Healthcare data such as HCC, HHS & CDPS require specific risk adjustment models, which we are adept at implementing.
To ensure error-free processes, we deploy best practices thus creating accurate risk scores. The corresponding premium payment while increasing patient care which includes correctly identifying code gaps, establishing experienced and knowledgeable staffing, performing in-depth and rigorous quality audits, and implementing the advanced process.
The extremely high accuracy of our data processing ensures clean claims and dramatically reduces denials. Every patient's information is registered with a high degree of accuracy. Our teams diligently ensure the exact choice of the appropriate Insurance codes from the master list. Not only do we make accurate entries from the scanned images, but we also capture specific information in accordance with the software and specialty.
The demographics registration process strives to document patient, guarantor, and insurance information with utmost accuracy. Our process includes checks for new or existing patients. All required information is taken for a new patient, and the latest insurance, patient and guarantor information is updated for an existing patient.
ICD-10 coding, and specific specialties are dealt with by our AAPC and AHIMA certified coders who document with appropriate CPT and ICD codes and Modifiers. While sticking to coding guidelines, we educate the practice about specific procedures that could be billed together with a particular treatment or accompanying medical services. At the same time, we ensure sticking to the coding guidelines.
By effortlessly supporting Revenue Cycle Management (RCM) and related processes, we magnify the financial performance of our clients. In partnership with our clients, we deploy healthcare expertise and operate as a direct RCM extension to Hospitals and Faculty Practices.
Over time, VECODE has developed sound working relationships with our clients by prioritizing and processing outstanding credit. [Incorrect adjustments, erroneous credits and misuse of debit codes makes this Credit Balance task quite challenging, requiring precision, attention to detail and a focus on operational excellence.] To make sure that outstanding credit balances get resolved expeditiously, our expert teams are proactive and vigilant. Our operating model is consistently focused on resolving your fund flow since most credit outstanding is treated as an adjustment rather than manifesting as an actual refund.
Our teams expertly process both manual and review electronic charge entries available in EHR / EMR. We draw 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.,
We possess the experience to link the correct ICD codes to each CPT code avoiding unnecessary rejections and denials.
All payments received through ERA / EOB will be posted on the system within 24 – 48 hours, and the reports reconciled daily. Denials are documented & moved to the Denial Analysis team. There exist two levels of quality audit to ensure the process is at par with global standards. The excellently trained staff understand patient responsibility, such as Secondary balance.
After carefully analyzing Claim Denials and accurately identifying the source, the primary cause is defined for every episode before escalating to the specified teams. The teams then fix the Denials & further ensure they don't recur in future, and the denial analysis reports are shared with the client every week.
We ensure all claims information runs through the scrub before, submitting to Insurance Companies, enabling a 99% clean claim standard. The trends and analysis are shared with the Coding and Claims entry team. All submitted claims are tracked electronically through clearinghouse and ensure the insurance payers accept the claims. In the unlikely event of any rejections, our team follow up for a quick resolution.
With the singular objective of bringing advantage and enhancing your collections ratio, we crunch time in A/R. Our expert team will skillfully handle accounts that require follow up on unpaid or underpaid claims.
Many downstream problems occur in the absence of proper eligibility and benefit verification, such as delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment. We, therefore, provide a remotely hosted Centralized Eligibility Unit for Hospitals and Faculty Practice Plans, which includes our experienced teams, technology, management, and our expertise to deliver high-quality, cost-effective patient insurance eligibility and related services. On verification of the data, the clients are updated with the required reports or by directly entering the information in the Medical Billing software.
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