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Medical Billing with AI Automation

Welcome to HiPaaS RCM Services, your trusted partner for seamless Medical Billing Services. We understand the complexities of the healthcare and insurance industries, and we're here to simplify the process for you. Our mission is to ensure that both healthcare providers and patients have the clarity they need regarding insurance coverage and benefits. Discover how our services can benefit you. We work with major EHR companies like Athena, eCW and others.  We use AI and Automation tools for billing and coding.

What We Do Different

01

Low Cost

We keep your medical billing and coding cost very low using offshore resources that work in your timezone. We understand how hard you work to take care of patients and we want you to keep the money

02

Certified Experts

Our medical billers are certified in coding and also go through HIPAA security training. With us you can be assured of high security. Our Communication skill and culture training covers the aspect to fit in to your needs.

03

Availability

Availability is biggest factor both for on boarding new resources and also be available on time zones. Our large scale makes sure you have some available on demand. Also our state of art facility helps billers to work in US timings

04

AI Automation

We save you money by automation and AI tools we use. Our focus is to automate repeating tasks and solve complex coding equations using algorithms. We have various tools at disposal for our coders to automate and complete the work quickly

Our services

Eligibility Check

Streamlined Verification: We offer quick and accurate eligibility verifications to confirm patients' insurance coverage details. Prevent Claim Denials: Our services help healthcare providers avoid costly claim denials by ensuring patients meet the criteria for covered services. Improved Patient Experience: Patients appreciate the transparency and convenience of knowing their eligibility upfront, reducing stress and confusion. Comprehensive Benefit Details: We provide a detailed breakdown of what services and treatments are covered by insurance plans. Cost Transparency: Patients can make informed decisions with information on co-pays, deductibles, and potential out-of-pocket expenses. Financial Planning: Our benefit verification services empower patients to budget for healthcare costs and minimize financial surprises. Features: Check eligibility explanation and summary. Check by service codes. Detailed eligibility for various service codes Complete Medicare and Medicaid eligibility data ( Part A, D ) Check extended benefits Check Home health eligibility, Nursing home eligibility, Hospice and others Check Therapy and mental health eligibility Check Chiropractor eligibility Check eligibility in realtime   Batch all eligibility request and submit offline.

As part of billing process, claims process or visits, we can check Eligibility and Benefit Verification Services and map it to patient data

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Medical Coding

Our coders are certified and are specialists in their role. The medical coders review encounters and post charges checking any unusual diagnosis codes, cross-checking procedures with the diagnosis codes, and ensuring proper units are billed. We focus on maximizing reimbursement through optimum coding, record keeping, and follow up. We also use automated generative AI tools to suggest the coding and easy to repeat data issues. Review and cross check codes and any issues contact the practice. With effective charge capture process we reduce claims denial and increase error-free submissions.

Our coding experts use internal automation tools to derive coding and charges to make the coding process efficient and less error prone

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Payment Posting

Payment Posting is critical part and most manual time consuming part. It also is important to provide financial snapshot of the practice. Our team focuses on automating and providing timely payment posting. Payment posting is the first line of defense to identifying any payer problems. Any denials for medical necessities, non-covered services and prior authorizations will be revealed and allows team members to resolve them. We also match the ERA and EOB to submitted claims and identify the differences in the paid versus submitted claims. We record the patient responsibility and research any denials. Our team makes sure you’re A/R and financials are kept current. We have tools to automatically post payments to EMR. We reconcile payments with treasury and bank lockbox files

We collect all Payment details ERA, EOB and Treasury files and post payments in RCM and EHR

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Patient Responsibility Collection

Based on payment posting and amount paid by insurance companies, our team follows up with patients for patient responsibility part. We provide payment gateway or integrate with you point of sales for credit card payments or check payments. Any portion which is above certain duration, we transfer it to collection teams.

We post Patient Responsibility details and follow your payment process to collect initial payments

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Prior Authorization

Complete Prior Authorization request and required data. This form includes details such as the patient's medical history, diagnosis, proposed treatment, and supporting documentation. The completed Prior Authorization request is submitted to the patient's health insurance company. Review Notification of Decision: Follow up with insurance company on decision. Collect additional supporting data and submit to insurance company If denied, the insurance company explore alternative options or appeal the decision. Features: Detailed prior authorization data creation Validate Prior Auth before submission Manual creation of Prior Auth request Add supporting data and attachments Track responses from Payer

Our team collects all data required for prior Authorization request and follow ups on submitted auth certificates

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Claims Submission

We streamline claims conversion and submission of claims batches to payers. We validate and correct the claims before submission Smart Claims creation and corrections, save time on data entry and corrections Exceptions are handled via manual corrections of claims data. Custom Data entry screens for CMS 1500s and UB-04s are available to enter manual claims. Automation is used to fix recurring data issues. Batches of claims are submitted and we manage responses from clearing house - 999 and 277ca. We fix any rejected claims and resubmit the claim to insurance companies. We also audit to make sure there are no duplicates.

Our team is expert in claims creation and Claims Submission. We fix rejected claims and make sure no claim is left behind

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Claims Denial Management

Our team researches every denial and spends time with insurance companies on phone understanding. We maintain list of top denial reasons as add them to medical coding and submission step. We research denial reason codes or situational codes. Based on denials we also add extra screening for eligibility denials. We have experts we can research the policy and coverage. As possible, we rework and re-submission to payers in a timely manner. Our team also checks the secondary payer information and submits claims to the secondary payer. If not resolved the claims and amounts are posted to patient responsibility account or make adjustments based on policies

Our team will research each Claims Denial and resubmit it. We also report on top denial and make sure they are included in coding process

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AR follow up

We keep the A/R report near real time with claims submissions, claims payments, payment posting, patient payments and denials. Our team follows up with Insurance companies for any claims payments that is taking time or deviates from defined SLA. We also follow up with collection agencies and other entities to keep the receivables current. We reconcile payments with treasury and bank lockbox files

We keep your A/R updated and follow up with Insurance Companies

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