Re-engineered healthcare processes
Practice Management Systems
About Globe RCM
GlobeRCM process improvement audit is to ensure process reliability in terms of documentation, delivery and quality. Identify improvement opportunities in standards and procedures Improved consistency and lower variability Reduced errors, rework, cycle time, cost etc..
All the internal errors captured during QC will be updated in the internal error log on the same day and feedback is given to the individuals. Team Leads will ensure that they maintain all the required details of an error like Batch#, Page#, Scan date, process date, process Name, Error description, Entry Name, QC name, QC date etc.
TAT report need to be updated based on the download and upload of the files. Any delay in the upload for any file should be justified in the remarks column on Client report. If there is going to be any downtime internally or externally it will be documented in the downtime time report.
Quality Assurance and audit in all sub process. Cross training matrix will be updated as and when required depending on internal movements, new joiner on board etc.
Claim transmission process at is zero free rejections by having random audit on all the claims on regular basis before transmission, to avoid rejection. GlobeRCM has a great experience of transmitting claims through different clearing house, like Availity/Cortex/Gateway/Navicure etc. Regular follow/up with clearing house and if there is any bomb transmission, it will be resolved in high priority. With the help of billing guidelines/ client specifications and with quality audit, rejections are highly reduced. GlobeRCM submit claims, which substantially reduces the amount of time the healthcare provider waits for payment as electronic claims are processed faster than claims submitted on paper.
CHARGE & DEMO ENTRY & INSURANCE VERIFICATION
GlobeRCM verify the patient information from the insurance like Co-pay, Deductible, Co-insurance, coverage period, benefits, life time max, claim mailing address, referrals and authorizations for the specific service. According to client specifications billing guidelines the charge is been created and audited twice before transmission.
Posting of Insurance and Patient Payments in the Client software by viewing the Explanation of Benefits and GlobeRCM ensure the benefits received by insurance like Payments, Co-insurance, Deductible, Adjustments, Write offs, etc posted in the client software perfectly to maintain the payment records. After posting the payment GlobeRCM transfers the patient balance like co-insurance, deductible and submits the co-ins to the secondary payer. Payment posting process at S-Pro is advanced implementing new technique to post electronically to reduce the manual processes. Based on Explanation of Benefits (EOB), the payments will be posted/reconciled in the Practice Management System. Regular follow up on electronic fund transfer to reduce the reimbursement TAT.
AR / COLLECTIONS
Accounts Receivable is the mainframe for medical billing service. S-Pro Account receivable analysts is been divided into two teams, one team dedicated for old AR (Above 120 days) and another one is for current AR ( 30 days to 60 days).Regular Follow up on pending claims and follow up on the appeals is done by the AR Team. Work order is been generated in daily basis for the better cash flow. According to the pending claims and higher $ value, the work order are generated for calling the insurances and all the information is documented in the clients practice management system. According to the insurance response for the balance, in the event of additional information or patient balance, AR analyst’s team will coordinate with the patient or insurance to take appropriate actions.
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