Quality Management

We review all claims before submitting them
To minimize error rates and reduce the risk of denials, the supervisor or team leader reviews all claims before submission.

We maintain a review log for billing and coding claims
The most common reasons for claims rejections are specified in a log list compiled by our billing staff. With the help of this ready reference, we track trends on remittance advice. We monitor and evaluate these trends in order to resolve the problems that are causing the denials and rejections for your practice. This way, you get increased revenue through reimbursements and reduce the risk of future claims rejections.

Monthly Billing Review
Every month, we hold billing review meetings where the entire team involved in billing processes is present. Every person involved in data entry, billing and payment posting, coding and documentation, denials review and down coding participates in the monthly review which includes

• An analysis of trends from the claims review log
• an update of any recent changes in billing or coding practices, from recent newsletters of insurance carriers
• current practice issues regarding the billing function

Quality Standards in Medical Coding
We conduct detailed procedural processes to assess quality at every stage.

• Shadow Processing- We audit every single file/transaction for accuracy and errors.
• Random Auditing - In addition to Shadow Processing, our experienced quality managers conduct random auditing tests to ensure quality at all levels.

Our Medical Coding standards adhere to international quality standards. We follow these practices-

• We use the most up to date books and software like CPT, ICD-9, HCPCS, C++ edit to keep in touch with the constant changes in the coding world.
• We work in accordance with client requirements and standards set by HIPAA regulations in order to assure turn around time.
• We have dedicated professionals who work under the AHIMA rules.
• Our coding staff have received extensive training under coding experts in the U.S. Certified coders monitor their work regularly and external coding and compliance experts periodically audit the department.

Feedback and Reporting
The feedback mechanism is one of the most crucial parts of the quality process. There is also a structured process to capture the client’s inputs, queries and problems and facilitate feedback throughout the customer life cycle.

The Quality Assurance reporting plan comprises of daily, weekly and monthly accuracy and speed level reports. Reports on the employee’s performance trends are also e-mailed to the client. Reports sent are customized according to the customer’s specific needs.