Trans-Quest
26
Revenue Cycle Management & Medical Transcription Services
-
Upload
md-shahid -
Category
Health & Medicine
-
view
2.319 -
download
0
Transcript of Trans-Quest
Revenue Cycle Management & Medical Transcription Services
T
Is your money being kept from Is your money being kept from you?you?We are professionals trained to overcome the
hurdles and tactics being used by GIANT insurance companies and HMOs
We will work to reclaim what’s rightfully yours! We will work to reclaim what’s rightfully yours!
ABOUT USABOUT US Trans-quest is a HIPAA Compliant, Knowledge centric organization, offering integrated Healthcare Revenue Cycle Management services.
We provide ‘Accelerators’ to overcome process and resource limitations within your Revenue Cycle Management.
Our services encompass Medical Transcription, Medical Coding, Medical Billing, Denial Management and Accounts Receivables follow-up for Physician groups, Individual Practitioners and Hospitals
Trans-quest has accumulated experience in handling virtually any specialties and consciously provides cost containment, excellent skills and cutting edge technology.
PROFESSIONAL TEAMPROFESSIONAL TEAM
Our people are our greatest assets. They are the very core of our customer-oriented culture that allows us to guarantee service levels unmatched in the industry.
Professional Procedural Coders certified by American Academy for Professional Coders (AAPC)
Billing Specialists with experience in handling diverse specialties.
Experienced AR Analysts and Denial Management Specialists
INFRASTRUCTUREINFRASTRUCTUREInfrastructure is the backbone of our operations. Our state-of-the-art technology center comprises of:
2 MBPS Internet leased line with assured 24/7 connectivity.
Network Infrastructure and Disaster Recovery.
Structured cabling for all workstations.
Network and Server monitoring executed by professionals.
Data back up with remote storage facility
100 % power back-up using online UPS and Generator with 24/7 assurance.
Secured FTP facility.
Insurance companies benefit at the physician’s expense
Trans-quest is your catalyst, cutting down receivables and accelerating cash flow
SERVICE OFFERINGSEligibility
Patient’s coverage is verified prior to visit
CodingMedical Records are reviewed and coded by Certified Coders
Demographic & Charge Entry
Billing specialists enter patient demographics and charges into the PMS
Transmission and Posting
Claims are sent to the clearinghouse and payments (EOB) received are applied to the PMS
Accounts ReceivableIncrease in collection ratio through accurate analysis and timely follow up
Revenue RecoveryOld AR are analyzed and corrective measures are taken (Resubmission)
IMPORTANCE OF ELIGIBILITY IMPORTANCE OF ELIGIBILITY VERIFICATIONVERIFICATION
You cannot collect fees from an insurance company for ineligible patients.
We ensure that every patient has been screened for Eligibility before their appointment and before a claim is submitted to the insurance company Ineligibility of just 5% of patients, i.e. 1.5 patients/day assuming 264 working days at an average of $50 per encounter, the physician loses $19,800 annually
EligibilityPatient’s coverage is verified prior to visit
CodingMedical Records are reviewed and coded by Certified Coders
Demographic & Charge Entry
Billing specialists enter patient demographics and charges into the PMS
Transmission and Posting
Claims are sent to the clearinghouse and payments (EOB) received are applied to the PMS
Accounts ReceivableIncrease in collection ratio through accurate analysis and timely follow up
Revenue RecoveryOld AR are analyzed and corrective measures are taken (Resubmission)
PROPER CODING & PCAPROPER CODING & PCA Are your CPT, ICD, and HCPCS codes up to date and
valid? Proper coding equals proper reimbursement! Incorrect codes cause delayed or denied payments Errors impact your cash flow.
Procedure Code Analysis
Simply provide us with your Super Bill
Listing all of your CPT Codes Listing all of your ICD Codes Listing all of your HCPCS codes
We will integrate your CPT, ICD and HCPCS codes into our proprietary Procedure Code Analysis software and ensure that you no longer lose money due to wrong/invalid codes.
EligibilityPatient’s coverage is verified prior to visit
CodingMedical Records are reviewed and coded by Certified Coders
Demographic & Charge Entry
Billing specialists enter patient demographics and charges into the PMS
Transmission and Posting
Claims are sent to the clearinghouse and payments (EOB) received are applied to the PMS
Accounts ReceivableIncrease in collection ratio through accurate analysis and timely follow up
Revenue RecoveryOld AR are analyzed and corrective measures are taken (Resubmission)
THE BOTTOM LINETHE BOTTOM LINE
Minor Oversights Can Have a Major Impact:
Invalid Codes 10
Frequency of Use Once a Week
Average Charge $50 per Code
Projected Cost $25,000 of lost revenue in a 50-week year!
ACCURATE ENTRY AND SUBMISSIONACCURATE ENTRY AND SUBMISSION
All our staff are trained internally and must have a minimum of 2 year “specialized” medical billing experience.
Our 3-tier Quality Assurance process ensures industry-leading accuracy
Level 1: QC check by specialized QC team
Level 2: Validation Check by software
Level 3: Validation Check by Clearinghouse software
We adhere to strict workflow management processes, that make sure there is absolutely no dropin quality standards
EligibilityPatient’s coverage is verified prior to visit
CodingMedical Records are reviewed and coded by Certified Coders
Demographic & Charge Entry
Billing specialists enter patient demographics and charges into the PMS
Transmission and Posting
Claims are sent to the clearinghouse and payments (EOB) received are applied to the PMS
Accounts ReceivableIncrease in collection ratio through accurate analysis and timely follow up
Revenue RecoveryOld AR are analyzed and corrective measures are taken (Resubmission)
ACCURATE ELECTRONIC CLAIMS ACCURATE ELECTRONIC CLAIMS TRANSMISSIONTRANSMISSION
Our target is to electronically transmit all claims within 12 hours from the time the Charge Sheets (Superbills) and correct patient documents are received by our office.
We receive a specialized acknowledgement report after transmission for immediate follow-up
One of the most common denial reasons given by insurance companies is that the claim is not in the system. We dispute the denial instantly since we maintain the proof of transmission for each claim.
Two types of reports generated after transmission
A) L1 Report – Generated 30 minutes after transmission, which does a validation check before forwarding to the insurance company.B) L2 Report – Generated 24 hours after transmission, which serves as an acknowledgement that the claims have reached the insurance company.
EligibilityPatient’s coverage is verified prior to visit
CodingMedical Records are reviewed and coded by Certified Coders
Demographic & Charge Entry
Billing specialists enter patient demographics and charges into the PMS
Transmission and Posting
Claims are sent to the clearinghouse and payments (EOB) received are applied to the PMS
Accounts ReceivableIncrease in collection ratio through accurate analysis and timely follow up
Revenue RecoveryOld AR are analyzed and corrective measures are taken (Resubmission)
INDUSTRY BEST PRACTICE BENCHMARKINDUSTRY BEST PRACTICE BENCHMARK
The total accounts receivable in the 0-30 day aging category should not exceed 70 percent of monthly charges.
The A/R in the 31-60 day category should not exceed 15 percent of monthly charges.
The A/R in the 61-90 day category should not exceed 10 percent of monthly charges.
The A/R in the 91-120 day category should not exceed 7 percent of charges.
EligibilityPatient’s coverage is verified prior to visit
CodingMedical Records are reviewed and coded by Certified Coders
Demographic & Charge Entry
Billing specialists enter patient demographics and charges into the PMS
Transmission and Posting
Claims are sent to the clearinghouse and payments (EOB) received are applied to the PMS
Accounts ReceivableIncrease in collection ratio through accurate analysis and timely follow up
Revenue RecoveryOld AR are analyzed and corrective measures are taken (Resubmission)
DENIAL MANAGEMENTDENIAL MANAGEMENT
Denied claims are worked on, rectified and resubmitted within 24 Hours on receipt of EOB.
All Denials which require additional documentation, are sent to the Doctor’s office on the same day that the EOB is posted.
We specialize in working your old Account Receivables and we are well versed with using correct appeal procedures in conjunction with Healthcare Laws.
DENIAL MANAGEMENTDENIAL MANAGEMENT
At Trans-quest Denial Management is handled by:
Identification of key denial reasons.
Identification of non-contractual adjustments due to denials.
Identification of Problematic Payers.
Identification of contractual issues.
Qualification of denial reasons.
Understand the financial impact.
Trans-quest optimizes Denial Management by:
Providing Good Documentation.
Using accurate Procedure codes and modifiers.
Utilizing well-informed, trained and qualified staff.
DENIAL MANAGEMENTDENIAL MANAGEMENT How do Trans-quest services help?
By entering correct and accurate details in the PMS.
Removing inconsistencies in the system that lead to denials.
Following up on claims until paid.
By using a tracking system, Trans-quest identifies
Type of Denial.
Reason for Denial.
Resolution of the Denial.
Corrective and Preventive action to eliminate denials in the future.
Benefits Of Denial Management:
Improved and accelerated cash flow.
Reduction in write offs.
AGGRESSIVE FOLLOW-UPAGGRESSIVE FOLLOW-UP
Our A/R and Denial Management Specialists receive extensive
training in AR follow-up. Aggressive follow-up starts 21 days after claim submission.
Our Specialists are chosen for their analytical skills and are provided with access to all the documentation required to make sure that the claim is paid on the first call.
E.g. When the Insurance rep says that the claim is “Not in system”, our Specialists are taught to immediately
retrieve the clearinghouse confirmation from our database and fax it while still on the call.
SUMMARY OF SERVICESSUMMARY OF SERVICES Insurance and Eligibility Verification.
Patient Demographics, Coding and Charge entry.
Payment Posting and Reconciliation.
Electronic and Paper Claim Filing.
Secondary Carrier billing.
Denial/Rejection Analysis.
Insurance follow-up and Appeals.
Practice Process Analysis and Continuous Improvement.
Additional Billable Services
Patient Statements, Collection Notices, Reminder Calls
Correspondence, Credentialing and Re-Credentialing.
HIPAA Compliance and Consulting.
Trans-quest’s Advantages vs In-house Billing
• Corporate Approach– Specialization, individual accountability, and
emphasis on reporting and metrics• Flexibility and Scalability
– Predictable cost component regardless of growth or seasonality
• Professional Qualifications– Heavy concentration of certified coders, trained in
an environment that crafts expertise with Trans-quest Office
• Total Focus, No Distractions– No site-level distractions due to compound duties
• ROI– Our staff is cost-competitive with most existing
billing operations, and allows staff to be productive in patient care and throughput
Trans-quest Advantages vs. Other Billing Companies
• Enhanced Analysis Based on Large-Sample Data (Benchmarking)– Better idea of acceptable performance in different
specialties• Professional Metrics
– Trend tracking, Daily / Weekly/ Monthly Financial Reports, Collection Reports
• More Manpower– Our ratio of staff per account is well above industry
standard, for higher touch and redundancy as well as better specialization
• Separation of Labor– No crossover in staff from one account to another.
Primary billers working your account are exclusive to your company. This results in more familiarity, improved performance and better HIPAA controls
• Application expertise
QUALITY MANAGEMENTQUALITY MANAGEMENT
The Quality Management System
Processes based on ISO best practices for all the elements, across entire lifecycle of an outsourcing engagement.
Build the security infrastructure in line with ISO Standards.
Define Business Continuity Management Systems. (BCM)
Knowledge Management
Process
Leadership
Quality Management
System
Technology People
Operations/Delivery
QUALITY ASSURANCEQUALITY ASSURANCE Experienced Quality Assurance team.
Initial training for all process associates prior to job assignment.
Monthly training based on continuously identified needs.
Live monitoring of transactions for each process associate.
Quality assessments of completed work based on random sampling.
Redundant Screening through many processes
Weekly quality review meetings to discuss quality concerns identified by our Quality Audit department
All employees are required to take refresher courses in respective departments
Monthly evaluations of all staff
VALUE PROPOSITION AND VALUE PROPOSITION AND PRINCIPLESPRINCIPLES
Allowing our customers to focus on Patient CareSuperior ServiceROI
Increased revenueReduced AR DaysLower Bad Debt Write-offs Reduced operational cost
On-time DeliveryFaster turnaround timeAccuracyProcess ComplianceInformation Security ComplianceTrend Analysis for Continuous Improvement
HIPAA – PHYSICAL SECURITY STANDARDS
HIPAA AT Trans-quest
Facility Access Controls
Centralized keycard access control across the entire billing facility.
Facility Security Plan
Locked doors, posted notice of restricted areas, Private security service for the facility.
Access Control and Validation process
Common practice is to question a person’s identity by asking for proof of identity, such as a picture ID, before allowing access to a facility.
Maintenance of Records
Maintain a logbook that notes the date, reason for repair and the person who authorized it.
Workstation Use and Security
Account creation through the network resources. Modifies and suspends user privileges through web interface.
Data Back-up and Storage
Maintain retrievable exact copies of PHI. Protect the security of PHI while operating in an emergency mode.
HIPAA – TECHNICAL SECURITY STANDARDSHIPAA – TECHNICAL SECURITY STANDARDS
HIPAA AT Trans-quest
Access Control Unique user identification, Emergency Access procedure, Automatic Logoff, Encryption and Decryption.
Audit Control Audit takes place once every 3 months, on the hardware, software and procedural mechanisms which record and examine activity in information systems that contain PHI.
Integrity We implement policies and procedures to protect PHI from alteration and destruction. We ensure that the access to PHI by a workforce member is appropriate.
Transmission Security Encrypted data transmission and password-protected electronic fax lines
