The key element of enhancing hospital productivity and patient satisfaction level is by taking the 1st step in a pre-planned systematic way. We can work through more skill-fully and maneuver the administrative request of scheduling patients and processing their billings and payments the easier it gets to reach out and care for each patient in a personalized way.

With the Affordable Care Act, eligibility verification is completely critical. Identifying patient responsibility upfront before the visit is critical to managing the receivables. Performing the eligibility verification helps us provide you submit clean claims. It avoids claim re-submission, reduces demographic or eligibility related rejections and denials, decreases errors, increases upfront collections; which ultimately leads to improved patient satisfaction.

The translation of traditional documentation starting from the reason for visit, symptoms, description of the disease, test-administer, medication history, outpatient procedure, etc. and assigning standardized, specialized alphanumeric codes to them. These all details are recorded in codes for future use and also shared with insurance companies for claims.

Often called prior authorization, prior approval, or precertification — may be a process that a lot of insurance plans impose before they comply with buy care. “Ever encounter situations where a number of your claims are denied by payers for lack of pre-authorization? If yes, you will greatly benefit from Qualmet pre-authorization services.” Pre-certification varies from payer to payer also the patient’s plan.

Often referred to as Charge Entry or Payment Posting, Charge Posting is a vital process within the medical billing cycle. It is the method of entering important inputs and details to enable claims processes. All data which are to be entered should be error-free and in an approved manner. The next process after charge entry is claims denial. Thus, there shouldn't be any mistake made within the charge entries.

Verification or credentialing is the process of obtaining, verifying, and evaluating qualifications for a care provider or services in a health care organization. Validation is written proof of license, education, training, experience, or other qualifications. Provider certification is the process of finding out if medical providers have the right qualifications to perform their duties.

One of the final stages of the medical billing process - sending the payment, requires a prepared cash flow. Once payments have been transferred to patient accounts, any denial will be resolved by appropriate payment methods. The payment method, in many ways, provides evidence of how your income cycle works. As a process, it is often performed on scales with considerable automation, this method allows you to understand the tendency to perform refunds and analysis.

In the healthcare sector, account receivable refers to the amount of money that payers and patients owe to a health care provider. Therefore, an AR call is followed, i.e. a communication process is performed to obtain information on outstanding claims from patients and the insurance provider.

Qualmet is committed to providing unparalleled transparency in client relationships. They provide one with access to proprietary software where one can see and track each stage of a claim’s life cycle.

Since healthcare reimbursements are decreasing and patients are incurring greater responsibility for healthcare costs, medical practices should properly manage patient accounts receivable to maintain their cash flows and we here at Qualmet manage patient accounts receivable to help both the practice and the patients.