The world of hospital coding and billing is certainly getting more complex and challenging each day. When you consider the complexity of the hospital environment and that hundreds of individuals are working at any hospital facility, it is a big task to ensure that the billing process is complete, and the successful re-imbursement is obtained on a timely manner.

Today, with increased cost of medical care, competitive market, and an aging population and definitely the complexity of the re-imbursement process, the demands on the any hospital employee are tremendous. We strongly believe hospital employee’s should dedicated all there focus on patient care, and that’s what we intend to do, to relieve them from many non core activities, assisting hospital employees to provide better care to the patients, by providing our specialized hospital coding and billing services.

Global Edge USA is a California based leading Hospital Coding & Billing Service Provider, offering complete gamut of services in the Hospital Revenue Management Cycle. Our services are designed to increase cash flow, lower costs and provide seamless integration with the hospitals existing set up. Our approach is of an extended billing office, utilizing advanced technology, sophisticated reporting and highly trained professionals.

We provide services such as insurance verifications, charge capturing, hospital procedure coding including inpatient DRG coding, outpatient APC coding, diagnostic coding etc, claims processing, electronic claims submissions, claims reviewers, reimbursement analysts, accounts receivable specialists, denial management, insurance follow up and payment postings.

Information And Insurance Verification

Patient demographic and insurance information obtained during admit /registration process is verified with the Insurance/third party carriers, including any additional authorizations or information that may be needed at the conclusion of the admission or encounter to procure payment. The patient’s registration form is updated with corrected or additional information.

Charge entry or capturing is carried by gathering all charge documents from all departments, within the facility that have provided services to patients. Making certain that all the charges are coded and entered into the billing system to ensure payment is received for all the services rendered.

All documents are reviewed for the services provided and appropriate ICD-9-CM are assigned, also CPT-4 codes as applicable are assigned. This is carried out by our expert certified in house coders. This being one of the important part of the service, as any inaccurate or missed procedure or diagnosis codes results in nonpayment, incorrect payment, or partial payment for the services.

All services rendered must have medically necessary diagnosis assigned, without regard to whether the services are coded or input from an encounter form. This all important aspect is carefully carried out, as any inappropriate diagnosis coding results in denial of payment, reduced payment or request for additional information that will delay payment.

All the information gathered and input into the billing system is processed and an appropriate claim form is generated. Claims will be sent electronically or manually processed to insurance carriers with the information necessary for reimbursement.

Lost or late charges or corrections to previously processed claims will generate a corrected or additional claim and is submitted to the insurance/third party carrier’s on the appropriate form. Re-billing does results in delay in payments, denials, and considerable time in researching and re-processing for re-consideration for payment.

All claims are reviewed, before submission to third part carriers, ensuring coding and billing guidelines meet requirements for specific insurance/ third part carriers.

After final payment has been made by the insurance carries, the accounts are assigned to representatives, to invoice patients, and notify the patients with follow up reminders, of their responsibility to pay and arrangements made for payment.

When patient payment is not received in a timely manner, collection activity on the balance of the patient account will begin. A series of collection letters are sent in an attempt to receive payment, in accordance to the guidelines, If the payment is still not received, the account is placed with an outside collection agency, or credit bureau.

When payments are received, the appropriate payments and insurance carriers are posted to the patient accounts along with any patient payments until the balance has been satisfied. The EOB, Explanation of Benefits received from the insurance/third part carriers is reviewed for payment details, and if any contractual write off’s – the difference between the facility charge and the payment received will be taken. Determination of whether appropriate reimbursement has been made, and if not, an appeal, a formal request for re-consideration is made.