Health care Services

Outsourcing of Data Conversion is a vital decision that has to be taken wisely. It involves transformation of your data into a new database and is very critical for effective functioning. Della helps customers migrate from one billing software to another. Sometimes the existing software's data cannot be used as input into the new software during software migration, In such cases, we do a manual conversion of the data and no matter how complex and voluminous is the task, Della provides comprehensive data conversion services. With years of experience, we offer wide spectrum of modern data conversion tools that helps in quick and cost effective and sets us apart from various other service providers. We have a team of conversion professional who excel in their field and ensure the conversion is accurate and reliable. We organize your data in a structured way so that you can access it without troubles. Save yourself the hassles of piles of papers and documents. Convert your valuable documents and reports in simpler formats and avoid data redundancy.

Getting the claims accepted, on the first submission!

Insurance eligibility verification is the most important and the first step in the medical billing process. Research confirms that most of the claims are denied or delayed due to inadequate or incorrect coverage information provided by the patients during visits and current coverage information not updated by the office / hospital staff. This lack of or improper insurance eligibility verification directly impacts the reimbursements.

Why opt for insurance eligibility verification

Insurance companies regularly make policy changes and updates in their health plans. Therefore, it is important for the medical billing company or the provider to verify if the patient is covered under the new plan to get maximum reimbursement. Confirming the insurance coverage facilitates acceptance of the claim on the first submission, whereas non-verification leads to several discomforts like rework, decreased patient satisfaction and increased errors other than causing delays and denials.
At Della India, we understand the importance of  insurance eligibility verification.

Help in reducing our clients’ revenue cycle, Minimize delays and denials considerably, Improve collections by reducing write-offs

Insurance eligibility verification process at Della Healthcare :

Verify patients’ insurance coverage with primary and secondary payers by making calls to the payers and checking through their authorized online insurance portals. We also contact patients for additional information, if required Update the medical billing system with eligibility and verification details such as member ID, group ID, coverage period, co-pay, Deductible and co-insurance information and other code level benefits information including max limits allowed. In case of issues regarding a patient's eligibility, we inform the client immediately Della dedicated insurance eligibility verification team delivers a thorough verification, thereby aiding dramatic reduction of the clients’ accounts receivable cycle.

RCM Account Recievables

One of the key areas in medical billing that directly impacts the cash flow is accounts receivable management. Therefore, it is only logical that a system of internal controls to properly manage medical billing AR follow-up is designed and put in place. At Della India, the AR management team is structured to be a complete solution provider to address difficulties that occur in cash flows and is operated as a part of the medical billing team. The goal here is to recover the funds owed to the client as quickly as possible. We aim at accelerating cash flows and reducing the Accounts Receivable days by submitting error free clean-claims, proper analysis of denied claims and regular follow-ups with insurance companies and patients for outstanding claims and dues. Our Accounts Receivable Management services include:

Insurance Follow up

Healthcare Providers and medical billing companies lose a lot of money due to lack of follow-up on outstanding claims with the insurance companies. The Della AR follow-up services are designed to ensure timely payment of claims. Della has a dedicated AR follow-up team that aggressively follows-up with insurance companies on all accounts. e-care’s trained staff constantly keep in touch with insurance companies via websites, fax, IVR and phone to ensure that claims are settled quickly. The AR management team continuously monitors the ageing buckets of the ARs and guarantee that all the claims are followed upon between 25-45 days from the date of entry depending on the payer. Medical billing AR follow-up with insurances is done to obtain the status of the claims, status of appeals and denial reasons in case claims have been denied. Every effort is made to have the claim re-processed on the phone, during the call with the Insurance representative.

Old Accounts Receivable Management Clean-up projects

Della India also undertakes clean-up of old Accounts Receivables. Many a time, practices and Facilities have accumulated unresolved Accounts Receivables either through lack of proper AR follow-up due to lack of manpower or sometimes they end up with these backlogs due to poor AR Management done by another medical billing company. Della India teams analyze the various accounts receivable reports provided by the client and determine strategies to work on the AR management strategy. The strategies are developed and executed, so that there is reduction of the bad debts and AR collections are maximized.

RCM Charge Entry

Charge entry is one of the key areas in medical billing. In the medical billing charge entry process, created patient accounts are assigned with the appropriate $ value as per the coding and appropriate fee schedule. The charges entered will determine the reimbursements for physician’s service. Therefore, care should be taken to avoid any charge entry errors which may lead to denial of the claims. Moreover, good co-ordination between the coding and the charge entry team will produce enhanced results. Della, provides charge entry in medical billing as a part of the healthcare revenue cycle management services suite or as a stand-alone service. Teams at Della have prior experience in handling the charge entry process on various medical billing systems and for several medical specialties. So the teams can start with the process directly after just a few calls to understand the nuances to be followed, saving training time and effort. The teams have pre-defined account specific rules in charge entry for different medical specialties and just add the nuances to them for each client, which reduces the room for errors and contributes to clean claims.

Charge entry process at Della Healthcare:

Charges are entered in to the client’s medical billing system based on account specific rules. The pending or held documents are sent to the client for clarification, on a pre-determined schedule. The final charges are audited by the Quality team and the clean claims are sent for transmission. The staffs of Della has excellent skill-sets in handling charge entry for different medical billing specialties. The teams do not just do pure data entry but provide value addition. In fact, if the teams find an issue with the super-bill at the time of entry, the charge entry for that super-bill is put on hold and a clarification is sought from the client before entering the charges.

RCM Coding

Della is one of the leading medical coding companies in India. At Della, we understand that medical coding is one of the most important processes in healthcare revenue cycle management preceding a claim submission. Accurate medical coding services are essential to reduce denials and generate more revenue for our clients. One of the main reasons for claim denials is medical coding errors. By meeting and exceeding the industry standards and compliances without compromising on quality, Della guarantees accurate coding and complete satisfaction to our clients. The principle followed by the Coding team is simple – “If it is not documented, it cannot be coded”. Our experienced and well-trained coders are proficient in providing the following medical coding services: ICD-9-CM, CPT-4, HCPCS coding, ICD-10-CM and ICD-10-AM medical coding Chart Audits and Code Reviews HCC medical coding Offshore coding audits Payer specific coding requirements

Coding Process

Every step in the process of medical coding is accomplished with perfection to ensure that an accurate and error free claim is submitted to the insurance carriers. There are also separate audit team that audits all the coding done before the charts are processed. Precision and accuracy in medical coding methodology produces consistency and eliminates the risk of errors. Della clients who outsource medical coding services also receive regular feedback on any coding guideline changes and coding-related denial analysis. Unlike some medical coding companies that rely on external training, Della continuously imparts professional training in medical coding to all our coders to ensure that they remain well informed and updated with the latest developments.

Denial Management

Denial Management

Della India is dedicated to minimize lost reimbursements and denials with highly efficient systems and services designed to meet our client needs. One of the major problems faced by healthcare providers and medical billing companies is that a large proportion of rejected claims goes unattended and is never resubmitted. Della Healthcare Denial Management process uncovers and resolves the problem leading to denials and shorten the accounts receivables cycle. The denial management team establishes a trend between individual payer codes and common denial reason codes. This trend tracking helps to reveal billing, registration and medical coding process weaknesses that are then corrected to reduce future denials, thus ensuring first submission acceptance of claims. Also, the payment patterns from various payers are analyzed for setting up a mechanism to alert when a deviation from the normal trend is seen.



Appeals for Denied Claims

For claims that are denied and need to be appealed, appeal letters are prepared and sent along with supporting documents including Medical Records for processing. If the insurance permits telephonic or fax appeals, the same is also handled through those channels



Patient Follow-Up

Della has a separate team of executives dedicated to calling only patients. Calls are made to patients to obtain missing demographics, insurance information and also discuss outstanding patient dues. Each patient account is meticulously tracked and followed-up by our trained and experienced staff till the payment is received. Processes are clearly laid out involving sending letters, statements, notices, making phone calls, etc. to expedite collections.



Credit Balance Audits

During the process of collection retrieval, an audit of all the accounts is undertaken to reconcile unidentified and duplicate payments. Processes are set such that the payer and patient overpayments are refunded or adjusted as per the policies of each client. Refund requests are prepared and sent to the clients to handle necessary refunds, after thorough research of the patient account to establish overpayments.



EDI-Setup

Della can do a complete EDI set-up for new practices or practices moving from paper based claims to electronic forms. The process includes setting up the user and database on the EDI (Clearing House) website, testing with sample batches to ensure that the 837 and 835 are processed correctly and integrating the EDI with the Billing system for ‘one touch’ transmission of claim batches. Other aspects that can be set-up are 276/277 (Claim Status) and 270/271 (Eligibility and Benefits verification).



Electronic Claims submission

The crucial step in the medical billing process is submission of the claims through EDI. The healthcare claims contain sensitive information including patient data and insurance information. Submitting claims through EDI reduces processing delays and ensures higher acceptance rates with Payers. Della teams have the skill and expertise to check for transmission related errors at a ‘loop level’. This ensures that any re-current errors like skipping of a line-item can be analyzed and resolved in conjunction with the Clearing House support teams. The Della team for each client typically identifies one key member to be responsible for the EDI. This person is responsible for Daily EDI transmission of claim batches Track the EDI transmission reports every day Identify ‘rejections’ from EDI transmission reports Send rejections back to Billing team for fixing the error Co-ordinate with Clearing House and resolve any field mapping issues With EDI submission, carrier confirmation report is also instant and prevents any time delays due to transmission errors. Also, tracking claims has become easier, corrections can be done for claims being rejected and re- transmitted without much delay. Once set-up, the electronic transmission process is very simple. But many organizations/practices do not understand the importance of constantly tracking the reports and the impact on revenue flow when not done diligently. The teams at Della, realize the importance of tracking the reports on a daily basis so that EDI rejections are handled immediately and re-submitted for processing. This ensures that there is no delay or lag in the payments from the Insurance payers.



RCM Payment Posting

At Della, payment posting in medical billing is one of the key processes that get the utmost attention from our Operations management. The payments in lieu of claims, which are received from the Payer and Patients, are posted in the medical billing system of the client to reconcile the claim. Della also does electronic payment posting in to the medical billing software and handles the exceptions (fallouts) manually to make sure no payment is missed. The posted ERAs are stored either in the billing system or a Document Management system (DMS) for future reference. Insurance Payment Posting: All payers either send an EOB (explanation of benefits) or ERA (electronic remittance advice) towards the payment of a claim. The medical billing staff posts these payments immediately into the respective patient accounts, against that particular claim to reconcile them. The payment posting is handled according to client-specific rules that would indicate the cut-off levels to take adjustments, write-offs, refund rules etc. When the client’s office delays in either depositing the Payer checks or sending the ERAs and EOBs for posting, then a negative balance prevails for that claim, which is a false representation of the actual scenario. This false representation would show an inflated AR, resulting in the Physicians not knowing exactly how much revenue is due to them. Patient Cash Posting: There could be several reasons why the patient needs to pay a part of the expenses including co-pays, deductible and non-covered services. If the amount due from the patients is very minimal, the Provider can set a mandate for taking write-offs. If the amount is quite large, then it should be collected from the patients either prior to or after rendering the services. Patients typically pay through checks or credit cards (via patient portals) and these need to be correctly accounted against the claim to avoid any inflated AR and proper closing of the claim.