Audit

Basically, there are only two ways for any company to improve its bottom line—increase revenue or decrease costs. Medical billing is a complex process and when the billing covers more complex matters or multiple events, the opportunities for errors multiply and so do the costs. The skill set and experience required to identify and challenge errors is a specialized expertise.

Our Audit procedure is very fair, transparent and we support our claim with evidence thus enabling you to cross match it with your records. Once we compile the results of Audit then we can define a strategy as how to fix these issues and increase your reimbursements/bottom line which is the essence of the audit.
Audit

We cover the following areas in Audit:

  • Fee Schedule: Are you getting paid by insurance companies what you actually deserve as per your fee schedule and are you billing them the right amount?
  • Billing and Coding Discrepancies: Is your billing company doing an outstanding job. Are they familiar with the coding changes and regulations, denied claims % etc.
  • Financial Bleeding: How much money have you lost and losing because of billing errors on a monthly basis
  • Accounts Receivable: How much is your AR for a particular month that we will do Audit for and also your average time frame to get the payments (Turn Around Time)
  • Identification of Weak Areas: Any errors, weak links, improvement areas
  • Compiling Audit Results: A detailed Audit report with evidences and numbers in black and white
  • Strategy Moving Forward: Suggest the moving forward strategy and how to overcome these areas

By making an audit a part of standard business practice, healthcare providers can add six- or seven-figure savings in their costs back to their bottom line.

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The eligibility verification process at PBS :

Eligibility Verification

Eligibility verification is the first step in patient registration process. Its the foundation for overall patient data management. Effective verification is compulsory for overall optimized revenue cycle management and we at PBS very well understand this.

Our verification system will:

  • Improve Account Receivable Cycles (reduce AR days)
  • Increase number of clean claims
  • Increase cash collections by reducing write-offs and denials

Payment Posting

Our experience in handling a number of medical billing softwares among various specialties helps us to begin charge entry directly, saving training time and effort. We ensure that relevant checks are made at each processing stage. The process is time bound with a turnaround time of 24 hours and is administered by a team well versed in medical billing software packages like Adapta Med, Advanced Data Systems (ADS), Medisoft, eClinicalWorks (ECW) among others.

Following HIPAA rules and regulations, all claims are processed in formats required by the insurance companies, with electronic claims being sent in the ANSI and NSF formats and paper claims being dispatched in HCFA1500 format. Our processes are optimally automated to ensure minimal errors and high processing speed.

Charge Posting

Demographic Entries

Our accurate data processing ensures clean claims and does reduce denials drastically. Our experienced team registers all patient information with high accuracy. We ensure to choose the correct Insurance codes from the Insurance master list. We capture specific information based on the software and specialty. We have the ability to make accurate entries looking at scanned images.

Our demographics registration process captures accurate patient, guarantor and insurance information.

Our process includes the following checks:

  • New patient or existing patient
  • If new patient, capture all required information
  • Existing patient – Update latest insurance, patient and guarantor information

Charge Entries

Our team has the ability to process both manual and review electronic charge entries available in EHR / EMR. We capture all relevant information from the super-bill like Performing Provider, Referring Provider, Date of Services, Location, Place of Services, Type of Service, Admission Date, Discharge Date, Number of units, Authorization Numbers, Referral Numbers, ICD Codes, CPT Codes, Modifiers etc.,

Our team has the experience to link the correct ICD codes to each CPT code avoiding unnecessary rejections and denials.

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Account Receivables Management

Accounts Receivable is usually the most sensitive area in the medical practice and is often the most ignored aspect. When cash flow is good, it is easy to focus on other areas of the practice. But when it slows down, we tend to point fingers which do little to solve the problem.

Establishing workable policies, monitoring their efficiency and adapting them as per circumstances will keep collections under control and this requires a genuine commitment which PBS offers.

We can help you:

  • Reduce average AR days to less than 45 days.
  • Drop the claims aged 120 days or older to less than 5% of total AR
  • Increase the collection ratio by 15% or more from the current level
  • Reduce write-offs from bad debt
  • Reduce claim denials
  • Improve your cash flow
  • Help you get paid promptly and in full for each claim

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Chronic Care Management

PBSMD offers a turn-key solution for practices, allowing you to receive your CCM revenue. The program provides a Call Center of trained and certified medical assistants who:

- Conduct chronic care phone calls with your patients each month
- Document the calls appropriately and securely in your EHR

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