SERVICES

 MEETING YOUR BILLING AND CODING NEEDS COMPLETELY

We moved from strength to strength to include an array of services, which would cater to the complete billing needs of the healthcare provider. The quality of our services are consistent because of continuous training and the rigid standards followed when it comes to delivery and client satisfaction.

PATIENT DEMOGRAPHICS ENTRY

GETTING EVERY INFORMATION RIGHT ABOUT THE PATIENT

charge-entry

Getting every information right about the patientis the key to a successful claim. Patient Demographics entry is a critical step avoiding a lot of back-tracking and errors in the claims process. The task demands an eye for perfection and accuracy, as it determines the actual reimbursement of Healthcare provider for the services rendered.

With a common exception for emergency treatment, a patient’s insurance details are verified upon entering the physician’s clinic or hospital for treatment. The patient demographic sheet or fact sheet is filled by the patient or someone close to the patient. This sheet with the data then reaches us electronically. We ensure that the fact sheet has all the details in order to facilitate a timely reimbursement of the treatment fee.

Patient Demographics Entry services from Qway will capture:

Patient Details: Patient name and ID#, Gender, Marital Status, Email, Date of Birth, Social Security Number, Contact numbers work and home and Address work and home.

Guarantor/Account Details: Guarantor Name, Date of Birth, Work and Home Phone and Address details

Insurance Details: Insurance Identification Number, Name and address of the Insurance company, Group name/ group number, Details of the policy and policy effective date and termination, policy number, Name of the insured, Date of Birth and the relationship of the insured to the patient.

ELIGIBILITY VERIFICATION

 CLEAN CLAIMS FOR CASH-FLOW

evThe Medical Billing process has some crucial and indispensable steps like Insurance Eligibility which directly affect its cycle. Lack of focus or process in verifying the patient’s eligibility for Insurance, leads to non-payment of claims, delayed payments, rejection of claims and frustration among patients.

Clean Claims for Cash-flow

For the seamless flow of the reimbursement cycle it is important for the healthcare provider to fix the authorization and verification step, which is the very start of the process.  QWay’s Eligibility verification process will verify the information that is relative to the patient’s screening process.

Our process clearly identifies:

  • Effective dates
  • Plan exclusions
  • Benefits
  • Coverage details
  • Co-pays and details of Co- Insurance
  • Pre- Auth Number
  • Patient Details as against details on the Insurance

Spotting gaps and errors in information is the first step we take to get you up and running on the claims process. Eliminate uncollectable revenue with our highly effective Eligibility verification process.

  • REDUCED A/R DAYS
  • CLEARER AND CLEANER DATA ON THE BILLING SYSTEM
  • LOWE CO-PAY, REGISTRATION AND BILLING ERRORS.
  • REDUCED BILLING AND COLLECTIONS COST
  • CONTROL BAD DEBTS AND IMPROVE PATIENT SATISFACTION
  • AID A MORE EFFECTIVE PATIENT FINANCIAL COUNSELLING PROGRAM
  • ACCELERATE REIMBURSEMENT AND ERADICATE REWORK

PRE- AUTHORIZATION

CLEAR THE REVENUE CYCLE TRACK FOR A CLEAN CLAIM. PRE-AUTHORIZATION ALWAYS PANS OUT!

PRE authGet the agreement nod from the payer for the healthcare service even before the service is performed. Pre- Authorization is a sure way to prevent payment delays, part-payments and denials. An authorization number on the claim form at the time of submitting for claims is the best route to a clean claim.

The key to Pre-Authorization is the obtaining of the correct CPT code and procedural code, which is often a daunting task. So, leave it to us. QWay’s trained and highly professional team which works on getting the correct CPT by checking with the physician and working out the most possible scenarios. So stop chasing claim payments. Pre- Authorization means prompt payments.

Your coders may have done their job, but it will be up to the provider to obtain the necessary authorization. A claim denial or part –payment affects the provider and which is why our focus on getting the Pre-Auth for the procedure is complete and absolute when you outsource it to us.  We work with physicians, hospitals, insurance payers and outpatient facilities and ensure the necessary pre-certification requirements are intact to obtain the Pre-Auth.

A Pre-Auth can prevent:

  • Payment delays and denials
  • Ensures the patients gets the maximum benefit under the policy
  • Avoids pay –and-claim
  • Enables a better financial counselling session with the patient

QWay’s Pre-Auth service will have you free up for time to focus more in patients and less on paper-work.

MEDICAL CODING

THE MUCH SPECIALIZED PROFESSION IN THE HEALTHCARE INDUSTRY MEDICAL CODING, IS ALL ABOUT ACCURACY OF INFORMATION.

Professional medical coders describe a patient’s history with codes which are used for filing healthcare claims and for the accurate diagnosis and recommendation of further procedures for the patient long after the claims have been paid. In totality, the physician, the hospital and everyone involved in the healthcare chain reads, communicates and arrives at a consensus on the necessary care for the patient based on these codes.

A PULSATING APPROACH TO MEDICAL CODING TO KEEP IT UPDATED.

Our Medical Coding services add significant value to your coding and overall operations. A single wrong code can have a huge impact on your revenue and revenue cycle, and this is why we keep our focus on being 100% compliant with the current coding guidelines.

Ongoing reviews and a commitment to continuous education on the latest coding regulations has us keep it current and updated on codes that concern patient care in the hospital and clinical setting.

With QWay as your Coding partner you can:

  • IMPROVE CODING ACCURACY
  • SMOOTHER TRANSITION TO ICD 10
  • OPTIMIZE STAFFING AND REDUCE SHORTAGES
  • REDUCE RISK OF COMPLIANCE
  • QWAY’S MEDICAL CODING

In order to keep our coding services credible and competent we have our own Medical Coding Training and Certification unit Coding Pulse.  This is to ensure that you have the best and most proficient coders on the team, which is in tangent with our commitment to deliver on coding accuracy levels, data integrity and to aid in the proper submission of claims.

The Coding team at QWay is headed by a Doctor who is CPC. CPC H and CPC P certified. Pre-adjudicating your claims before submitting them to the Insurance company our Turn-around time is 12-24 hours.

Hospital Based Coding

  • In-patient
  • Out-patient
  • Interventional Radiology
  • Emergency
  • Observation
  • Clinic
  • Psychiatry

Physician Based Coding

  • Gynecology & Obstetrics
  • Pathology
  • Anaesthesiology
  • Pediatrics
  • Orthopedics
  • Urology
  • Diagnostic
  • Hospitalist
  • Hierarchical Conditions Category (HCC)
  • Outpatient – Surgery

DEMO AND CHARGE ENTRY

THE RIGHT CODES AND CHARGES FOR EVERY CLAIM

charge captureUpdating charges and codes for every medical procedure is the key to a successful claim. This specific area in medical billing is updated constantly and we stay ahead of competitors when it comes to implementing these changes in codes and charges in our Demo and Charge entry process services.

Our goal is to get it right at the very first –time and the team relentlessly pushes harder to achieve higher standards and benchmarks when it comes to the first –pass rate of claims. Charging requires niche skills with an eye for perfection and accuracy, as they determine the actual reimbursement of Healthcare provider for the services rendered.

Demo and Charge entry services from Qway will capture:

  • Charge Entry
  • Service Date
  • Billing Provider
  • Healthcare Provider
  • Admission Date
  • Referring Physician
  • Pre-Auth Code
  • CPT Code
  • Diagnosis code
  • Demo Entry:
  • Patient Details: Patient name and ID#, Gender, Marital Status, Email, Date of Birth, Social Security Number, Contact numbers work and home and Address work and home.
  • Guarantor/Account Details: Guarantor Name, Date of Birth, Work and Home Phone and Address details
  • Insurance Details: Insurance Identification Number, Name and address of the Insurance company, Group name/ group number, Details of the policy and policy effective date and termination, policy number, Name of the insured, Date of Birth and the relationship of the insured to the patient.

PAYER AND FRONT END REJECTIONS

 ELIMINATING PROCESS ERRORS FOR A CLEAN CLAIM

rejectionsClearing house rejections or Payer and Front end Rejections are billing problems which slow down your cash flow. These are process errors and can be reduced to zero. Rejections occur due to one or many errors on the claim form and are returned back to the biller by the payer because of these errors. Errors!……Seriously? Do you want to dent your receivables because of clerical errors?

At QWay Healthcare, Payer and Front end Rejections are handled by staying updated, following due diligence, communicating adequately and aptly, and following through. We strictly audit all the important touch points to ensure that the claim is not returned for reasons of a clerical error.

Unlike Denied Claims, rejections occur due to errors like Incorrect Patient Information, Incorrect provider Information, Incorrect Insurance Provider Information, Incorrect Codes, Mismatch and omission of codes, Undercoding, Upcoding and poor documentation.

QWay strives to reach the highest level of accuracy when it comes to sending a clean claim and we get down to meticulous checking of every detail on every claim form.

We study new codes, stay vigilant to avoid trivial errors like misspellings and digit errors, co-ordinate with the payer company, and follow up with the representative who works on that claim.

Our goal is make sure that the biller or the healthcare provider is rightly reimbursed for the services.

PAYMENT/CASH POSTING

PAYMENT POSTING PROCESS FROM QWAY HEALTHCARE IS TUNED FOR PROGRESS AND PROMPT PAYMENTS.

claimsAs experts in handing small, mid-size and large volume payments, we understand that the cash posting process marks the end of the billing cycle.  The process also affects other critical areas of the healthcare provider like the overall efficiency, patient satisfaction and cash flow.  QWay handles the entire process with professionals who have an eye for detail with complete and thorough knowledge of the billing cycle. The Payment Posting team is trained well-enough and executes every action based on a set of procedures, and handles last minute errors with the right protocols.

The team achieves a higher success ratio and works towards closing all payment postings on the last day of the month. We work on a turnaround time of 24-48 hours with a success ratio of 100% and rally to keep it consistent.

QWay’s Cash Posting services include:

Bank Statement Reconciliation : We reconcile accounts with the bank statement versus lockbox deposits, Credit and EFT to ensure that:

  • There is no unaccounted money left to age which leads to follow up and other clerical activities.
  • To zero down on secondary and tertiary claims and avoid patient balances.
  • To reduce on DSO and 120+ fallout

Posting Payments : Co-pays, Credit Card Payments and Lockbox payments.

EFT/ERA Downloads : Our team of trained professionals download 835 files from the different clearing house websites like Claims Remedi, Emdeon, RealMed, Navicure, Zimed Gateway etc., and any errors at the time of downloading and uploading the same on to your software is deftly handled by our supervisors.

Credit Card Payments : We process these payments with utmost sensitivity and scrutiny as we are aware that these payments come over-the-counter, over-the-phone, or as emails. We have a strict compliance policy when it comes to credit card information handling.

DENIALS MANAGEMENT

 WE TRACK, TREND MANAGE AND REDUCE THE TORRENT OF CLAIM DENIALS.

denialsINCREASE REVENUE BY 20% OR MORE, SPEED UP YOUR CASH FLOW.

Denials can have an adverse effect on your cash-flow. Managing denials promptly and effectively will result in an increase in the cash flow and enhance the effectiveness of the billing process with higher first-level passes. QWay’s Denial Management Program addresses both historical and future claims with the ability to recover otherwise lost revenue.

Denials occur due to reasons like:

  • Inaccurate or Incomplete Insurance information
  • No Pre-Authorization Code
  • Errors and Omissions related to coding and charges
  • Filing claims past the stipulated time
  • Credentialing Errors or no enrollment of the provider.

Qway effectively handles denials by classifying them according to Provider, Financial Class, Type of Denial and Payer.

By including process reports and measuring all claims denied by your payers, our team fixes every issue in the pipeline.

The Denial Management process at Qway is carried out with data and trend analysis – the key to the success of the process. Our systematic way of tracking denials gets information back to the billing process to prevent future denials of the same nature.

We drive up your cash flow and reduce the flood of denials by:

  • Analyzing the volume of the denials and baseline analysis
  • Evaluating denials with respect to age, claim expiration, non-meeting of deadlines
  • Statistically estimating the denials based on payers, providers, CPT codes and general non-compliance to the ICD 10 standards.

A/R ANALYSIS & FOLLOW-UP

MINIMIZE A/ R DAYS AND INCREASE ANNUAL REVENUE

g4178SIGNIFICANT AR ANALYSIS AND FOLLOW-UP PROCESSES.

Of the plethora of things that top the agenda of a healthcare provider running behind payments due and clearing blocks in the payment pipeline, is a pain that every clinic, hospital or physician group would love to avoid.

Accounts Receivables at a hospital/ nursing home was purely a departmental activity until sometime ago. New and evolving payer plans, co-insurance agreements, patient co-pays, and the increase in patients with a high deductible health plan has exceedingly complicated the nature of AR

It demands the healthcare provider to revamp and re-strategize their revenue cycle management. The process is now complex requiring the skill of specialists and trained professionals who have diligence, analytical skills and patience.

Well, if the importance of the issue doesn’t hit you well-enough, take a look at what the Accounts Receivables analysis and follow-up service can do for the healthcare provider:

  • 15% OVERALL INCREASE IN ANNUAL REVENUE
  • MINIMIZE ACCOUNTS RECEIVABLE DAYS
  • ACCELERATE CASH FLOW
  • REDUCES OVERHEADS 30-40% BELOW OPERATIONAL COSTS

Keep your financial health intact with QWay Healthcare’s A/R Analysis and Follow-up. Your Revenue cycle will now become SMART, SMOOTH and SEAMLESS. Enjoy the even and predictable flow of cash.

HOW WE HANDLE AR ANALYSIS AND FOLLOW-UP?

We do a scrupulous Study – An in-depth research on the accounts to determine the right follow-up strategy. Understanding the size and scale of your receivables and the risk- exposure.

We prime for the Process – A thorough eligibility check, claim scrub and continuous analysis for patterns on global problems, procedures and codes.

We stay on top of Quality – Readily available reports, quality assessment, technical support and special assistance during crisis.

WORKER COMP/ NO FAULT FOLLOW UP

MAXIMIZING COLLECTION & PATIENT REVENUE

work compWorker Compensation and No Fault Billing are challenging areas in medical billing when it comes to invoicing and collecting. The increase in government regulation has the insurance company maneuver through the policies and guidelines and use it to their advantage. Worker Comp & No Fault Follow up are subject to a wide variety of guidelines which vary depending upon the financial class. These claims are also extremely time-sensitive when it comes to filing.

At QWay we work towards maximizing collections and maximizing patient revenue.  Well how do we?

  • By using legal maneuvering and state insurance policies to the advantage of the patient and the healthcare provider.
  • By utilizing all the information at the hospital available at the time of discharge and further supplement information to increase the chances of clearance
  • Use trained experts, professionals and an ‘in-house’ counsel that specializes in these claims.

We specialize in:

  • Inpatient/Outpatient Workers Compensation and Billing Follow up
  • Inpatient/Outpatient No fault Billing and Follow up
  • Physicians Worker’s Compensation and No fault billing and follow up.

Many healthcare providers and billing companies faithfully create invoices and then stagger when it comes to follow-up because of the lack of technology, time and personnel to follow-through.

Our professionals have extensive experience in handling Workers Comp and No Fault Follow-up as they are individuals who have worked in the insurance sector and in the healthcare Sphere.

APPEALS PROCESSING

 STRATEGIZING FOR A HIGHER SUCCESS RATE

appealAppeals are an important part of the medical billing process. Appealing on a denied claim with sensitivity to its specific timeline is critical for the healthcare provider to recoup money. Moreover, if you are able to identify a pattern in claims that are denied, and the existing practice isn’t helping much when it comes to appealing on those claims, it means the physician or the healthcare provider is not aware of compliance issues or guidelines and the current billing process is incorrect by default.  It also goes to show that the healthcare provider or the physician isn’t doing much to rectify these errors.

At QWay we improve your Appeals process by:

  • Using a strategy for Appeals: Most of the time it is so, that the healthcare provider may not be able to appeal on every denied claim. They may only focus on the high value ones and leave out claims of smaller denominations which may have a potential chance of reimbursement after appeal. At QWay Healthcare we devise an Appeals strategy which is sure to deliver results. It is also a proven way to have you appealing on all the right claims in order to make the efforts worth the returns.
  • Categorizing and Tracking Denials: We categorize denial by type/person.  This practice helps us identify patterns in denials and enables us streamline the process.
  • A strong Appeal letter: Using a standard template to draft an appeal letter may not be a wise thing to do. We customize every appeal letter based on the type of denial. While we take all the necessary precaution to include important details we quote industry guidelines, CMS and CPT guidelines and the payer’s reimbursement guidelines to give the appeal a higher likelihood for clearance.

Appeals Processing at QWay is done just the right way, in the right time and with the right documents and only for the claims deemed fit.

RETURNED MAIL PROCESSING

 SPEED UP ON COLLECTION AND SAVE TIME.

credentialsWe believe in making your practice more efficient and QWay is a company which goes that extra mile to make the claims process an easy and seamless one.

Undelivered mails and Address changes can bring down the speed of the claims process and have an impact on the cash flow. Our services to address Returned Mails speeds collection and saves you time.

Our service makes sure that your staff don’t waste productive time on the phone with the insurance provider for hours trying to find out a resolution.

We sort all your returned mails after analysis. Identification of new addresses, and a detailed report on the status of each account is maintained and forwarded to enable the entire team access the status.

How does QWay’s Returned Mail Processing help the healthcare provider?

  • Improves efficiency by offering the right focus and expertise for handling returned mails
  • Brings down write-offs and speeds recovery.
  • Identifies new addresses quickly and increases cash flow.
  • Outsourcing enables the provider to reduce the cost and time spent in handling returned mails.

CREDENTIALING

 A FASTER AND MORE TRANSPARENT SERVICE

credentialsAs a healthcare provider, you must be aware of the importance of Provider Credentialing. It is a verification of your experience and expertise as a healthcare provider and your interest and willingness to provide services. Above all, without credentialing you will be able to practice medicine in a cash-only mode without the privileges at hospitals or other facilities.

Provider Credentialing at QWay is faster and more transparent for the healthcare provider as we have a home-grown solution to serve the purpose.

Provider Credentialing is critical for the practice of a physician. It isn’t just another form to be filled. It is a complex process with many steps and most of all it is ongoing. QWay Healthcare approaches Provider Credentialing as a process which requires complete and constant maintenance and management. We offer Provider Credentialing as a solution and as a service, and cater to the end-to-end management of the credentialing process.

See below the key aspects of our Provider Credentialing Service.

  • We understand that Credentialing does not stop after the physician or the healthcare provider has submitted forms. Which is why keep take the necessary steps to prompt physicians to give us data periodically about their practice and service.
  • While most practices manage credentialing manually or use an electronic database that has limitations in connecting with other databases, we use a high-end Credentialing Software in order to reduce the paperwork and offer physicians, healthcare providers and payers instant and the latest status about each other.
  • Credentialing is not complete even after the submission of myriad documents to a number of third parties for verification. Although most health plans and facilities do not mandate a full re-hash of the documents, it is necessary to submit annual updates. QWay manages the ongoing maintenance of credentialing information by adding staffing resources and creating a sustainable workflow.

Prioritize Credentialing to stay in Practice. Choose QWay Healthcare to stay fully enrolled with participating health plans, and give patients admitting privileges.

REFUNDS PROCESSING

PROCESSING VOID AND STALE DATED PATIENT AND INSURANCE REFUNDS.

refundsWho wouldn’t want to have a credit balance on their books? However, a Credit Balance for the Healthcare provider can pose serious risks and become a liability if not managed well. Why so?

We deal with Credit Balances in an expeditious manner when it comes deciphering, processing and posting refunds or making account corrections, which is the key to protect revenue cycle integrity.

A Credit Balance is not ‘extra cash’ or an asset for the healthcare provider. It means that you actually lit the fuse and it can go off anytime damaging your reputation and corroding goodwill if not managed through an effective A/R process.

It is the fiduciary responsibility of the provider to manage this risk. Almost 55% of credit balances are due to incorrect postings as per data available on the industry. Misuse of debit codes, wrong adjustments and credits that are processed erroneously are quite challenging to clear. QWay establishes a strong working relationship with clients in order to process their credit balances in a timely fashion and reduce the backlog.

The team at QWay is comprised of professionals who have strong analytical skills with experience in hospital accounting standards and norms. Our cohesive working model with clients, and internal processes enables in resolving a higher number of credit balances as an ‘account correction’ instead of a refund. A successful Credit Balance process lies in its effectiveness to prevent it.

What we do at QWay to reduce and resolve Credit Balances?

  • Complete analysis of the account along with the EOB
  • Inspect patient liability and other issues on adjustment
  • Check to see if a double payment was made and if so refund
  • Check if there are two Insurance carriers and both are acting as primary
  • Work towards increasing the number of CPAT (Certified Patient Account Technician) credit balance analysts.

OLD AR AGED AR

 ANALYSIS AND TRACKING TO AVOID PILE-UP

old arWorried about Old AR? Outsource it to us and sit back and relax while we work it down. A lot of medical billing companies would focus only on projects that shore up bottom line, but shy away from taking up projects with a lot of old AR. At QWay, we have proven techniques and processes to exclusively manage Old AR.

Cleaning up Old AR and managing denials requires prudent and calculated efforts from a medical billing company.

We recover old AR and manage them judiciously by:

Being aware of the TFL: We are a medical billing company that proactively works towards avoiding AR pile up. The Timely Filing Limit which is considered as one of the main reasons for AR pile -up varies from one payer to another. We learn the pre-determined TFL of the payer and submit claims accordingly.

Timely filing of Appeal:  A denied claim needs to be carefully assessed by the account receivables professional. It is important to file an appeal within 7 days of receipt of denial notice from the payer. We watch it on time when it comes re-filing of appeals, in order to crunch down on aging AR.

ATB, AR Report and EDI: Using an EDI report allows us to easily track the change in the status of the reports. The ATB (Aged Trial Balance) report throws a lot of light on the outstanding amount due and the AR Report enables the accounts receivable professional to contain the DRO (Days in Receivables Outstanding) within the 60 and 90 days.