Breaking Barriers in BPO through innovations

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TrinityMag Global Services
Trinitymag Global Services Medical Billing
Services
Breaking Barriers in BPO through innovations
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Welcome to TGS Professional Medical Billing
TGS PMB

• TGS is a full service billing center specializing
  in electronic filing of insurance claims, patient
  balance billing, and collection of old
  receivables.  Located in New Delhi.
•   Core Services
• These services represent the bulk of our daily
  tasks and are the ones that provide you with your
  cash flow.  They encompass everything needed to
  completely bill a claim from the initial
  superbill to getting your payments posted.
• Practice Management
• These services are comprised mainly of the
  reporting that is generated from the Core
  Services.  They allow you to optimize your
  collections and ultimately increase your cash
  flow.

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TGS Medical Billing Services

• Medical Transcription
• Scheduling
• Coding
• Fee Schedule
• Credentialing of Providers
• Demographic Super Bill Entry
• Transmission of Electronic Paper Claims
• Payment Posting
• Denials Management
• AR follow-up on unpaid claims
• Follow up Electronic Claims(10 days), Paper
  Claims(30 days)
• Appeal on low payment
• Patient Bills
• Weekly Reports Top 10 carriers)
• Monthly Reports Financial Report)

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Why Outsource to TGS

• Have You Considered Outsourcing your Medical
  Billing to TGS Experts?
• Outsourcing your medical billing claims
  can be very profitable for Physicians because it
  eliminates all the daily expenses associated with
  Keeping medical billing In-House. It is Aceteras
  responsibility to relinquish these expenses from
  your
• practice enabling you to receive greater
  profitability.
• What Are Some Of The Benefits Of Outsourcing
• Shortened insurance payment cycles of 10-14 days
• Increased cash flow
• Reduced outstanding accounts receivable
• Customized reports analyzing your practice
• Patient Account Management by a highly qualified
  professional
• No need to invest thousands into a new system
• No need to train your staff on a new and
  sometimes complicated system
• You save money and time!
• Access your patient account information via your
  own computer

The Expertise
Our Execution Strategy
People Power
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Set Strategic Goal
Collect Performance Data
Condition for Performance Gap
Quality In TGS
Hourly , Daily Weekly Performance Cycle
Collect Ongoing Performance Data
Communicate Results
Generate Competence / Performance Gap
Track Results
Analyze Performance
Set Performance Target
Develop Key Performance Indicator
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INDUSTRY BENCH MARKS

• Account Receivables Days gt 60 Days
• Total Account Receivables - -gt 2.5 times of
  monthly Charges
• Collections - -gt 40
  of monthly Charges

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TGS Forging Ahead
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CAPABILITIES
TGS has experience of 5 plus years in the Front
Office / Back Office Medical Billing / Practice
Management Industry. The staff at TGS have worked
with most of the states along the eastern as well
as the western coast of the US. Keeping abreast
of the changes in guidelines for billing various
carriers through participation in Medical Billing
Forums, subscribing to Manuals and Bulletins from
Insurance Companies. TGS has a comprehensive
training schedule for both experienced as well as
fresh candidates. We always maintain a bench
strength so that the day to day routine of the
clients do not suffer at any point.
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SKILL SETS

Specialties Radiation Therapy Obstetrics
Ambulatory Surgical Centre Orthopaedics Patholog
y ENT Family Practice Pediatrics Gastroentero
logy Podiatry General Surgery Psychiatry
Gynaecology Radiology Infectious Disease
Internal Medicine Cardiology Neurology Oncol
ogy Hematology Physical Therapy Software Medic
(Misys PM / Tiger) EMDS Excalibur Medical
Manager Medplexus Medisoft PMC
Lytec SequelMed Geysers Ka
reo Vericle NextGen
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EXPERIENCE

• We have staff who have physical hands on offsite
  experience of working with group practices in
  various states for more than 5 years.
• We have worked with group practices in Family
  Practice, Internal Medicine clients in the State
  of Maryland.
• We have onsite experience in the following
  domains
• Scheduling of Appointments
• Front Office
• All the processes in Medical Coding / Billing
• Liaisoning with Software Companies
• Data Migration from one software to another

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Modules in Medical Billing

• Flow chart of Medical Billing
• Process of Medical Billing
• Scanning Department
• Coding dept
• Patient Demographics
• Superbill / Charge dept
• Quality dept
• Transmission dept
• Payment posting dept
• Insurance Follow up / Analysis
• Patient Analysis
• Month End Reports

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FLOW CHART OF MEDICAL BILLING
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PROCESS - MEDICAL BILLING
CLIENT IN US
SCANNING TO INDIA
CODING
ACCESSSING SOFTWARE
PATIENT DEMOGRAPHICS ENTRY
CHARGE ENTRY
QUALITY AUDIT
Unpaid Claims For corrective action
Paid Claims for cash application
TRANSMISSION OF CLAIMS THRU CLEARINGHOUSES
CASH APPLICATION
AR ANALYSIS / CALLING
ACTION ON DENIALS / REJECTIONS
CASH TALLYING
MIS / GENERATION OF REPORTS
REPORTS TO CLIENT
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SCANNING DOCUMENTS TO INDIA
US Office scans Patient Demographics, Charge
Sheets, Insurance Card Copies, etc.
Scanned copies would be saved as .TIF (Tagged
Image Format) file and placed in FTP Site
In the FTP Site, Files would be placed in the
common path which can be accessible by India
Mail to India on Scan date, File name and
directory path.
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MEDICAL CODING
Log to be maintained with File name, Total
charges, Specialty details, etc before Coding.
Coding of Diagnosis to the utmost specificity
using ICD-9 CM Manual.
Coding of Procedures by referring to CPT / HCPCS
/ ASI Manuals
After Coding, files to be handed over to Charges
Department for processing.
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PATIENT DEMOGRAPHICS
Documents to be sorted Patient wise before
entering into the system
Patient Account Numbering to be done, if system
does not generate automatically
Patient , Name(LFM), Address, SSN, Sex,
Employer, Home Ph, Work Ph, Guarantor, Marital
Status, Subscriber details, Doctor, Insurance
information etc to be entered in the system
If any clarification is required, send mail to US
office
After entering, printouts to be taken and data to
be checked
Log to be maintained with Total Patients,
Patients entered, Pending details, etc.
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CHARGE ENTRY
Patient Demographics and Coding to be done before
entering Charges
Charge File to be sorted by Patient / Date of
Service
Patient , Doctor , Place of Service, Type of
Service, Date of Service, Procedure Code,
Diagnosis Code, Modifier, Units, Value, Referral
, Prior Authorization, On Bill comments, etc.
to be entered in the system
If any clarification required, send mail to US
office.
After entering data, file to be given to Quality
Audit for checking
After checking and corrections, Claims to be
transmitted.
After Transmission, Charges completion details to
be sent to US office.
If any incorrect details found, Charges
department to be informed
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QUALITY AUDIT
Quality Audit for Patient Demographics and
Charges before sending batch wise update to client
Patient , Name, Address, SSN, DOB, Home Ph, Work
Ph, Guarantor, Subscriber details, Employer, etc
to be checked in Patient Demographic File
Date of Service, Procedure Code, Diagnosis Code,
Modifier, Units, Value, Place of Service, Type of
Service, Referral, Prior Authorization, On bill
comments, Location, etc to be checked in Charges
File
After Quality Audit, files to be given to
Supervisor / Manager for sending Batch Update to
client.
If any incorrect details found, Charges Team to
be informed of the same and correction done
Log to be updated with patients checked, charges
checked, correction details, etc
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TRANSMISSION Electronic / Paper
After Quality Check is through, List of
Electronic Claims to be separated
Transmission processes to be accurately
followed to avoid rejection
Claims to be transmitted electronically through
Fast claim, Envoy, Halley, Navicure , Emdeon,
Availityetc.
After transmission, log to be updated with
patient , claim, total claims transmitted,
pending claims, etc.
If any incorrect details found, Charges
department to be informed
Send mail to Charges department after completion
of Transmission
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CASH POSTING
Checks and EOB(Explanation of Benefits) to be
arranged before doing Cash Posting
Insurance Name, Check , Total Check Value to be
cross verified with the Check and EOB Copies
In the EOB Copy, Claim, Date of Service,
Procedure , Units, Charges to be identified
before posting
Application of Payment, Deductible, Co-insurance,
Adjustments, Write offs, etc in the Cash Posting
If any incorrect details found or any details
missing, follow up to be done with Insurance
After Cash Posting, Claim, Patient Name and
Value to be checked for tallying data with the
EOB
Log to be updated with Total Checks, Total Value,
Posted details, Pending details, etc
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INSURANCE FOLLOW UP
COVERAGE INFORMATION
TREATMENT ELIGIBILITY
CONTRACT INFORMATION
INSURANCE FOLLOW UP
CARRIER FEE SCHEDULE
CLAIM STATUS
PAYMENT DETAILS
PROVIDER INFORMATION
DENIAL REASONS
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INSURANCE ANALYSIS
Claims pending for additional details required
Claims not in the Insurance system
Claims rejected by Insurance
Claims denied by Insurance
Claims pending after 30 days
Log to be updated with details of Patient, Name,
Claim, Value, Insurance, reasons, etc
Analysis and actions to be carried out for
resubmitting the claims
Claims to be printed again and sent to insurance
Claims to be corrected for rejections and resent
to Carrier
Claims to be corrected for denials and resent to
Carrier
AR to follow up with insurance and get the claim
status
Information to be faxed or sent through courier
to the insurance
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PATIENT FOLLOW UP
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PATIENT ANALYSIS
Bills returned due to incorrect address
No correspondence from patient
Patients giving wrong information
Patient Bills would be sent monthly once and
three times to the patient.
Log to be updated with details of Patient, Name,
Balance, Bills sent details
AR will follow up with the Patient for getting
payment from him
If Patient does not pay or respond properly even
after 90 days, his account would be moved to
Collection Agency.
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MONTH END REPORTS
Audit Recap
Month-end Financial Reports
Doctor Financial
Patient Financial
Service Analysis Reports
Aged AR
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REQUEST FOR INFORMATION

• We request to answer the following
  questions so that we can plan our transition /
  migration and business process.
• Volume of Business
• Current AR
• Total of Providers in the Group
• Payer Mix
• Software being used
• Specialty
• State in which the practice is located
• MIS Reports of Last Month End and Year End
• Clearinghouse being used
• Access to your system for viewing Master Data

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Looking forward for a long term association with
you.
San Francisco Bay Area3940 Freedom Circle.Santa
Clara, CA -95054Phone No 408-200-7468Los
Angeles Area200 Continental Blvd.El Segundo, CA
90245 TrinityMag Global Services E-74, 1st
Floor, Bharat Nagar New Friends Colony, New
Delhi-110025 (646) 810 1148 E-mail
query_at_trinitymag.com