File
Log to be updated with patients checked, charges
checked, correction details, etc
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TRANSMISSION
Electronic / Paper
After Quality Check is through, Listof Electronic Claims to be separated
Transmission processes to beaccurately followed to avoidrejection
Claims to be transmittedelectronically through Fast claim,
Envoy, Halley, Navicure , Emdeon,Availityetc.
After transmission, log to be updated
with patient #, claim#, total claimstransmitted, pending claims, etc.
Send mail to Charges departmentafter completion of Transmission
If any incorrect details
found, Charges departmentto be informed
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INSURANCE FOLLOW UP
TREATMENTELIGIBILITY
COVERAGEINFORMATION
CONTRACTINFORMATION
DENIALREASONS
INSURANCEFOLLOW UP
CARRIER FEESCHEDULE
CLAIM STATUS
PAYMENTDETAILS
PROVIDERINFORMATION
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INSURANCE ANALYSIS
Claims pendingfor additionaldetails required
Claims not inthe Insurancesystem
Claims rejectedby Insurance
Claims deniedby Insurance
Claims pendingafter 30 days
Log to be updated with details ofPatient#, Name, Claim#, Value,Insurance reasons etc
Analysis and actions to be carriedout for resubmitting the claims
Claims to beprinted againand sent toinsurance
Claims to becorrected forrejections andresent to Carrier
Claims to becorrected fordenials andresent to Carrier
AR to follow upwith insuranceand get theclaim status
Information tobe faxed or sentthrough courierto the insurance
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PATIENT FOLLOW UP
TREA
TMEN
T
ORM
ATION
COVERAG
E
INFORM
ATII
PAYMENT
INFO
RMATION
PERS
ONA
L
INFO
RMA
TION
PATIENT
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PATIENT ANALYSIS
Bills returned due toincorrect address
No correspondencefrom patient
Patients givingwrong information
Patient Bills would be sentmonthly once and three times tothe patient.
Log to be updated with details ofPatient#, Name, Balance, Bills sentdetails
AR will follow up with thePatient for getting payment from
him
If Patient does not pay or respondproperly even after 90 days, hisaccount would be moved toCollection Agency.
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Doctor
AuditRecap
Patient
MONTH END REPORTS
Month-end
FinancialReports
nanc a
ServiceAnalysisReports
Financial
Aged AR
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REQUEST FOR INFORMATIONREQUEST FOR INFORMATION
We request to answer the following questions so that we can plan
our transition / migration and business process.
1. Volume of Business
2. Current AR
3. Total # of Providers in the Group4. Payer Mix
5. Software being used
6. Specialty
7. State in which the practice is located
8. MIS Reports of Last Month End and Year End
9. Clearinghouse being used
10. Access to your system for viewing Master Data
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Looking forward for a long termassociation with you.
San Francisco Bay Area
3940 Freedom Circle.
Santa Clara, CA -95054
Phone No : 408-200-7468
Los Angeles Area
200 Continental Blvd.
El Segundo, CA 90245
TrinityMag Global Services
E-74, 1st Floor, Bharat Nagar
New Friends Colony, New Delhi-110025
(646) 810 1148
E-mail: [email protected]