High-Tech Billing Solution That Meets CMS, NUCC, HIPAA Regulatory Standards

With EMR gaining its importance post the stimulus bill; the Billing application can’t be ignored. For any small, medium or large level of medical information business, medical billing health care services is the most indispensable and easy on the pocket for the healthcare industry.

Binary Spectrum’s billing application is a robust platform that automates electronic claims, remittances, member enrollment, eligibility and disenrollment processes for a large HMO. The application has delivered adaptability to client software and billing process with prompt medical billing services, thereby saving on client’s staffing and operational expenditures. It helps scale up the claims processing capability, and is able to do so in a timely manner while being able to deal with a variety of vendors.

The billing solution provides seamless integration features for charge creation based on the data provided in the clinical charting functions to avoid duplicate and error prone data entry. The transmission of claims could be done either through electronic means i.e. ECT or paper based preprinted forms.

The following are the list of EDI Messages supported:

For Batch transactions-

• 837 P/I (professional / institutional) – Electronic Claim files

• 835 – Healthcare electronic Remittance advice request form

• 834 – Enrollment and disenrollment for Medicaid eligibility

• 820 – Electronic response files for premium Payments to insurer

For Real time transactions-

• 271 / 272 – Member eligibility request / response

• 276 / 277 – Claim status request / response

• 278 – Authorization and Referrals

The key differentiator of the Medical Billing application is that there are multiple ways of creating a final charge for a patient.

• At the time of booking an appointment, an encounter can be started, treatment plan details can be captured and the encounter can be ended which takes the user to charge creation screen & for creating the charge for the encounter.

• Another flow is from the book appointment page. There is the option of super bill which starts the charge creation process, imports all the services that are captured in the super bill to the charge creation screen & creates the charge, associating the appropriate prices for the services.

Benefits for the Billing Companies:

Billing companies can benefit from the following:

• Reduce efforts in entering data

• Automated Workflow and Rule Management

• Compliance checks and acknowledgement generation

• Support for multiple integration mechanisms for Vendor interactions

• Parsing and Validation mechanisms

• Integrated processes related to primary care physician, the HMO and the government funding bodies (CMS / ACHA)

Benefits for Physicians:

The billing solution will help physicians to:

• End medical billing hassles

• Support for Real-time Messages

• Support for both Government and Private multiple health insurance plans and in variety of ways including guarantor, co pay, primary/secondary/tertiary

• Timely and accurate charge entry and claim generation

• Implementation and conformance to applicable standards including HIPAA, standard procedures CPT and illness nomenclature ICD.

• Faster payment to doctors accurately

Binary Spectrum delivers significant system and personnel designed software with superior 24 / 5 customer services. Our solution centric approach helps us to endow with technical expertise for cost effective robust solutions to our clients.

Leave a Reply

Your email address will not be published. Required fields are marked *