Patient Billing and Coding Solution for Practice
Management Software |
| The Task |
| To develop a comprehensive billing solution for US healthcare practices meeting CMS, NUCC, HIPAA regulatory standards and Insurance company's policies and processing requirements. |
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| The Challenges |
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Support for both Government and Private multiple health insurance plans and in variety of ways including guarantor, co pay, primary/secondary/tertiary |
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Timely and accurate charge entry and claim generation |
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Electronic and Paper claims generation |
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Implementation and conformance to applicable standards including HIPAA, standard procedures CPT and illness nomenclature ICD. |
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| The Solution |
| Binary Spectrum developed a comprehensive complete billing solution with the following features: |
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Charge Capture |
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New claim |
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Find claims |
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Paper claims conforming to NUCC |
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Electronic Claim Transmission |
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Payments Recording |
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Patient statements |
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Rebilling |
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Apply transactions |
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| After every visit, the provider prepares a bill based on which a charge is created for the patient. Information on facility, case, accident, and co-pay is maintained. This application helps display details of patient account number, insurance profile, place of service, physician name, patient's illness, type of accident, state of accident, expected and actual co-pay. Additional details supporting this application consist of type of claim generated and CPT codes. The CPT codes helps in calculation of the charge that would be paid by the insurance company. |
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| Claims are generated on NUCC 1500 format through paper or through ECT. These claims can be reviewed and re-billed in case of any issues found during the billing process. There are modifiers wherein the minor services rendered along with CPT are posted. The posted items can be modified and can be applied for refund if it's an insurance payment transaction. The payment entry can be done based on the type of transaction like insurance payment, credit or debit adjustment, write-off, denial or transfer. |
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| The Result: |
| The application helps doctors to get paid accurately and in a timely manner. It provides insight on the receivables which can be actively followed up. |
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