Billing System

Why should you be Interested?

The process of Billing starts as soon as the patient registers at the healthcare facility. From that first step, it is utmost important to gather relevant and accurate information regarding the basic details of the patient including insurance coverage and home address.

Another critical task (at check-in or check-out) for the billers or staff is to collect copayment when applicableThis facilitates the timely collection of the financial responsibility of the patient

Billing Process Workflow

The first step after a patient checks out leads to the creation of a superbill. It is generated by coders and billers by using patient’s information and codesSuperbill is widely used across the U.Sby healthcare providers to create claims. It contains the location, signature, and name of the provider along with

attending and referring physicians of the respective case.

It also encompasses details of the patient. For instance-Date of birth, insurance information, and other patient data used for billing purposesIn additionvisit information, procedure and diagnosis codes, modifiers and quantity of items used during the treatment, etc is accurately mentioned which suggests the importance of this document. This information is then copied off the Superbill and used by billers to chalk out claims

When the billers complete their work in chalking out claims, they submit these claims directly to the respective payer and in some cases, they get in touch with another organization to submit the same.

These organizations are called clearinghouses and their primary task is to push claims from providers to payersTo be sure, these companies also verify the information within claims to ensure reimbursement. If the need arises, our billers use valuable services of such clearinghouses only to expedite reimbursements.

Now as the claim reaches the payer, the due process of adjudication unfolds wherein payer assesses the scope of provider’s claimAt this stage, claims can be rejected or acceptedRejected or denied claims are transferred to back-end billing whereas accepted claims are converted into patient collectionsThe collections then reach accounts receivable and it is the duty of medical billers to follow with patients and ask them to submit their financial responsibility in favor of the provider.

With such an elaborate workflow adopted by AIWSwe’re bound to generate better revenues for your healthcare facilityWe undertake Billing services and its responsibilities from the very start and discharge duties until the cycle completes effectively, optimizing the Revenue cycle of your establishment

Credentialing

Credentialing refers to the process of ensuring if practicing doctors, clinicians, and physicians have undergone the necessary training to practice medicine within a specific city or stateWithin the scope of this process, information provided by practicing medical professionals in terms of their

  • Residency
  • Licensing
  • Qualifications
  • Career History, and 
  • Certificates 

is thoroughly reviewed before the professional commences a new practice in the same or a different stateAIWS offers credentialing and re-credentialing services for established and new healthcare venturesWe expedite this otherwise tedious and time-consuming process by completing relevant forms within a stipulated timeframe.

A. Provider Credentialing

The process of getting a physician (or provider) connected with the patient so as to enable patients to utilize their insurance cover against medical services consumed during the treatment.

Identified as a critical step in the revenue cycle, Provider Credentialing involves six important steps:

• Provider’s Data: Updating doctor’s information in alignment with relevant policies.

• Payer’s Database: Attach data, label and attach images of the providers in the database of the payer.

• Follow-up: Stay on top of credentialing requests submitted with the authorities.

• Complete Documentation: Source missing documents and update payer’s database

• Verification: Verify the information provided by the practitioner.

• Analyzing the Application: Find exceptions in the application