Medical Billing

Patient / Insurance Verifications

Eligibility Verification is a department in MEDHAMS, which functions exclusively for the verification of a patient's active coverage with the Insurance company, and also to check if he/she has an eligible benefit for the procedure to which he/she is scheduled in the facility/Doctor's office/Ambulatory Surgical Center, and finally ensuring that the patient that is about to walk-in for the procedure is thoroughly eligible for that service from the Insurance Company's perspective.

Benefits of Insurance Verification: :

•  Verification department minimizes the denial of the claims to increase the revenue.
•  Verify the Referral/Prior-authorization if the procedures are covered or not.
•  Verify whether provider is covered for the procedure like Lab services and DM
•  Determine the Deductible met and Copay for the services

Medical Coding

Medical coding is the process in which medical coders assign numerical codes to medical diagnoses and procedures in order to bill insurance companies for reimbursement for healthcare services.

Medhams coders are certified and Industry Experts with sound knowledge in ICD-10

Coding Process :

• Receive Medical records, Physician notes, Implant log and patient demographics from the Client
• We ensure that Common Procedural Terminology codes are assigned for every medical procedure and service provided to the patient.
• We Make Sure to code the Primary codes for all the services and add appropriate modifiers and add on codes in the coding level as per LCD & LMRP
• Quality team verified the codes issued
• Codes entered in to client system or sent securely via Server/FTP

Patient Demographics

• Medhams team access the information via the Server (or directly from Software Screen as the case may be) and enter information directly into the client software
• We have the ability to work on scanned images as well as electronically submitted demographic sheets.
• Medhams can accurately process insurance information (selecting appropriate insurance details).

Charge Entry

• Medhams specialist's process charges for all specialties with good appropriate state and specialty rules.
• Trained in regulations related to Medicare, Medicaid, Managed Care, Third Party Liability, Workers Compensation, Preferred Provider Organizations, Indemnity Insurers.
• Paper and Electronic claims are sent daily. Electronic claims are submitted directly to: Medicare, Medicaid, Blue Cross/Blue Shield & most commercial insurance carriers.
• Medhams performs Internal Quality Assurance at different levels to provide the high quality output.

Payment Posting

• Daily Deposits balanced accurately.
• For partial payments, analysis is done and corrective action is taken.

Our Payment Posting Capabilities include:

• Manual Posting
• Auto Posting
• Processing of Electronic Remittances
• Expertise with processing ERAs/EOBs for Medicare and literally 100's of Payers

Claims Analysis / Denial Management

• It is quite difficult to understand the requirements/ rules of the Insurance Companies and send all the claims as per their requirements. So, Insurance companies normally deny / reject the claims, which does not fulfill their requirements and mention the same in EOB copies / return the claims. Some of the insurance companies take more time to process the claims and some of the insurance companies may keep the claims with them for need of additional information from the practice.
• Due to the above situations, Analysis Team is necessary for every practice to identify the denied claims / pending claims / rejected claims and analyze the same for taking up the necessary

Common reasons for a claim denial:

• Patient registration errors.
• Lack of referral or authorization.
• Incorrect diagnosis codes.
• Correct coding edits.
• Duplicate billing.
• Timely filing.
• Changes to payors' organizations.

Claims / AR Follow Up

• Claims Analysis team analyzes the claims and they would be sending the queries/ information to Follow up Team to collect from Insurance Companies.
• They understand the functionalities of the insurance companies and they coordinate with the Insurance Representatives and receive the information.
• Our goal is Aging report follow-ups not to exceed 30 days

Provider Enrollment

• This is an important function for any practice and all the Physicians have to be enrolled with the Insurance Companies before they render the services to get the payments from the Insurance Companies. Otherwise Insurance companies would not pay for the services rendered by the physicians.
• For enrolling the physicians, MEDHAMS work closely with the physicians office to get their information and follow up with insurance companies for getting the enrollment done for the physicians.
• MEDHAMS maintain lot of confidential documents and play a major role in the development of practice.