1. Upload your electronic patient care records into our billing software.
2. Verification of demographics using Transunion’s TLOxp software. This software verifies mailing addresses, phone numbers, dates of birth, and social security numbers.
3. Scrubbing of claims for accurate insurance through Waystar.
4. Additional scrubbing of claims through Solution Group’s Black Ink software. This second scrubbing locates hard to find commercial, Worker’s Compensation and auto insurances.
Once we have the most accurate demographics and insurance information, the claim is sent to coding where trained coders review the patient care record in its entirety. Once reviewed, they choose the most appropriate ICD10 code, HCPCS level of service codes, origin and destination modifiers. They build a summary of the patient care record that explains medical necessity, reasonableness and further backs level of service billed. As an added level of comfort for both us and our customers, all billers are put on a 100% review of every single claim that they bill until they reach a consistent < 5% error rate. We think a second set of eyes on each claim until a biller is completely confident and competent are essential to our success.
We check for required patient, crew and facility signatures at this stage. Physician Certification Statements of Medical Necessity are checked for validity and completeness when required by insurance.
We can also work with our clients to manage patient deductibles based on your thoughts and our recommendations for increased revenue. Any claims that can be submitted electronically are. Paper claims are mailed twice per week. Payments are posted to accounts promptly. Denials are worked daily. A monthly aging report will be supplied for your review. This will be set up to automatically email your designated recipients.
In addition to all processes above, we will work denials and follow up on unpaid claims using our team of accounts receivable experts. This process aids claims that need a little more time and attention to reach payments level. Additional monthly reports include Payer Mix and Top Denials.
We will provide a one-time onsite documentation training for your staff.
We encourage and will assist with your company obtaining a company Certified Compliance Officer to oversee the compliance of the day to day operations.
Under the OIG guidance the Compliance program is currently voluntary however, we at Jan-Care Diversified feel it is an important component of our industry and highly recommend.