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Eligibility and Benefits

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. Even though Eligibility and Benefits verification is the primary and one among the foremost important step in Medical Billing but it is often very time consuming and distractive for the office. Qualmet Global Services offers efficient and price-effective services and simplifies this process for you so that you'll specialize in other areas.

Benefits offered by Qualmet Global.

Complete and Accurate Information Before Patient Visit

Qualmet eligibility and benefits verification service doesn't simply confirm coverage. Rather our Eligibility and Verification specialists check out the patient schedule beforehand, check the eligibility of the patient with the Insurance, analyze the type of coverage the patient. They also check his/her deductible and the way much has already been applied.

Information recording system

Recorded information is shipped back to you or updated in your EHR / Practice Management Software and which becomes readily available to your front office when the patient checks in. Having all the above information at entry time helps your staff to gather co-pays at the purpose of service which generates more revenue and reduces Administrativecosts benefiting your organization.

Easy, Efficient & Cost-Effective

Qualmet eligibility and verification process increases the efficiency of your front office and eliminates hours spent on the phones or multiple websites logins for checking patient eligibility. More importantly, reduces the number of claim delays and denials by filing clean claims within the first instance.

Pre-cert Obtaining

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. With the ever-changing Payer policies, managing pre-certifications becomes a task in itself for the front office taking their focus far-away from the foremost important task of patient care.

We, at Qualmet Global services, offer an efficient and price-effective Preauthorization service for your practice.

Our experienced and knowledgeable expert team takes care of the subsequent tasks -

  • Review each case to work out if pre-certification is required by the patient’s insurance firm of the planned service.
  • Collect the specified also as complete Information.
  • Apply for Authorization / Pre-Certification for required procedures to the Payers.
  • Answer queries / submit additional information sought by the Payers.
  • Regularly update the Authorization number received within the Practice Management Software.
  • Maintain a record of the Authorizations received.
  • Submission of a Monthly Report for all the cases handled alongside the result.
  • Give reasons where authorization wasn't received.

Benefits to Provider

  • Minimum delay in getting authorization
  • No loss of revenue thanks to claims denied for lack of authorization
  • Patient-centric approach
  • Specialised manpower dedicated to the present task
  • Reduce your front office staff’s workload so that they will specialize in patient care

Charge Posting

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. To make sure the entries are error-free, there should be honest coordination between the charge entry team and therefore the medical coding team.

It is essentially the primary line of defense that identifies payer’s problems, issues like denials for medical necessity, non-covered services, and prior authorization are going to be uncovered and may tend to team members to deal with and fix it.

At Qualmet Global Services, we follow a well-structured charge entry process. The detailed steps followed through the method make sure that relevant checks are made at each processing stage which enables us to manage a zero-error process and supply our services with speed, accuracy, and efficiency.

Our team has substantial experience and understanding of the healthcare industry and offers great expert skills in facilitating investigations and enabling quality decision-making.

Benefits offered to the provider.

  • 1.Accurate posting of Patient demographic detail Charges Entry or Payment.
  • 2.Posting transactions within the revenue cycle software provided by the customer.
  • 3.Works towards achieving productivity standards.
  • 4.Adherence to a customer stated turnaround requirements.
  • 5.Adherence to the company’s information security guidelines.
  • 6.Demonstration of ethical behaviour in the least times.

Outsource your Charge Entry Services to Qualmet Global Solutions Are you trying to find top quality, well-managed Charge Posting Services? Why don't you think about our world-class outsourcing services? Determine more about our key competencies, top quality infrastructure, competitive pricing, and benefits.

Appointment and Scheduling

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.

The overall stages of HRCM (Health Risk Condition Management) offered by Qualmet covers all the aspects of a patient's interaction with our organization – starting from the first contact for diagnosis to the final reconciliation and payments of the patient accounting data.

Among all the stages of claim submission, Pre-encounter Transactions includes

  • Stage 1: Appointment scheduling
  • Stage 2: Pre-registration
  • Stage 3: Point-of-service (POS) Patient Responsibility

Are you tired of Long hold times and queue? Confused by eligibility and prior authorization requirements? Complex and hectic processes? These lead to impacts negatively on patient’s satisfaction levels. The key to efficient patient scheduling begins with understanding the patient

Qualmet tackles these smoothly by asking the right questions and implementing the right approach for the delivery of expected care. We offer a coordinated and streamlined appointment scheduling and management procedure with more improved revenue cycle performance to work towards building patient’s trust.

Qualmet appointment process

  • Streamlining the patient's pre-registration process by Scheduling appointments via the provider’s online contact portal.
  • Compiling of patient’s demographics for easy eligibility and preauthorization requirements.
  • Fixing the appointment schedule based on availability.
  • Notifying the patient about the appointment and confirming.
  • Sending automated reminders for further ease.

This proactive engagement with patients through an online portal and automated reminders can decrease the patient no-shows, and at the same time, appointment management helps to manage their schedule with ease and cut the long wait-time.

Improving patient engagement, optimizes and organizes the process for both parties, and allows end-to-end tracking of patient payment history and outstanding payment.

Medical coding

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. The medical coder works to ensure the consistency and credibility of the code being used. This is the only way to ensure that insurance companies are properly charged. These are important to maintain records of patient’s health status. Error-free medical coding is important for further services like medical billing, defining insurance claims, etc.

We use standard verified Coders with preferences

  • CPC (Certified Professional Coder) from AAPC
  • CPC-H (Certified Professional Coder for Hospital (inpatient) from AAPC
  • CPCO (Certified Professional Compliance Officer) from AAPC
  • International Disease Classification, 10th Edition (ICD-10-CM)
  • (CPT) Current Procedural Terminology
  • International Classification of Diseases, Procedural Coding System (ICD10- PCS)
  • (HCPCS) Healthcare Common Procedure Coding System

Are you tired of Long hold times and queue? Confused by eligibility and prior authorization requirements? Complex and hectic processes? These lead to impacts negatively on patient’s satisfaction levels. The key to efficient patient scheduling begins with understanding the patient

Qualmet tackles these smoothly by asking the right questions and implementing the right approach for the delivery of expected care. We offer a coordinated and streamlined appointment scheduling and management procedure with more improved revenue cycle performance to work towards building patient’s trust.

What Medical Coding Services offered by QualmetGlobal ?

  • Coding as part of Revenue Cycle Management
  • Independent Medical Services
  • Physician training to improve doctor's records
  • Provides complete templates designed to assist the physician in compiling the Medical records of the patient.
  • Designed for specialists
  • Can be used as such or integrated with your EMR software

Why choose Qualmet Global ?

Coding is a small, but an integrated piece of the income cycle and it is often a complex procedure to implement. Qualmet International Services for Researching Your Income Cycle can act as an oil-based machine.

  • Ensure compliance with ICD-10
  • Reduce AR back defects
  • Decreased DNFB
  • Improving care
  • Reduce conversion times
  • Enjoy reliable data reporting

Medical coders are the driving force who manage behind- the- scene operations so that the revenue cycle management can be processed in a well-defined manner. In a way, Qualmet is the perfect place to address all your needs.

Payment Posting

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. Payment submissions allow you to view payments and provide a brief overview of financial practices, making it easier to identify issues and resolve issues quickly.

Qualmet Global Services for Medical Billing Improvement.

Some of the services we offer are

Benefit Analysis (EOBs) Analysis

Our managers post the payment to the data and at the same time analyze the data to determine the corresponding payments such as insurance receivable percentage, entry frequency, denial, etc

Actions based on EOB analysis

Recorded information is shipped back to you or updated in your EHR / Practice Management Software and which becomes readily available to your front office when the patient checks in. Having all the above information at entry time helps your staff to gather co-pays at the purpose of service which generates more revenue and reduces Administrativecosts benefiting your organization.

Tracking revenue

Our team at QUALMET GLOBAL tracks real-time availability and cash flow status. This provides easy access to the inflow rate to take necessary action when cash flows are reduced in unforeseen circumstances.

Benefits of QUALMET Global Services

  • Profit restores your income cycle to maximize profits
  • Re-solve problems repeatedly and avoid rejection
  • Current Improve current processes
  • Rejection resolution time
  • Tax Precise submission of claims to second taxpayers
  • Quality High quality and accuracy
  • Accurate understanding of your A/R cycle.

Payment through Qualmet Global Services will facilitate this process in your medical system and provide you with efficient costs. We follow best practices in quality management and information security to ensure that outbound payments are processed to meet the needs of your business while maintaining industry standards.

Account Receivable

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. This helps to follow the payment process and get the required payment information effectively. Looking for resources that can work on payroll to get you out of a massive AR?

If so, you should consider outsourcing AR Calling services from Qualmet Global. The financial situation of the doctors, hospitals, specialized clinics, etc, is important for their survival and they can continue to provide services only after receiving full payments. Therefore, the AR service is essential to maintain continuity in the functioning of a health care organization. At Qualmet Global, we ensure that the AR calling process is carried out by a team of experienced AR professionals with extensive experience in the call services available. They can follow up on pending claims. Also, help start collections, track the reasons for denial of claims, track the remaining outstanding payments made by the customer, and the due date, provide timely reports, and more.

How to benefit from the available services?

Account Recovery Services can be seen to work in the following ways

  • Improve Your Account Acquisition Process
  • Reduce Time and Cost
  • Allow yourself to focus on your core business operations
  • Customer Performance Monitoring
  • Quick collections

AR Services offered by Qualmet Global ?

Trace a claim for unpaid insurance

Refusal is resolved promptly with follow-up answers. Our health care team can help you maintain low AR days by diligently following the medical insurance company and patients at the cost that comes your way.

Denial Managemen

Deal with any refusal within the allotted time. Statistics Identify styles in CPT codes, insurance, and denial types; use process improvement programs to increase the number of innocent claims.

Create AR reports

Our AR call specialists can help you create monthly/quarterly/annualfinancial reports on account receivables.

Contact Qualmet Global for fast, reliable, and inexpensive AR services. We will identify and track down the payers until your payment problem is resolved. The result would be collected payments and reduced AR backlogs.

Claim's Transmission

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.

This requires liaison with various organizations, including medical schools, licensing boards, and other organizations, to ensure that providers have the appropriate licenses and certificates. Besides, the evidence-based organization confirms that there are no previous reported issues that suggest that providers are not able to effectively treat patients.

The process includes the following steps

  • Application Testing.
  • Key Source documents.
  • Outgoing Call Centre.
  • Tracking with payers.
  • Data Entry.
  • Provider Data Keeping.

Qualmet Global offers a complete range of services to fully fulfill all your doctor's certification requirements

  • Doctoral Qualification Review
  • We evaluate factors such as individual license, education, experience, training, residency, training, and any special certifications to determine whether a physician meets the standards set by the Taxpayer.

  • Supplier Acceptance and Documentation
  • Hospital Right and Credentialing
  • Transfer Testing
  • Preparation and Submission of Forms
  • CVO Verification-Credentials Verification Organization (CVO)
  • Important Completion Expiration Compliance

What are the Medical Registration Services offered?

Verification and re-verification

We obtain validation certification from insurance companies before a patient appointment.

Dedicated Team

The team completes the verification information and sends it to Commercial Insurances.

Important Tracking

Our medical billing services and that all compliance is done properly with a smooth registration.

Gateway Registration

Resolving Data Entry Problems and Maintaining Integrity However, the process of getting a supplier included in a payer involves a lot of manual labor in terms of completing application forms and providing clarification of questions from payers and their follow-up to close the verification application. Qualmet Global for a reputable fast as we understand the forms required by each payer, and their policies and procedures

process Monthly Report

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.

Qualmet works to develop customized reporting templates to enable one to see their practice’s financial performance and help them to identify opportunities for improvement. As result, the status of a claim is never hidden from the customer.

Monthly progress report is a great tool to help one diagnose the financial health of the practice, but that doesn’t mean they’re easy to understand. Given the different number of reports available it is important to figure out which one is beneficial and more effective for practices.

Qualmet has narrowed the list of potential reports down to the three most important for independent medical practices

  • The Accounts Receivable Ageing report
  • The Key Performance Indication report
  • The Top Carrier/Insurance Analysis report

Qualmet selected these monthly billing reports because they will show how the practice is performing on important revenue cycle metrics, whether claims are being paid in a timely fashion, and how well insurance carriers are paying one for key procedures, among other things.

If claims are not paid during a specified time period, Qualmet follows up with the carrier regarding the unpaid claim. All calls are logged. Based upon the information gathered, Qualmet will take necessary action on the unpaid claim to correct and resubmit it. For this it may include re-billing, re-coding, or sending appeal letters to the carrier.

Qualmet Global Services provide unparalleled transparency through comprehensive reporting and web-based tools that let you manage performance. Monthly reports are being prepared to provide a clear view of the functioning of Qualmet Global Services which in turn is beneficial to the customer.

Patient's Account Receivable

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.

Employers are moving away from traditional health insurance plans since employer insurance cost is continuously rising. High-deductible health plans offer lower premiums to employers and in exchange, they take higher deductibles. We at Qualmet provide employers with an assurance of patients' accounts receivable.

Qualmet Patient receivables (amounts that are due directly from patients' side via deductibles or other reasons) have become a larger piece of a practice’s accounts receivable due to the popularity of high-deductible health plans.

Medical practices should develop a set of policies and procedures that would address all of the obstacles that prevent the practice from collecting patient receivables which we at Qualmet help them with, by keeping monthly progress and billing reports. The due sum that has to be paid by patients for the health-care services rendered to them, the patient's account receivable are the sales patients make under credit terms. We at Qualmet try focusing on setting up proper procedures for generating invoices to be sent out to patients or insurance companies for payment, through the excellent management services we ensure a hike in medical billing cash flow. We at Qualmet maintain progress reports and help medical practices and patients account receivable.