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Medical Billing Process at Outsource2india

The medical billing process flowchart at O2I follows a series of clearly defined steps with a complete focus on accuracy, quality and process audits. The following are the steps involved in the medical billing process at O2I:

Insurance verification
1
Patient demographic entry
2
CPT & ICD-9 coding
3
Charge entry
4
Claims submission
5
Payment posting
6
A/R follow-up
7
Denial management
8
Reporting
9
  1. Claims Transmission to O2I: The hospital forwards the medical claims to O2I's medical billing team via courier or as scanned documents. The medical claim is supported by patient details such as demographics, superbills, charge sheets, insurance verification data, a copy of the insurance card and any other information pertaining to the patient. All such documentation is scanned and uploaded onto our secure FTP server for access by O2I's expert medical billing staff.
  2. Retrieval and Checking of Medical Claims by our Team: O2I's medical billing staff access the medical claims and supporting documents from our secure FTP servers. All documents are checked for illegible or missing documents and the hospital billing office is notified immediately so that they can re-scan and send missing documents.
  3. Medical Coding: An important step in claims processing is to fix the procedure and diagnoses codes for each patient based on standards such as CPT ('Current Procedural Terminology')and ICD-9 (International Classification of Diseases, Ninth Edition). The 'level of service' determines the associated 5-digit 'procedure code' while the 'diagnosis code' is based on the medical diagnosis made by the doctor.
  4. Charge Creation: Our trained Medical Billing professionals will then create appropriate medical claims based on billing rules pertaining to specific carriers and locations. All medical claims are created within agreed turnaround times - generally 24 hours. A thorough audit and checking of the completed medical claims is done at multiple levels within O2I. The medical claims are checked for valid and complete information, correct procedure and diagnosis codes and veracity of all other relevant information about the patient since incomplete/incorrect information is one the single most common cause for rejection of medical claims.
  5. Medical Claims Audit: A thorough audit and checking of the completed medical claims is done at multiple levels within O2I. The medical claims are checked for valid and complete information, correct procedure and diagnosis codes and veracity of all other relevant information about the patient since incomplete/incorrect information is one the single most common cause for rejection of medical claims.
  6. Medical Claims Transmission: Medical claims created are filed for follow up before they are sent electronically to the claims transmission department with all relevant information on each medical claim.
  7. Claims Submission to Insurance Agencies: The audited, listed and recorded medical claims are now printed out and dispatched to concerned Insurance Agencies or governmental departments with any attachments or supporting documents that may be required for ultimate settlement.
  8. Follow-up and Settlement: This involves the final stages when our expert medical billing team follows up consistently with the insurers and payment agencies until the final settlement is disbursed.

Medical records of patients at a hospital contain demographic details about the patient, summary of his medical history, summary of diagnoses and regular medical updates on each physician visit. The patient settles the payment by submission of his medical insurance details at the hospital front desk. It is implied that the hospital or healthcare facility receives the final payment only when the insuring agency settles the claim.

Medical Billing Process: The O2I Advantage

O2I has over 12 years of experience in providing expert medical billing services to healthcare service providers, medical billing companies and insurance companies, mainly in the U.S. and UK. Our services include a range of medical billing activities such as patient demographics entry, charge entry and posting, accounts receivable and claims follow-up besides other services.

Gain in the following ways, by outsourcing your medical billing requirements to O2I:

Quality Assurance at O2I

  • Medical Claims Audit
  • Strict quality control standards
  • Quality Assurance reviews of all claims before submission
  • Billing and coding claims review log
  • Monthly billing review

Communication Best Practices

  • Email, fax and voice communication
  • Use of templates and protocols to streamline medical billing process. Both O2I and customer reviews updated spreadsheets and medical billing review log
  • All electronic documents preserved for about 120 days unless otherwise specified (with all paper documents being destroyed)

Security measures at O2I

  • Confidentiality of billing data
  • Restricted employee access to files and folders
  • Patient Data Privacy
  • Secure FTP Servers
  • Systematic data back up of all patient visits
  • Detailed internal data and communication back up

Compliance Standards at O2I

  • HIPAA compliant
  • Trained in regulations related to Medicare, Medicaid, managed care, third party liability, workers compensation, Preferred Provider organizations, indemnity insurers
  • Proficient in medical claims standards such as CPT, HCPCS, ICD-9
  • Proficiencies in Medical Coding - Level I, II, III

Concerns in Outsourcing Medical Billing to India

Medical Billing service providers in India are well established and have significant experience in the industry. With an in-depth knowledge about the factors that drive the industry, their awareness on generic problems faced in medical billing is also high.

Some of the most common concerns about outsourcing medical billing services are:

  • Healthcare fraud
  • Inaccuracies in submission of medical claims
  • Non-conformance to all existing Federal, State and Payer regulations
  • Stringent compliance requirements
  • Need for familiarity with U.S. medical billing laws

Medical Billing Services – Precautions by Indian Companies: There are programs designed to communicate reportable compliance items to billing agents. Medical billing service providers have familiarized themselves with US medical billing industry practices. With adequate training and knowledge sharing mechanisms in place, medical billing companies in India ensure that each staff member has access to vast knowledge repositories on the latest in the medical billing domain. Ongoing program development and implementation significantly reduce the risk of inappropriate medical billing practices and unlawful billing techniques.

Read more about the advantages of outsourcing medical billing to India.

Outsource Medical Billing Services to O2I

Outsourcing medical billing is a common practice today and O2I has the skill, expertise, and knowledge to deliver cost effective, quality results. If you would like to find out more about O2I's medical billing services, please fill in the inquiry form and our Client Engagement Team will contact you within 24 hours. Let us assist you through the outsourcing process by catering to all your medical billing requirements.

Please contact us here with your outsourcing requirements.

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