Health Care Medical Coding

Our Every Deliverable will be Made with Estimable Quality...!!!

Modcha Medical Billing specializes in custom designing and implementing advanced practice management, cash flow, revenue generation, administrative efficiency, and collection strategies for small and medium medical practices. Our primary goal is to improve your top-line and bottom line.

Modcha Medical Billing is a one-stop solution provider that is capable of meeting all requirements of a medical practice.

1.Pre-certification & Insurance Verification

The patient list, a copy of the insurance card and demographic details are sent to us via email/fax or secure FTP. Our medical billing specialists call up the insurance company prior to the appointment. Pre-certification is done for specific lab tests, diagnostic tests and surgeries. The details are sent to the hospital/clinic in the prescribed format.

2. Patient Demographic Entry

The medical billing specialists enter patient demographic details such as name, date of birth, address, insurance details, medical history, guarantor etc as provided by the patients at the time of the visit. For established patients, we validate these details and necessary changes, if any, are done to the patient records on the practice management system.

3. CPT and ICD-9 Coding

Our coding team works in accordance to CPT codes and ICD-9 and ICD-10 Coding compliance, and consists of AAPC certified coders with over 2 years of multi-specialty coding experience. You may send us superbills with diagnostic notes with or without ICD and CPT codes. If codes are already provided on the superbill, they are validated by our coding team compulsorily to prevent any ‘up-coding’ or ‘down-coding’ and therefore, any denials.

4. Charge Entry

The fee schedules are pre- loaded into the practice management system. CPT and ICD-9 codes are entered into the system. The billing specialists ensure that all details have been provided in the claim and ready to be filed.

5. Claims Submission

Claims are submitted electronically via the practice management system. However, we can process paper claims also. At this stage, a thorough quality check is done by a senior billing specialist and then submitted. The rejection report received from the clearing house, if any, is analyzed and the necessary changes are done. These claims are then resubmitted.

6. Payment Posting

Scanned EOBs and checks are sent to our team. All payments are entered into the system. The amounts from EOBs/checks and amounts posted in the system are reconciled on a daily basis. A daily log is updated with these data.

7. Account Receivables Follow-up

All claims in the system are examined and priorities are set. First the claims close to their filing limits, and then work down from the age of the claim. Periodic follow-ups over phone, email and/or online is done to get the status of each claim submitted to the insurance company.

8. Denial Management

Analysis of denials and partial payments is done by our senior medical billing specialists. Payors, patients, providers, facilities and any other participants are called to follow-up on denied, underpaid, pending and any other improperly processed claims and the action is documented in the system. We will call patients, if authorized by the provider, to obtain information from the patient needed for billing such as ID# and to update the COB (Coordination of benefits) with their insurance companies. Secondary paper claims are processed and sent to the client office for submission.

9.Telephonic Patient Customer Service and Client Tech Support

Our clients and their patients get local telephone numbers for support and follow-up. Well-trained, experienced, and knowledgeable personnel answer these calls. Calls from physicians are directly routed only to the most highly trained medical billing professionals in our call center. Included in our prices is also customized remote controlled tech support for our physicians’ computer systems and day-to-day MS Office/Windows software queries.

Competitive Pricing

Most medical billing companies charge between 8% and 12% of the amount collected, to their physician clients. We charge our clients, an average of 7 to 8% of the actual amount collected, after it is collected. That is substantial direct savings and cash-flow improvement to our physician clients, day on day.

Our clients—doctors running their own medical practices—take home an average of 40% more profits than other doctors from their practice – and work less.

Medical coding process at Modcha Innovative Solutions
1. Accessing patient charts

The process starts with you sending us the patient information. The data transfer can be through VPN or you can give us permission to access data from your practice management system. You can totally be at ease about the security of your information as we at Flatworld Solutions hold our integrity high. Also we sign a Non Disclosure Agreement (NDA) with you to bring a legal binding to our assurance of security.

2. Pre-coding

At the pre-coding stage, codes are entered referring to insurance companies, doctors, diagnoses and other procedures. Each medical coder will follow these codes throughout the coding process.

3. ICD and CPT Coding

Our coders follow ICD-9-CM, LMRP, CPT Assistant, and HCPCS Level II medical coding. Codes are assigned and entered in accordance with the procedural codes avoiding any kind of up-coding and down coding errors. The compatibility of diagnoses is verified with the procedural codes that are entered into the system and if there are any discrepancies, the required modifications are made.

4. Quality Check

An intensive quality analysis check is performed at every stage of the coding process. Our quality experts conduct a multiple and rigorous check for accuracy, avoiding any possibilities of up-coding/down-coding before delivering the coded charts to the client.

5. Submission of coded charts

Once the coded charts are prepared, they are submitted to the client in an electronic format. These charts are further used in the claims processing phase. If you would want to use our medical billing services, our medical billing team will take charge from this stage.

Detailed Report

We provide reports detailing billing transactions on a weekly, bi-weekly, or monthly schedule. We also capable of customization of these reports as per the client’s preference.