Our Services

Eligibility Verification and Pre-authorization

Verifies insurance eligibility and obtains pre-authorization of claims in a timely manner. When a patient makes an appointment, the healthcare provider collects information to establish a patient insurance eligibility.

Medical Coding

Charge capturing is the process by which patient services are transcribed into billable charges using universally accepted medical codes. These codes are how insurers determine reimbursement amounts. Without proper medical coding, the insurance company may deny the patient’s claim. This results in delayed provider reimbursement.

Medical Billing

Medical Billing is the process of submitting and following up on claims with payers. It is often considered tedious but is nonetheless vital to every provider, whatever the size of their practice. Outsourcing your medical billing requirements to indus med means claims are prepared properly; any issues or potential errors are flagged before submission; and batches of e-claims are submitted quickly and more frequently so as to reduce the billing cycle. Accounts receivable and denials are likewise managed efficiently, with any legitimate payer denials identified and corrected for future cycles, giving providers the much-needed peace of mind.

Medical Claim Review-Submission and Resubmission

Once a patient’s treatment has been properly coded and audited, the claim is sent to the insurance company for approval. RCM ensures this submission happens quickly by tracking and managing the claim from the start of the process.

Submission

Medical and Insurance reviews are conducted by a specialist team of qualified professionals with a different set of medical skills and backgrounds. This team includes medical doctors, pharmacists, nurses, physiotherapists, laboratory specialists, and several other paramedic staff, who have insurance expertise in reviewing medical necessity and insurance protocols.
Medical reviews are conducted to validate and assure medical record documentation is complete and billed services are justified and compliant as per the patient’s health insurance policy. The reviews also ensure that all insurance and pre-approval protocols are strictly followed for each claim thereby helping to:

• Decrease the chances of rejection and ensure early payment;
• Monitor physician error trends and patterns that adversely impact cash, while identifying and analysing rejection trends;
• Identify training needs for providers to address the known defaults and decrease rejection rates; and
• Regularly provide feedback to enhance the smooth process flow.

Re-submission

Our Resubmission team comprises highly skilled multi-disciplinary professionals with extensive experience in administrative, medical and insurance related processes. Their objective is to review remittance advices received from payers for any denials and apply the necessary corrections and medical justifications through the:

• Complete analysis of factors that led to the non or partial payment against submitted claims;
• Re-process claims with necessary changes and justifications and submit to the payer for re-evaluation;
• Review the price list and contract terms with payer if rejection is related to the same;
• Complete review of medical documents and provide medical justification to payers for services claimed; and Provide suggestions for corrective steps to be implemented to reduce rejection rates.

Denial Management

Proactive identification and resolution of claim denials to maximize revenue recovery.

Denial management is a critical aspect of revenue cycle management (RCM) that focuses on identifying, addressing, and preventing the denial of claims by insurance payers. When a claim is denied, it means the insurer has rejected the request for reimbursement for services provided. Effective denials management involves understanding the reasons for these denials, implementing strategies to address them, and resubmitting claims with the necessary corrections. This process helps healthcare providers recover lost revenue and maintain financial health.

What Problems Can We Solve For You?

Frequent Claim Denials: Claims can be denied for various reasons such as missing information, coding errors, or lack of authorization. These denials can lead to significant revenue loss and disrupt the cash flow of healthcare providers. Pure RCM assists in identifying the root causes of denials, implementing corrective actions, and preventing future occurrences by ensuring that claims are accurately and comprehensively submitted.

Complex Resubmission Process: Resubmitting denied claims can be a cumbersome and time-consuming process. It requires thorough documentation, adherence to payer-specific guidelines, and timely follow-up. Pure RCM streamlines this process by leveraging our expertise in denials management, ensuring that resubmitted claims are corrected and submitted promptly to maximize reimbursement opportunities.

Payment Collections

Our services in payment collection from insurance companies on behalf of providers. We understand the challenges providers face in receiving timely payments from insurance companies, and our dedicated team is here to assist you in streamlining this process.

Our services include efficient communication with insurance companies, timely follow-ups, and swift resolution of any payment issues that may arise. With our expertise in this area, we aim to help providers like you focus on delivering exceptional care to patients while we take care of the payment collection.

E-Learning, Staff Training Programs & Internship

We provide training programs to staff to raise their efficiency which covers everything from claim to resubmission and denial management, medical documentation requirements for EMR quality.

Also we provide documentation improvement, clinical coding services, in-house staff training, training for doctors, nurses, insurance coordinators, billers.

Internal Audits

We provide internal medical audits for clinics. Our audits are designed to ensure compliance with medical regulations, improve operational efficiency, and enhance the quality of patient care.

We will explain about how our audit services can benefit your facility.we do systematic performance assessment within a healthcare organization. Most healthcare elements can be audited & looks at components of payer reimbursement processes to evaluate compliance with payer guidelines and federal and state regulations.we perform auditing for provider or for third party on its behalf. We provide reports of audits not only to identify incorrect coding, but also to prevent errors from being repeated. Habitual claims errors impose a cumulative effect on providers & thereby results payer & regulatory reproach.