Under the Healthcare Provider section, we have the Pre-registration and Pre-authorization process. This process constitutes collecting of patient demographics and updating in the software, including verifying patient’s eligibility, complete pre-authorization process, screen for medical necessity, collect patient responsibility, recognize the payment risks followed by, scheduling patient for provider visits. At Finnastra, we clearly understand that this process has to be repeated and precisely followed for improved cash flow of patient’s up-front collectables such as deductibles and co-pays. Finnastra abides to follow the process consistently and ensures accurate care and decreased revenue cycle days.
Finnastra advices to implement the following process of registration:
- Patient registration specialists enter patient’s information in to the patient demographics.
- We perform eligibility checks, verify if the service requires any authorization, and also screen for medical necessities, and update the same in the patient’s account.
- We always validate and update patient’s information which gets registered in provider’s facility.
Eligibility and Benefit Verification
The prime and fundamental action in submitting a “clean claim” is performing Eligibility and Benefits Verification. Finnastra, through its Eligibility and Benefits Verification service, guarantees that the patient account is set up with most updated insurance details, so that clean claim can be generated for adjudication by the insurance.
Eligibility verification and plan-specific benefits information before services render fewer claim rejections and denials; however, it also lays the foundation for an effective patient financial counseling program.
In the absence of a proper Eligibility and Benefit Verification, problems such as delayed payments, rework, decreased patient satisfaction, increased errors, and non-payment occur. Finnastra deploys staff, technology, management and expertise by setting delivering high quality cost effective Eligibility and Benefit verification services as a bull’s-eye.
Demographic Entry and Charge Capture
Our streamlined demographic and charge entries ensures flawless service. The data entry assures seamless solutions at complete discretion of personal information. A good, error free patient demographic form with accurate information indicates a perfect claim submission. Providing adequate information will curtail the need of insurance companies to contact billing office for queries and issues.
Electronic and Paper Claim Submission
Claims submissions can be made either electronic or through paper. However, an electronic claim submission comparatively maximizes claims processing efficiency to paper submissions. A uniform bill or electronic submission form is advised to be submitted by the providers who render quick covered services. We at Finnastra, insist on submission of electronic forms, which transmits quickly and accurately. They are also considered reliable. The e-claims can be submitted all time and any time in a week. This helps us to typically minimize the processing time provided with complete information.
Many a times the paper submission comes as alternative source of submitting the claims. It is typically submitted on HCFA-1500 claim form for professional or other non-facility services and on an UB-04 claim form for services provided in a facility.
Claims must be submitted specifying all services rendered for every vertical and fee-for-service encounter within 90 days of the date of service or discharge.
The claims reach the insurance payers once the complete submission is processed. The expenses in lieu of claims, received from the payer and patients are posted into our advanced medical billing system. The process involves issuing of checks with Explanation of Benefits (EOB). The payment posting includes the EOB, statement from the provider and the check copies to ensure effective payment processing. Our billing staff ensures that the payments are posted instantly into the respective patient accounts, against that particular claim to reconcile the claims. We insure that the payments are handled exceptionally well, without any mishaps to our clients.
This process is one of the key steps in the revenue cycle.
At Finnastra, we follow up on pending claims, initiate collection, analyze the reasons for the claims denial, track outstanding receivables, execute appropriately, and ensure that maximum revenue is collected. We assure the increase in cash flow for your practice and reduction in the number of days of accounts receivable.
We analyze on the outstanding accounts receivable balance, which are accountable and uncollectable, and process further, to maximize revenue. Our AR specialist determines the co-insurance amount and bill the insurance company accordingly.
We generate and share routine report to our customers, detailing collection progress, payments, and adjustment.