Healthcare

Employee Pooling (ʺEPʺ) Healthcare Services delivers specialized, turn‐key RCM support services to Independent Physicians, Physician Groups, and Billing Companies. “EP” has a team of Medical Billers and Coders helping clients with their deep insight and knowledge, propelled by strategically designed workflow processes.

Packaged as a complete solution for clients, EP’s RCM services allow clients to focus solely on patient care, whilst we the entire billing and payment collection process for them. The revenue collection cycle is shortened effectively allowing health care providers to provide better services.

We customize our services to suit client requirement and ensure that we deliver what we promise.

The following are Medical Billing Services that “EP” can currently assist with. You can retain as much responsibility as desired and work with “EP” to customize processes to meet your needs.

 

Revenue Cycle Management Services

1. Insurance Eligibility Verification

  • After the patient schedule is received we verify patients’ coverage benefits either by calling up the payer directly or thru payer websites. The services we provide for insurance verification are:
  • Preauthorization
  • Benefit verification
  • Updating the verified details in Practice Management System

2. Patient Demographic Entry

Patient data is validated and checked, the billing specialists enter patient demographic details in the Practice Management System. This step is critical for the claims to be paid, we ensure that details are entered accurately with no errors. The demographic data we validate/enter includes name, date of birth, address, insurance details, medical history, guarantor etc. as provided by the patients at the time of the visit. For established patients, these details are validated and change updated, if any, to the patient records on the Practice Management System.

3. CPT and ICD-10 Coding

Our coding team Follows CPT codes and ICD-10 Coding compliance. Super-bills may be sent to us with diagnostic notes with or without ICD and CPT codes. Super-bill will be validated by our coding team if codes are already provided to prevent any 'up-coding' or 'down-coding' and therefore, any denials.

4. Charge Entry

The billing specialists capture the date of service, billing provider, referring provider, POS, admission date, CPT / procedure codes, ICD-10, number of units and modifiers. An effective charge entry process can improve the financial health of healthcare service provider by eliminating reducing denials, revenue leakage and thereby improving patient satisfaction.

5. Claims Submission

Claims are submitted electronically using the Practice Management System (we can process paper claims also). We do a thorough quality check at this stage and then submit the claim. We analyse the reject report received from the clearing house and resubmit the claim after required changes are done.

6. Payment Posting

Payment Posting is a very crucial step. Payment Posting can be:

  • Manual Payment Posting.
  • Electronic Remittance Advisory (ERA) Posting.
  • Denial Posting

Payments, whether from payers or patients, are posted in Practice Management System using accurate posting methods. We analyze the data to identify underpayments, overpayment, and denials. Patient balances are captured and posted appropriately.

7. Account Receivables Follow-up

We run aging report in the billing system and priorities follow-up based on aging and dollar value of the claim. First, the claims close to their filing limits, and then work down from the age of the claim and take appropriate action. We follow-ups over phone or online with the payor to get the status of each claim submitted to the insurance company.

8. Denial Management

Denial management is a critical step for a healthy cash flow and successful revenue cycle management. Denials Management including analysis of partial payments and denied claims by our billing specialists. Payors, providers, and any other participants are called to follow-up on denied, underpaid, pending and other improperly processed claims and appropriate action is taken and documented in the system. Secondary paper claims are processed and sent to the client office for submission.

Why Employee Pooling (ʺEPʺ)?
  • Up to 40% savings on operating expenses
  • 24/7 support and services
  • Consistent superior service delivery in contrary to client SLAs and KPIs
  • Scalable resource pool with revenue cycle expertise
  • HIPAA-compliant process
  • ISO 27001:2013 certified
  • Strict information security policies and practices
Our Pricing Models

Unlike other revenue cycle management companies, we don’t trust in a one-size-fits-all approach. Instead, we analyze your operational requirements to tailor a go-forward plan to help your revenue cycle process remain on top of changes.

1.      Transaction Pricing – (Short term project)

2.      FTE Pricing – (Long-term projects)

3.     % of Collection 

RCM Brochure

To get the brochure please Click here