Billing Process

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Zen Billing Process

Zen_Billing_Process

Authorization

  • Eligibility Check
  • Benefits Check
  • ICD-10 check
  • Get Auth

Authorization Goals

  • Every required services should have an auth in place.

Charge Entry

  • Download Superbills
  • Eligibility Check
  • CPT/ICD/Modifier Check
  • Place of Service
  • Insurance Check(P/S)
  • Referring Physician Check
  • Reconciliation of Charges & Submission
  • Clearing House Rejection Log Review
  • Send Daily Charge Entry Report
  • Missing Info send to provider weekly. Put info on Box
  • Response to client (Daily)
  • Complete the Provider Dashboard Weekly

Charge Entry Goals:

  • Claims Filed on Time 0% TFL Denials
  • Claims with valid eligibility < 2% Denials for Eligilbity
  • Charge Entry Accuracy CPT/ICD/Modifier/Place of Service – < 2% Denials for any of these

Payment Posting

  • Download ERAs, EOBs
  • Post the ERA, EOBs
  • Reconciliation of files downloaded and posted
  • Check ERA/EOB posting for accuracy
  • Bill Secondary Insurance, if secondary Insurance Medi-Cal Write off Balance
  • Flip balance to patient
  • Denial Separation and Work Denials

Patient Statement:

  • Check patient balance for accuracy
  • Apply Unapplied Credits
  • Separate Patients with 3 statement sent &email box link office

Patient Calls

  • Patient Calls: Calls to be returned in 24 hours. If patient not reached, leave a VM and follow up next day.

Payment Posting Goals:

  • Claims posted Accurately less than 2% patient calls for posting errors
  • All Claims billed to secondary (if any) 0 claims sitting in 90+ A/R to be billed secondary
  • All Denials to be worked routinely

Account Receivables:

I: Denials/RA Analysis:
  • Make required calls for Daily Denials
II: A/R Work ( 30 +)
  • First Focus 120+
  • Second Focus 60 to 90
  • Goal: 40 Claims/Day
III: Rolling A/R
  • Reduce Payment Cycle
  • Review claim status for claims submitted 30 days before In Process, Denial, Not on File. Provides insight into expected payment

A/R Goals:

  • 60-90 – 25-30%
  • 90-120 – 3 to 5%
  • 120+ < 10%
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