Alpine-Soft can help your practice achieve this success because RCM is our core competency. We maximize your revenue despite decreasing margins by lowering your overhead, decreasing accounts receivables and reducing your costs. Partnering with Alpine-Soft Global reduces the burden of RCM on your staff and helps you maintain your operations in the face of declining and value-based reimbursement. Alpine-Soft can even negotiate existing contracts to ensure that you are being paid at the highest possible rates. We are dedicated to increasing reimbursement, getting your claims paid faster and making sure no revenue is left on the table! Our multi-level Quality Assurance (QA) process is the key to delivering service with extremely high profitability. Your claims are prepped by our team of offshore specialists, and always undergo final authentication by a US-based team of billing experts. All processes and transfers of data are HIPAA compliant, using secure 256 bit AES encryption and VPN division. We are committed to providing our services within compliance standards and in accordance with all existing Federal, State and Payer regulations.
Outsource Medical Billing Services
- Pre-certification & Insurance Verification
- Patient Demographic Entry
- CPT and ICD-10 Coding
- Charge Entry
- Claims Submission
- Payment Posting
- Account Receivables Follow-up
- Denial Management
The patient list, a copy of the insurance card and demographic details are sent to us via email/fax or secure FTP. Our medical billing specialists call up the insurance company prior to the appointment. Pre-certification is done for specific lab tests, diagnostic tests and surgeries. The details are sent to the hospital/clinic in the prescribed format.
The medical billing specialists enter patient demographic details such as name, date of birth, address, insurance details, medical history, guarantor etc as provided by the patients at the time of the visit. For established patients, we validate these details and necessary changes, if any, are done to the patient records on the practice management system
Our coding team works in accordance to CPT codes and ICD-10 Coding compliance, and consists of AAPC certified coders with over 2 years of multi-specialty coding experience. You may send us superbills with diagnostic notes with or without ICD and CPT codes. If codes are already provided on the superbill, they are validated by our coding team compulsorily to prevent any 'up-coding' or 'down-coding' and therefore, any denials.
The fee schedules are pre- loaded into the practice management system. CPT and ICD-10 codes are entered into the system. The billing specialists ensure that all details have been provided in the claim and ready to be filed.
Claims are submitted electronically via the practice management system. However, we can process paper claims also. At this stage, a thorough quality check is done by a senior billing specialist and then submitted. The rejection report received from the clearing house, if any, is analyzed and the necessary changes are done. These claims are then resubmitted.
Scanned EOBs and checks are sent to our team for Payment Posting. All payments are entered into the system. The amounts from EOBs/checks and amounts posted in the system are reconciled on a daily basis. A daily log is updated with these data.
All claims in the system are examined and priorities are set. First the claims close to their filing limits, and then work down from the age of the claim. Periodic follow-ups over phone, email and/or online is done to get the status of each claim submitted to the insurance company.
Denials Management including analysis of denials and partial payments is done by our senior medical billing specialists. Payors, patients, providers, facilities and any other participants are called to follow-up on denied, underpaid, pending and any other improperly processed claims and the action is documented in the system. We will call patients, if authorized by the provider, to obtain information from the patient needed for billing such as ID# and to update the COB (Coordination of benefits) with their insurance companies. Secondary paper claims are processed and sent to the client office for submission.