Physical Billing Process


PATIENT SCHEDULING AND REGISTRATION

YAVARNA HEALTH STREET PROVIDES CUSTOMIZED PATIENT SCHEDULING AND REGISTRATION PROCESS THAT WORKS THE WAY YOU WANT IT TO WORK BY PROVIDING


  • Personalized schedule templates and appointment types
  • User-defined schedule views – by appointment type, location or provider
  • Customizable welcome email for new patients
  • Automated phone and email appointment reminders and confirmations





  • Receive patient schedules from the hospital via fax, email or EDI
  • Verify patients’ insurance coverage
  • Contact patients for additional information
  • Update the billing system with eligibility and verification details including member ID, group ID, co-pay information, coverage start and end dates, and so on


INSURANCE VERIFICATION

INSURANCE INFORMATION OF EVERY NEW PATIENT SENT TO US IS VERIFIED AND UPDATED AS LISTED





MEDICAL CODING

Yavarna Health Street has put in place an expert team of highly credentialed and experienced coders. All our coders are AAPC certified, have a minimum of 5 years of experience and are continually working to stay on top of latest changes in the industry.


Leveraging this vast repository of expertise, we can provide following medical coding outsourcing services.

  • Offshore coding audits
  • HCC medical coding
  • HCPCS, ICD -10 and CPT-4 Coding
  • Payer specific coding services
  • Chart Audits and Code Reviews



DEMO AND CHARGE ENTRY

Medical Claims Audit – The claims are then put through a series of rigorous auditing sessions, which involves extensive testing at various levels. The completed claims then go through the second round of examination for validation of information, including correctness of procedures and diagnoses codes. Only those claims that are error-free go to the next step.

CLAIM TRANSMISSION AND WORKING ON CLEARING HOUSE REJECTIONS

Once the charges are created and their correctness is established, they are filed with the payer electronically. At the clearing houses, the accuracy of information contained in the claims is validated and a report is sent back within 24 hours in case of any inconsistencies. Once we get the report, the inaccuracies in the claims will be rectified and within next 24 hours’ error-free claims will be resubmitted to the insurance company.






  • Payment Posting from Explanation of Benefits (EOBs) to Patient Account
  • Indexing of EOBs to patient account
  • HCPCS, ICD -10 and CPT-4 Coding
  • Analysis of EOBs for under-payment or over-payment
  • Reconciliation to Match Payment Posting to Actual Deposits



PAYMENT POSTING

OUR EXPERIENCED TEAM OF MEDICAL BILLING AND CODING EXPERTS CAN CARRY OUT ALL PAYMENT POSTING PROCESS




DENIAL MANAGEMENT

We track every claim that is denied and present it in a manner that allows fast identification of trends. With this kind of powerful intelligence in hand, we can dramatically drive up the first-time claim acceptance rate and stop the torrent of claim denials.


SOME OF THE KEY FUNCTIONS OF OUR DENIAL MANAGEMENT PROCESS ARE AS FOLLOWS:

  • Identifying the root cause of denials – We identify and interpret patterns to quantify the causes of each denials
  • Supporting accurate workflow priorities – We collect every piece of information related to denied claims, including status, escalation and correspondence with payers, which will be very helpful in streamlining the recovery process
  • Providing timely and accurate statistics – We provide accurate analytics and reports that can go a long way in preventing future denials




We give priority and act within the specific appeal timeframes of each insurance so that our efforts would result in revenue that would benefit both the provider and the biller.

  • We identify and interpret patterns to quantify the causes of each denials
  • We collect every piece of information related to denied claims, including status, escalation and correspondence with payers, which will be very helpful in streamlining the recovery process
  • We provide accurate analytics and reports that can go a long way in preventing future denials


REJECTED MEDICAL CLAIMS FOR APPEALS

Appeal plays an important role in the RCM cycle when a claim gets denied or underpaid. Before filing an appeal, it is important to evaluate the claim to determine whether it is worth spending the time and money. At Yavarna Health Street our well trained RCM specialists review every intricate denial and understand the possibilities of an appeal to ensure they are cost effectively resolved