Medical Coding:

With recent updates implemented by Medicare, healthcare service providers have major concerns, for coding of medical services, provided to patients–incorrect level of coding i.e.

  • UpCoding at – usage of codes that can fetch inappropriate higher revenues or
  • DownCoding – usage of codes where reimbursement will be lower for the health care service provider

UpCoding :

(selection of higher level of procedure Codes for rationalmore reimbursements) of medical services, may lead to URAC Audits, followed by the legal enforcements imposed by Medicare, leading to suspension of licence of medical practices; when found guilty.

DownCoding :

leads to heavy loss of revenues. Under certain categories, service practitioner may or can be penalized for inappropriate or inadequate level of patient care.

Sevenphoenix Assurance:
  • Our Approach of – “Code is what is Documented” and stringent follow up with service provider for documenting care given to patients makes Coding easy and ensures accurate coding of medical services.
  • We guarantee 99% accuracy of coding of medical records with TAT of 24 Hrs.
  • Stringent Quality norms ensures a Coding service most reliable and beneficial to service providers.
  • Improvement in reimbursement is observed up to 10% due to timely submission of claims and improvement in auto-adjudication, where claims are approved for payment because of accurate coding of medical services.
  • Coding team undergoes rigours training for them to achieve CPC-P, CPC-H and other necessary credentials before commencement of coding of medical records.

Billing Services:

  • Charge (EMR & EHR - Management)
  • Claim Submissions -- Electronic & Paper Claims

With the implementation of revised regulations of HIPAA – “The Final Rule”; It is mandatory for medical service practitioners to maintain all medical (EMR) and health information (EHR) records in electronic formats to enhance portability of information without any hassles.

Our Team of tenured professionals has the expertise on Legacy, as well as Advanced Applications, thereby delivering undisrupted quality services to healthcare service providers.

Sevenphoenix Assurance:
  • Reconciliation and Tracking of every medical treatment provided to patient, helps service providers to get paid for every care provided to the patient.
  • In some of the cases, reimbursement needs to be submitted in Paper forms, due to established norms by insurance carriers. Our team, carries out such submissions of claims in paper formats efficiently.
  • We guarantee 99% accuracy in billing & insurance claim filing with a TAT of 24 Hrs max.

Payment & Collection Management

Payment reconciliation is another key area for effective financial management of healthcare services. At any point of time, health care service provider should have correct knowledge of what is paid, as on date and how much is balance with Insurance carriers.

Sevenphoenix Assurance:
  • Our experts reconciles the records received in electronic formats ERNs (direct deposits to bank accounts) or PaperChecks – EOBs on daily basis or as per Insurance Carrier schedules and prompts controllers for any irregularities.
  • Our Team also takes actions for the cases withheld by carriers or claims denied for payments for various reasons.
  • Aggressive follow up with Insurance Carriers for outstanding payment of medical services provided to patients reduces Collectibles and improves business efficiency; thereby improving the quality of care provided to patients.
  • Principle of Queue follow up – “Oldest to Latest” followed by “Highest to Lowest” helps to recover every cent payable to healthcare service provider by Insurance Carrier as well as by Patients. This enhances revenue by 18-20% within 3 cycles of ageing report.
  • All the services provided by us are governed by the quality centric work flow with intermittent audit check points against acceptable quality levels set as per the Service Level Agreement.