Front Office Services

• Appointment scheduling and confirmations
  
  Mayflower team takes the incoming requests for appointments, schedules the appointments and confirms the time of visit with the patients. The team handles the queries and gives specific instructions, if any, to the patient for the particular visit.
  
  
• Insurance verification
  
  The insurance of the patient is verified whether he is covered under the specific plan or not and the patient notified of the same.
  
  
• Preauthorization services
  
  Preauthorization is a critical part of the reimbursement process and one that cannot be overlooked. Most procedures or surgeries require preauthorization from the insurance. We at Mayflower verify that this is done by the physician who will perform the procedure.
  
  

Backoffice services

BILLING (Sample Deliverable report; Case study; FAQs)

• Patient Demographic Entry
  
  The patient demographic details are fed into the system.
  
  
• Patient insurance Data entry
  
  Insurance Data is entered based upon the insurance card of the patient.
  
  
• Charge posting
  
  Charge entry service consists of entering CPT codes, ICD codes, modifiers and other related information into the Billing Software according to guidelines.
  
  
• Insurance payment posting
  
  Cash posting service consist of posting primary insurance payments, adjustments and transfer co-insurance to secondary insurance (if available) or patient. Posting of secondary insurance payment is also done by us.
  
  
• Self-pay posting
  
  Self pay posting service consists of posting payments made by patients to the healthcare provider.
  
  
• Denial posting
  
  Claims needing resubmission that is claims denied by insurance are checked for all necessary documents like Medical records, Referral, Authorization etc. and resubmitted.
  

CODING: (Sample Deliverable report; Case study; FAQs)                                               [ Top ]

Medical coding is the seamless and exact translation of medical encounter data to the series of codes used to communicate this data to insurance companies and government agencies. These codes are the diagnoses and the procedures codes. Medical Coding aids in identifying the claims and displays the entire history of the patient and the services performed.

We at Mayflower have certified coders from AAPC who help you in converting the physician’s note into these codes according to the current CMS guidelines and help you get reimbursement.

• Physician Coding :
  
  Coding for the reimbursement of physicians for direct patient care services where E&M codes are assigned along with the other procedures done if any and diagnoses codes.
  
  
• Facility Coding
  
  We help our clients in assigning facility ED codes in compliance with hospital specific guidelines and CMS approved guidelines. The different methods employed would be point systems and patient acuity system, ACEP guidelines or any other hospital specific guidelines.
  
  
• Hospital Coding
  
  We have expertise in coding for different specialties in hospitals consisting of CPT procedural codes, HCPCS codes for supplies and services and ICD codes. We make sure that we are compliant with CMS and other relevant associations while coding for specialties.
  
  

ACCOUNT RECEIVABLE SERVICE (Sample Deliverable report; Case study; FAQs.)

1. Receivable Analysis
2. Payer Follow-up
3. Denials Management
4. Reporting
5. Practice Analysis

INSURANCE FOLLOW-UP

Accounts Receivable Process/Assessment Process Daily Insurance aging report is run and claims are analyzed. The analysis is done to identify:

1. Un-paid Claims
2. Low Paid Claims
3. Denied Claims
4. Rejected Claims
5. Claims not on file

And subsequently our collection agents call up the respective insurance companies to seek explanation.

APPEALS

An appeal is a special kind of complaint you make if you disagree with a decision to deny a request for health care services or payment for services you already received.

Here's how our appeal process works.

• We track the results of medical claims recovery by keeping a denial rate report and by recording the turnaround time from claim filing to payment.
  
• We have a system to time appeals submitted and ensure that no time is wasted in the appeal process. We also develop standard appeal letters that can be easily customized with information about the particular patient and situation involved in every denial.
  
• We see that we do not appeal very low dollar claims by setting a minimum of $10 for first appeals, and $20 for second appeals.
  
• If an insurer routinely down-codes claim, we appeal for the code that was submitted originally and include supporting documentation.
  
• If an insurer consistently refuses payment for a certain code, we request the physicians to meet with the insurer to discuss the situation and bring along supporting documentation instead of sending more appeals.
  
• Before signing any contract with a payer, we request the physicians to make sure that the claim appeal process is explained clearly. This helps us determine steps to be taken after a denial and consider steps for further action.
  
• Steps for further action include finding out whether mediation is allowed, whether grievance hearings are held, can the group request a physician peer review if a claim is denied for medical necessity etc.
  
  Although appeal strategies may not always work, most practices find that at least 50% of their appeals get paid. This kind of return is well worth the time and effort involved in pursuing appeals, particularly if the accounts receivable team's appeal processes are efficient.