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For the provider segment, Optisol
Healthcare work closely with the medical hospitals, medical
billing companies and physician groups to provide revenue
cycle management services. We leverage our domain expertise,
operations capabilities, our existing contact center expertise
and technology infrastructure to provide accurate and timely
support in managing the entire process of revenue cycle. Our
goal is to replicate provider offices from offshore to enable
health care professionals to get paid for services and supplies
accurately and quickly.
Our delivery model gives the flexibility of providing Revenue Cycle Management services as both bundled and unbundled services. In the bundled version, our operations platform is robust and comprehensive to provide medical coding, Billing and Accounts Receivables from a one stop approach. We also cater to specific requirement of providers by becoming services partner for any of these services as a separate capsule.
Our Medical Coding team has certified and seasoned coders to offer high quality
coding services to healthcare providers. Our coders have proficiency in the
following code sets and usage guidelines; CPT-4, HCPCS, ICD-9-CM.
Our current staff comprises of coders for the following specialties and we are
continually adding more specialty capabilities:
Radiology
Interventional Radiology
Evaluation and Management
ER
Surgical
Coding compliance is our prime concern and we offer 100% focus from our side to
ensure that our coders are effectively trained and audited to deliver this.Our
coders work in accordance with updated standards and methodologies laid down by
CMS,AMA, Medicare contractors, federal organizations and any client specific
policies.
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At OptiSol we enter the $ value to each treatments specified in the charge sheet of a provider. A charge sheet contains the description of the medical treatment and its corresponding CPT codes and ICD codes. These codes are used to identify and define treatments and its associated billable amount for a provider. These charges and the details of the patient, provider, and other service line details are captured in billing software. We are flexible to the needs of independent physicians / hospitals in terms of accommodating ourselves with their existing Billing systems / platforms.
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Upon the receipt of billing details from a provider / provider office by an insurance company, the insurance company performs series of validations / adjudications on the claim and makes a payment or payment denial decisions. These details are again sent back to the provider and insured. Based on these details, the provider office updates the payment details in the billing software. Typically in this process the details that need to be captured are cheque details, payment amount, provider details etc. This is basically a process of updating the payment details for the earlier entries in “Charge Entry” process.
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