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Medical Billing at Pacific

Medical Billing has become the crucial part of revenue management for the healthcare service provider and hospitals. Millions of dollars are lost annually due to under pricing, coding errors, missed charges and un-reimbursed claims. Pacific's medical billing service enables to eliminate these loses and accurately process the medical billing. Our professional approach and expertise always helps our client by freeing with the tedious tasks of billing and follow-up function. Pacific's medical billing service incorporates latest technological and software developments and is very user friendly. Medical Billing service is customized to meet individual clients specific requirements.

Medical Billing Experts at Pacific

At Pacific our medical billers understand the basic and major medical coverage plans, such as the Fee-for-Service Plans, Health Maintenance Organizations (HMOs), Point-of-Service Plans (POS), and Preferred Provider Organizations (PPOs), and know the different methods of billing patients and understand the medical billing industry and all it's complexities.Medical Billers at Pacific are experts with the terminology & softwares most often used in a medical office like MediSoft, Surgi Source, AdvantX etc.; they have expertise to electronically file claims, and knowledge on the most common types of insurance policies. Medical Billing experts understand database management, spreadsheets, electronic mail, and possess state of the art word processing skills, proficient in bookkeeping. Our Medical Billing experts will explain charges to the patients, and communicate effectively. Medical Billers also have a good working knowledge of medical terminology, anatomy; claims form completion, and coding. Our Medical billing specialists also process responses from the insurance companies which include the - explanation of benefits (EOB).

Medical Billing Services

Data entry - we obtain information from the provider and/or practice and enter this information into our database.

File claims - most claims are filed electronically and only a few go on paper. This is dependent upon the insurance carrier the claims are going to.

Statements - are mailed out from our office on behalf of facility. The protocols of statements and collections are done specifically to client's specifications.

Payments - as we receive payments and explanations of benefits from client, we post these in to our database. Each EOB will be audited for correct payment and/or benefits.

Reports - are done on a monthly basis. Because each provider and/or practice is different, we are always open to customize reports on client's requirements.

Medical billing is a serious business in this day and age of medical practices. Without the proper knowledge of medical billing and reimbursement methodologies, providers and practices will not receive the proper reimbursements, if any reimbursement at all. Pacific can help to manage billing process professionally and enhance your revenue generation.

Demographic and Charge Services

Pacific is a leading Back-Office Provider of offshore Medical Billing Services to Healthcare Organizations. We have expertise in Demographic and Charge entry service for many Specialties ranging from General Practice to more complicated specialties.We provide demographic identification and verification as patients register for healthcare services. Verification of patient demographic information at the time of registration provides significant benefits to the healthcare service providers; better staff productivity, fast reimbursement and enhanced customer satisfaction.

Demographic Entry Service

New demo:

Individual patient details are cataloged in billing software. The entries done consist of Patient Demographics, Insurance, Employment and sponsor details.

Modify demo:

This service consists verifying patient information, registered in the billing software with the current information and update if necessary.

Charge Entry service

Charge entry

Our charge entry service consists of entering CPT codes, ICD codes, modifiers and other related information into the Billing Software.

Claim submission

The claims submission to insurance company proceeds electronically after demographics and charges are entered in to the billing software. Speeding up the reimbursement and reducing the claim rejection.

Quality process

Pacific has two levels of checks for claim processing. This reduces underpayments and denials of claims substantially and provides prompt and accurate settlement of claims.

Stage I: Our quality assurance team does complete checkup of each and every entry of demographic and charges fields in Billing software. This process itself reduces 99% of the errors. Audit is conducted ascertaining maximum accuracy. We audit each and every field in demographic and charges.

Stage II: 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.

Payment/ Deposits posting Services

Pacific's professional Cash posting Service delivers account creation and payment posting service for each individual patient record and effectively lowers the overall cost of Healthcare providers. Recording and managing of cash posting service requires expert and dedicated human skills and innovative technology. Our highly skilled and experienced executives do Insurance payment posting, Self-pay posting and Denial posting, maintaining high levels of accuracy and confidentiality.

Our success in cash posting service has been driven through successful assimilation of technology and customer focus. We have constantly invested in technology and experienced manpower. Our solutions have increased productivity and reduced equipment, manpower and infrastructure costs.

Payment Posting Service

Insurance payment posting

Payment posting service consists of posting primary insurance payments, adjustments and transfer co-insurance to secondary insurance (if available) or patient. Posting of secondary insurance payment is also done by us.

Self-pay posting

Self-pay posting service consists of posting payments made by patients to the healthcare provider.

Denial posting

Claims needing resubmission that is claims denied by insurance are checked for all necessary documents like Medical records, Referral, Authorization etc. and resubmitted.

Quality process

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.

Reports

The reports regarding transaction volume (Number of line items received and submitted by us) are provided to clients as part of the service. These reports are generated Daily, Weekly/Fortnight, Monthly based on the customers preference.

Accounts Receivable Services

Pacific's Accounts Receivable Service saves Healthcare service providers valuable practice time and resources and focus on building core competencies.

Many healthcare providers have tried managing accounts receivables, in the process ended up mismanaging the whole thing, resulting in reduced cash flow and increased collection cost and negligence. Our account receivable service improves cash flow, reduces account receivables, increases collection ratios, and enhances customer relationships with timely Accounts Receivable Follow-Up Service.Pacific has invested in building cutting-edge technology and highly skilled workforce to provide best practice and service. Our professional approach and timely follow-up has increased the revenue to many healthcare providers. Call center executives meticulously follow patient records, analyze them, take up with the insurance companies, address and rectify the problem.

Account Receivable Service

Receivable AnalysisPayer Follow-upDenials ManagementReportingPractice Analysis

Account Receivable Process

Assessment Process:

Daily Insurance aging report is run and claims are analyzed. The analysis is done to identify:

› Un-paid Claims
› Low Paid Claims
› Denied Claims
› Rejected Claims
› Claims not on file

Analysis Process:

Our competent and knowledgeable professionals review each claim in each payor type to insure proper reimbursement to the healthcare provider. After the Claims are analyzed, steps are initiated based on the following:

› Claims needing resubmission are checked for all necessary documents like Medical records, Referral, Authorization etc. and resubmitted.
› Claims that need to be appealed for low payment, timely filing etc.
› Separation of Denials.
› Issue of instructions to the callers for follow-up to get the status.

Quality process

Quality audits are done at every stage and all accounts that are given for calling are closely monitored. Account receivables are tracked and documented properly.

Reports

The following reports are generated monthly or as per client's preference. Reports provide information on monthly collection and account receivable outstanding.

› Estimated Account Receivable Payments
› Practice Analysis
› Collection Ratio Report
› Insurance Analysis
› Account Receivable Aging Report
› Insurance Aging

Full Practice Service

Pacific Medical Business provides full practice management. Our objective is to be the best full practice service provider at a reasonable cost. This objective has served us well, as we have never failed to exceed the performance expected from our clients. Claims are aggressively monitored to ensure the accurate and timely processing. Customized reports are also generated based on client's requirements.

Benefits

Confidentiality

Confidentiality of medical records is assured by providing secure locked files for all records. Computerized records are password protected and kept separate from other databanks. Pacific has zero tolerance policy for any breech of confidentiality.

Direct Contact

Our flexible work environment allows you direct communication round the clock when you have questions or concerns regarding your practice.

Responsibility

Pacific takes responsibility for all the systems necessary to assure proper payments, as well as for keeping up with the constantly changing rules and regulations associated with medical billing.

Cost Benefits

Outsourcing eliminates costly and unproductive training periods, frees you of the burden of billing & collections. Medical Healthcare providers will have more time for better patient care due to reduced paperwork.

Pacific serves to new practices as well as established practices. Cash flow is the lifeblood of any practice. New practice cannot afford to experiment with the unknown concerning their billing. It is vital to have the billing system up and running as fast as possible. Pacific assures a smooth and predictable transition for the start-up, as well as for the established practice.


In today's economy, you have to be good today and better tomorrow. Flexibility is critical and you cant achieve it alone.
 
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