To minimize error rates and reduce the risk of denials, the Quality Auditor reviews all claims. We maintain a review log for billing, Posting, and AR/Denials. The most common reasons for claim rejections are specified in a log list compiled by our staff. With the help of this ready reference, we track trends in remittance advice. We monitor and evaluate these trends to resolve the problems that are causing the denials and rejections of your practice.
Every month, we hold review meetings (Feedback Session) where the entire team is involved, and RCM processes are presented.
This includes:
- An analysis of trends from the claims review log
- An update of any recent changes in billing or coding practices, from recent newsletters of insurance carriers
- And current practice issues regarding the function
Process We Follow for Quality Assurance
We conduct a keen & detailed procedure to assess quality at every stage:
- I. Shadow Processing- We audit every single file/transaction for accuracy and errors.
- II. Random Auditing - In addition to Shadow Processing, our experienced quality managers conduct random auditing tests to ensure quality at all levels.
The Quality Assurance reporting plan comprises of daily, weekly, and monthly accuracy and speed level reports. Reports on the employees’ performance trends are also e-mailed to the Management and client.
Eminence Healthcare Services is committed to providing a quality benchmark of 96 % to its business associates.
Compliance
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was passed by United National Congress and signed by the then President Bill Clinton on August 21, 1996. The main objective of this act was to amend the Internal Revenue Code of 1986. This was to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery. Also, it promoted the use of medical savings accounts, improved access to long-term care services and coverage, and simplified the administration of health insurance.
It even includes promoting the use of medical savings accounts and improving access to long-term care services, coverage, and simplifying the administration of health insurance.
HIPAA has Two Titles:
Title I: Protect health insurance coverage for workers and their families when they change or lose their jobs.
Title II: known as the Administrative Simplification provisions, makes it mandatory for providers, health insurance plans, and employees to establish the national standards for electronic healthcare transactions and maintain national identifiers or credentials. AS also addresses the security and privacy of health data.
There are subsections of the law related to administrative simplification and confidentiality of protected health information. These laws have far-reaching effects on Providers, Payers, Managed Care Organizations, their business associates, and any entity storing, processing, and transmitting healthcare information.