Our company, Cleverbuck Solutions Inc ., is recognized as a International leader in medical billing and coding services. Via the streamlined medical billing procedure, we have aided numerous healthcare service providers throughout the years.
At Cleverbuck Solutions Inc., the skilled specialists employ the most effective technology to do the task for our clients. Customer satisfaction is and will always be our top focus. For the past two years, we have provided our valued service and amassed a base of devoted customers that serve as a testimonial for our abilities.
As a market leader in medical billing and coding services, we always ensure that our clients see increased collections. Our extensive multispecialty billing experience improves our performance and allows us to stay on top of industry changes.
Throughout a patient's entire medical episode, there are various financial transactions involved. Many financial transactions take place during the entire process, starting with the patient entering the healthcare facility to register and ending with the final payment of bills.
A crucial part of the billing process that makes use of our coders, billing, EHR, and medical billing software is revenue cycle management. It ties together the patient's medical and administrative data and unites the clinical and commercial facets of the healthcare sector.
We help hospitals and health systems enhance revenue, focus on delivering high-quality care, and improve patient experience. We have a staff of over 100+ highly skilled employees ready to relieve your workload.
Health systems, hospitals, and medical organizations can benefit from our full-cycle revenue cycle management services and industry-leading process automation technology in the following ways:
1. Better collections
2. Decrease overall process costs.
3. Cut back on A/R days
4. Enhance previous authorization and eligibility verification Improve the accuracy of medical coding
5. Enhance governance and compliance control daily business operations and the revenue cycle.
6. Simplify procedures
7. Everything was made simple with our end-to-end revenue cycle management; from the first visit to the last payment.
8. Medical Billing Services
9. Clean claims must be submitted, and timely follow-up with insurance companies is required.
10. Medical Coding.
The medical billing industry has developed into a crucial part of the healthcare sector. It is a very time-consuming process to submit the claim paperwork, follow up, and appeal the claim with the insurance company. But, Cleverbuck Solutions Inc, makes sure that you don't have to worry about any of the stressful responsibilities by taking care of them all for you.
Our staff of skilled medical billers and coders is prepared to offer the customers a service that will meet all of their needs. If our clients have any unique requests, we make sure that the solutions are designed specifically to meet those requests.
Benefits of Medical Billing Services:
1. Medical billing translates a healthcare service into a billing claim.
2. The responsibility of the medical biller in a healthcare facility is to follow the claim to ensure the practice receives REIMBURSEMENT for the work the providers perform.
3. A knowledgeable biller can optimize revenue performance for the practice
Electronic Medical Records (EMR) and Electronic Health Records (EHR) are two types of digital medical billing systems that are reliable and follow the rules set forth by the federal government. EMR and EHR will assist medical service providers in receiving timely payment from insurance companies.
In the market, there are several EMR/EHR software suppliers, and each of them has a unique product to offer. We at Cleverbuck Solutions Inc can offer you a complete medical billing solution and are equipped and educated to use the majority of the top EMR/EHR software currently on the market.
In order to get your claims paid on time, our team of proficient licensed medical coders from AAPC and AHIMA works quickly on your medical data and precisely codes to the utmost specificity.
Medical coding is the process of transforming healthcare diagnoses, practices, services, and equipment into internationally recognized medical alphanumeric codes.
Medical records are created each time a patient sees a doctor, physician, or other healthcare professional.
The documentation for these medical records could be anything from a transcription of a doctor's notes to lab and radiological reports.
Professionals with training in medical coding and billing subsequently convert the medical records into global alphanumeric codes. The insurance payers who will make the payment receive the converted codes next. then, with the
Our team of medical coding experts ensures that our clients are properly maximizing their revenue in a compliant and accurate manner by staying up to date on the latest industry changes, including ICD10- CM, ICD-10-PCS, CPT, and HCPCS. Our AAPC and AHIMA certified coders are also up to date on all other relevant industry changes.
You may anticipate complete, effective, and end-to-end risk adjustment coding services that will have a favorable influence on your healthcare organization by utilizing our meticulous processes that are based on the highest standards.
Medical transcription, also known as MT, is an allied health profession dealing with the process of transcribing voice-recorded medical reports that are dictated by physicians, nurses and other healthcare practitioners.
Medical reports can be voice files, notes taken during a lecture, or other spoken material. These are dictated over the phone or uploaded digitally via the Internet or through smart phone apps.
Denial Management is an extremely important part of improving the Revenue Cycle Management (RCM) of any medical practice. Through this process, clinics are ultimately able to improve the quality of services they offer to their patients. There are four steps to denial management:
1. Identify that a claim has been denied and investigate the root cause of denial.
2. Manage the steps involved in correctly filing, and, wherever possible, reversing denials. This can involve directly routing claim denials, creating standard workflows, and creating specialized online tools.
3. Monitor the denial management process by logging and categorising all claims and auditing the work of your employees.
4. Prevent or reduce the risk of future denials by revising processes, re-training staff, or adjusting workflows
5 Claim Denial Types
There are five main types of claim denials and they involve:
1. Hard denials cannot be reversed and result in written-off revenue or lost revenue. This type of denial can be appealed if it results from some errors.
2. Soft denials are temporary and can be reversed with the right follow-up action. The reasons for soft denials can range from missing or incorrect information to coding or charge issues. This type of denial doesn’t need to be appealed.
3. Preventable denials are hard denials that are caused by the actions of the medical practice such as late submission of claims or incorrect codes.
4. Clinical denials are hard denials that are based on things such as medical necessity or level of care.
5. Administrative denials are soft denials that can be appealed. The insurer provides a cause of denial that can be rectified in some cases Claim Denials vs Claim Rejections - What’s the Difference?
Denied Claims
Claims denial is when a claim is received and processed by the insurer but payment is denied. The reasons for this can vary. For example, a claim can be denied because of some critical errors that were initially missed, or be in breach of either patient or provider obligations.
In such cases, it's not possible to simply submit a claim with the correct or updated information. You have to start a denial management process that involves two main steps:
1. Determine the cause of denial. The insurer will usually provide an Explanation of Benefits or Electronic Remittance Advice (ERA) with information on why the claim was denied.
2. Appeal the denial. Once you have determined the reason for the claim denial, you can submit an appeal. You can send back any claim to the payer for additional processing.
3. Keep in mind that if you resubmit a denied claim without making an appeal, the new claim will be treated as a duplicate and will automatically be denied also. This will only cost your practice more time and money.
Rejected Claims
Unlike denials, rejected claims are not processed and do not need to be appealed. They usually happen when the provider fails to meet the data requirements.
Common mistakes that lead to rejections include clerical errors or mismatched procedures and ICD codes. For example, even if a single digit on the patient’s insurance number is missing or incorrect, the claim will automatically be rejected.
Once the insurer rejects a claim, they will send it back to you, the provider. These claims will not show up on an ERA.
Then, you can correct the mistakes and resubmit the claim without an appeal since it never enters into the insurer's system and won’t be treated as a duplicate.
New to running your own clinic? Make sure to follow our steps for working as a private practice manager!
5 Most Common Reasons for Denial in Medical Billing
#1. Missing Information
Missing information is one of the most common reasons for an instant denial
You have to keep in mind, however, that even filling out the claim form entirely and accurately does not necessarily guarantee that all the necessary information has been provided.
This is because insurance companies usually provide complex requirements that often call for additional information, such as:
Whether the patient received a referral
Whether another treatment was attempted prior
What kind of testing the patient has undergone
To have these types of denials reversed, make sure to send the missing or incorrect details to the insurer as soon as possible.
#2. Typos
Another frequent reason for a denied claim is because of typos. Mistakes such as misspelling a patient’s name, an error in the claim date, or the wrong billing code can cause your claim to be denied.
However, you can appeal these denials and possibly have them reversed if corrections are made quickly.
#3. Patient Obligation
In some cases, a denial is coded as a patient obligation. There are several reasons this can happen and it’s the insurance company that should specify them.
Some of the most common contractual issues include:
The patient deductible is not met
A referral was required but not received
The service is not covered
it was unclear due to missing information whether the claim was covered
The claim was made to the wrong issuer
#4. Contractual Obligation
Health insurance companies and medical practices usually have contracts with their own specific conditions and obligations. Failure to meet these are also to blame when claims are denied.
The following are examples of typical issues caused by contractual obligations:
The claim was filed too late
The claim was already paid
The provided services or treatments were unnecessary and their necessity could not be proven
#5. Non-covered or Excluded Procedures
Most health insurance companies don’t cover all procedures and have certain exclusions such as therapies or treatments for pre-existing conditions.
However, these kinds of exclusions are becoming less and less common due to the Affordable Care Act, under which they are obligated to cover 10 Essential Health Benefits.
In case you have such claims that have been denied, they were most likely denied due to an incorrect code or billing mistake, not because the procedures aren’t covered.
Conclusion
Though claims denials can be costly and frustrating sometimes, you can minimize their negative impact on your clinic with effective denial management.
Customizable speciality billing services are one of our specialized services. Patients might receive a variety of treatments from medical service providers, and not all of them adhere to the same medical billing model. The therapy and the service provider are taken into consideration while designing our specialty billing services. Our knowledgeable and skilled staff can execute the billing process and comprehend the needs.
For greater revenue and more efficient operations, we specialize in process improvement. Our claims BPM and KPM services for payers significantly lower costs and TAT (turnaround time) through integrated process redesign and technological advancements. Payer clients can further reduce expenses with the assistance of our paper to EDI conversion, repricing, and rule-based auto adjudication support services.
In order to compete, payers must strive to maximise accuracy at every stage of the claims payment process. By identifying overpaid claims, payers can save money thanks to our thorough grasp of medical claims and contracts and our evaluation technique. Our payer support services allow Cleverbuck Solutions Inc to improve accuracy while increasing income for our client.
we
.qwwq
.
wewewe
.