Accurate patient information, insurance details, and demographic data must be collected during the registration process. This helps in ensuring that claims are submitted with correct and up-to-date information.
The most ignored part of revenue cycle management, eligibility verification –if done correct, can rise the number of “clean” claims. If the verification method is smooth, many problems like late payments, revise, reduced patient satisfaction, amplified errors, and non-payment can be addressed. At Lex We understand the importance of accurate verification of medical insurance claims for an insurance provider, and ensure that our services are accurate. Our contributions include
Out team at JANUCARE Verify and confirm the documents received from the Healthcare Providers and Clients, this will be taken care before the treatment. It helps them authenticate the patient's coverage details and collate the related documents serially - as instructed by the insurance provider.
Our JANUCARE Team verify the patient's insurance coverage with the primary and secondary payers. Then, our team completes the verification process by accessing the Clearing House tool, insurance provider's online portal or by directly calling them over the phone
If wanted, our team at JANUCARE promptly contact the patient to seek any missing/incomplete/invalid information. This helps in keeping track of all the information and cross verifying these details before the final submission is made.
Once the documents are in command, we submit the final report that integrates all the insurance benefits. It includes details like Policy ID, Member ID, Group ID, Policy Effective Date and Termination Date, Copay, Coinsurance, Out of Pocket Deductible, IN-Network Deductibles, etc. This process denies any last-minute schedule changes and saves time for both the healthcare staff and patient.
At JANUCARE, we do charge entry as a part of the healthcare revenue cycle management services. Since we have prior experience in handling different renowned medical billing software and several medical specialties, we start with the process directly, saving staff training time and effort. We pre-define account specific rules in charge entry for different medical specialties which reduces the room for errors and contributes to clean claims.
At JANUCARE, payments received from patients and insurance companies are posted to the patient’s accounts in the client’s medical billing system. The posted payments are balanced against the deposit slips to ensure accuracy in payment. The payment posters also check for any under payment being made to the accounts. We also do electronic posting of payments into the medical billing software and ensure that the EOB files are stored for future references.
The largest and normally the most significant asset of all healthcare providers is their accounts receivable. At JANUCARE, our Accounts Receivable management function is designed to be the complete solution to difficulties that occur in your cash flows and is operated as an extension of your business section. The goal here is to recover the funds owed to you as quickly as possible by continuously work on identifying and improving processes that can improve efficiencies at each step of healthcare revenue cycle management while meeting the industry’s best practices.
Claims can be denied or partially paid for various reasons, including coding errors, missing information, or lack of medical necessity. Denials must be carefully reviewed, and any necessary corrections or additional information should be submitted promptly for reconsideration.
In cases where claims are denied and the provider believes the denial was unjustified, an appeals process can be initiated. This involves gathering relevant documentation and communicating with the insurance company to appeal the denial and seek proper reimbursement.
Aging reports provide a snapshot of outstanding balances categorized by the length of time they have been unpaid. These reports help identify and prioritize overdue accounts for follow-up actions.
For patient portions of the bill not covered by insurance, healthcare providers send statements to patients to request payment. Effective communication and clear explanations of charges can help reduce confusion and increase patient cooperation in making payments.
Regular follow-up is crucial to ensure that claims are being processed and payments are received in a timely manner. Communication with insurance companies and patients helps resolve any outstanding issues and facilitates the collection process.
Monitoring key performance indicators (KPIs) related to accounts receivable, such as average days in AR, denial rates, and collection rates, can help identify trends and areas for improvement in the revenue cycle. Efficient accounts receivable management in medical billing helps healthcare providers maintain a healthy cash flow, reduce revenue leakage, and improve overall financial performance. It requires a combination of accurate data entry, thorough claims processing, proactive follow-up, effective communication, and continuous analysis of the billing and collection processes.
At Janucare we Setup ERA (Electronic Remittance Advice) and EFT (Electronic Funds Transfer) enrollment. ERA and EFT are electronic processes commonly used in the healthcare industry to streamline billing and payment procedures between healthcare providers and insurance companies. ERA involves receiving electronic explanations of benefits, while EFT involves receiving electronic payments directly to your bank account. Here's a general outline of the steps you might need to take to set up ERA and EFT enrollment: