Quite a significant number of claims fails to satisfy the eligibility verification criteria and as a result, the patients are put to inconvenience.The experts at REQS painstakingly verify data relating to the patient eligibility and ensure a totally patient friendly procedure towards processing of claims. Patient eligibility verification is one of the most important and prime steps leading towards the clearing of claims. Lack of proper eligibility and benefits verification leads to delayed payments, increased errors,non-payment of claims thus by leading to patient dissatisfaction. At REQS, we effectively tackle this problem through the remotely hosted solution for eligibility verification at hospitals and at medical practice centers. REQS deploys expert staff accessible via toll-free numbers, working towards the objective of delivering high-quality cost-effective patient insurance eligibility verification and related services.
Efficient eligibility verification services lead to increase in account receivable cycles, reduced account receivable period, and increased number of zero error claims and an overall increase in revenue by reduction of write-offs and denials.
REQS follows highly standard issued medical billing-coding process through a structured methodology which has been proved successful for several large US clients. Our coding services will offer assistance to our clients in experiencing an increase in returns and reduction in the number of denials.
Every information in the Patient Demographics sheet is important hence REQS ensures accurate and quality entry of basic demographic information about an individual or patient which will directly impact physician’s monthly revenue.
[Capturing information like Patient’s Name, Patient Information, Patient Employer Information, Patient Guarantor Information, Physician Information, Insurance Information, Account #, Patient details such as Sex, Patient Date ofBirth, Marital Status, Patient Address, Patient phone number, etc]
To reduce the chance of claim rejection we ensure that every claim is verified to check Date of service, Billing Provider, Rendering provider, Physician, Place of Service, Type of Service, Admission date, CPT Codes, ICD codes, Modifiers, Authorization or Referral Details and Co-pay Details. We do this with manual check & random quality audit in order to ensure accuracy.
Our Expertise is aware of all nuances of payer communication when handling a payment posting account.
EOB / enter the allowed amount, paid the amount, Analysis of EOBs for Under Payment or Over-Payment and patient information like Patient Name, Date of Service, Procedure Code, then calculating the contractual adjustments which will make the follow up easier with the insurance companies.
Our experts will systematically follow up on accounts receivable, claims and allthe pending claims, An in-depth analysis of rejections denials is carried out and our systematic accounts receivable projects can efficiently detect and identify different medical billing scenarios which result in non-payment of dues; and help resolve those problems to effect an increase in the number of claims paid.
Process claims are submitted automatically while claims presented conventionally are also processed. This follows a thorough quality check by senior billing specialists, even rejection reports received from clearing house is analyzed,necessary changes are made if any and resubmitted.
At REQS denial management is one of the core activities to ensure client satisfaction and is carried out by senior medical billing specialists [ Our scope includes Payers, Patient, Providers, facilities and any other participants are called to follow-up on denied, underpaid, pending and any other improperly processed claims and the action is documented in the system.] If authorized by the provider we also have the facility to call up patients [to obtain information from the patient needed for billing such as ID# and to update the COB (Co-ordination of benefits) with their insurance companies. Secondary paper claims are processed and sent to the client office for submission].
Our experts are always available for immediate support to you and your staff no matter what the issue or problem is.
Quality is the key to performance and at REQS we check for all types of errors starting from [typo, billing error, specification and system errors] along with Shadow Processing and Random Auditing to ensure compliance with quality controls. Every team is provided with a weekly quality report and the performance of each billing staff is continuously monitored and periodically appraised for better outcomes.
REQS realizes the significance of quality, and to fulfill our goal we have efficient quality control at every step, by a team of quality resources personnel, all entered demographic changes are duly verified. Further, a representative sample of all demographic changes and payment effected that have preliminarily undergone by quality resources personnel are once again verified by senior quality personnel.
Call quality monitoring, which is a quality measurement process to evaluate and establish the quality of voice delivery for patient and insurance follow up.
Compliance monitoring, which checks for adherence to legal and statutory compliance and conformance to client-specified policies and procedures.
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