The USA is home to numerous hospitals and healthcare providers who are committed to providing sound healthcare services to the people of the country round the year. A big part of what keeps them going is payment which the sooner they get the better as any delays can affect their functioning both in short and long term. Almost everyone in the USA is covered by health insurance but with more than 1600 insurers and with each of them having a different plan hospital billing and collection becomes a complex thing to do. Moreover, one also has to adhere to the existing government rules and regulations in place when filing the bills that can be processed easily. This is why the healthcare industry employs numerous billing service providers and specialists who help with consistent revenue cycle management.
Hospital Billing and Collection includes gathering patient information, filing claims in the right manner, follow ups and reimbursement. Three parties included in this are the patient (first party), healthcare provider (second party) and insurance company/payer (third party). Specifically for hospital billing and collection the second party has to be a hospital wherein service can be provided by anyone who works for the hospitals be it general physicians, surgeons, nurses, physical therapists etc. It is the duty of the Hospital billing and collection service provider to gather the information from all the parties and negotiate the payment. This is in agreement with their ultimate objective of ensuring that the hospital is adequately compensated for the services offered.
The steps followed by the hospital biller and collector are:
The trained professionals at Capline are well versed with the process of hospital billing and collection right from the initial registration to the final payment statement. We eliminate the day to day operational stress felt by hospitals so that they can concentrate solely on providing the best patient care.
Hospital credentialing is the process of verifying whether or not a provider is qualified to provide medical services. The hospital requires information from the provider about their education, training, experience, licensure, experience, insurance and background. After a provider has been verified through hospital credentialing, the provider gets the authority to practice medicine.
In the year 1951, the joint commission was formed to create the first ever accreditation standards manual which would formalize hospital quality standards. The commission asked hospitals to form credentialing committees which would conduct regular reviews and check physician competence. There were no rules per se to collect and verify this information but the documents required were the same for all.
The documents are verified through primary sources for cross checking records for consistency as well as background checks and sanction checks by the Office of Inspector General (OIG). This task is sometimes performed by the hospital office staff with hospitals also resorting to third party contractors who are credentials verification experts.
After the documents have been verified, the hospital sends the applicant’s files to the credentialing committee who may meet the applicant to further discuss their profile with the stakeholders. If the committee approves the application, they send the information to the Joint Commission.
Post Hospital Credentialing Services
Once the hospital has received approval from the Joint Committee for the hospital credentials of the physician in question, they can grant privileges to the physician to practice at the hospital. The privileges are categorized into three parts namely active or admitting privilege which allows the physician to admit patients in the hospital, courtesy privilege which allows physician to admit or treat patients as a consultant and surgical privilege which allows the physician to perform surgeries as an outpatient and in the operating room.
In order to keep providing high quality patient care experts need Hospital Credentialing. Nonetheless, it can be a very cumbersome and complicated process especially when done by someone who has no prior experience.
Capline provides you efficient hospital credentialing services that include primary source verification, continuous follow-ups as well as conducting background checks. Our trained personnel and advanced technology ensures that your patients are protected at all times as the credentialing process is carried out in a smooth and efficient manner.
Hospital insurance verification is the process of reviewing the actions taken after the claim has been settled. Almost everyone opts for medical insurance which is why it is extremely necessary to keep track of insurance claims. This is where hospital insurance verification companies step in as they help hospitals verify the insurance claim filed as well as with the final claims submission. The hospital insurance verification is carried out to ensure that there is no fraud committed on the part of both the insurance company as well as the hospital. It is the duty of every hospital insurance company to review the patient’s insurance eligibility for the plan he/she has applied for.
Below is a list of all the steps involved in the process of hospital insurance verification:
Hospital Insurance claim reimbursement is quite a technical process with a series of steps that need to be performed in a systematic manner. Over the years Capline has helped hospitals with insurance verification and processes claims in an efficient manner. Our experts ensure that you get the amount for the services provided by eliminating instances of frauds and denials.
We provide tailor made services for a range of medical fields for both hospitals and physicians. Our Specialties include: