ProMaestro Pre-Billing & Post-Billing Services:

With the rapid changing reimbursement models making the patient more liable, we focus on cash collections, reduction of front-end denials and easing out the liability on the patient during registration & post billing services.

Our Pre-Billing Workflow

ProMaestro’s Pre-Billing suite of solutions and services create efficiencies in financial clearance process.

Insurance Eligibility & Benefits Verification:

We ensure that Physicians & Billing companies are confident on their revenue cycle.

Once the appointment is fixed in the EMR system, our team starts the insurance verification process within 24 Hours via web or calling making it easier for the front desk to collect the co-pays and deductible shares in prior from the patient.

Demographic Entry:

Getting the patient data right from the start is most important in the revenue cycle. We validate the patient data is accurate and complete prior to billing.

ProMaestro helps providers in auditing information and correcting errors prior to billing, improve efficiency and quality at the point of registration, ultimately leading to reduced denials.

Medical Coding

“A right code will reimburse you right remuneration”.

Medical coding is a crucial process involved in RCM. ProMaestro Professional Coders certified AAPC & AHIMA provide highly accurate and compliant coding services. This ensures cost saving at all levels.

Our Coders are:

  • Certified from AAPC and AHIMA.
  • Proficient in ICD-9 CM, CPT coding and HCPCS codes across various specialties.
  • Comprehensively trained and pursue continual education.
  • Stringent in quality audit and HIPAA compliant.
  • Geared up for ICD-10 implementation in 2014.

Our coders review denied claims regularly which ensure smoother cash flow.

Charge Entry:

Our team checks CPT and ICD codes from the medical transcripts or super bills and the compatibility of the diagnosis and procedures codes as per LMRP, to ensure submission of clean claims.

We have implemented three layers of quality.

  • Claim Scrubber by billing software
  • Manual re-check by Charge entry team
  • Random Quality Audit using statistical data

Electronic Claim Submission:

The vital step in the medical billing process is submission of the claims. The claims contain sensitive information including patient data and insurance information. Submitting claims electronically reduces processing delays. With electronic submission, carrier confirmation report is instant and there by making it easier to track claims.

Our Post-Billing Workflow:

Our Post-Billing solutions help in prompt and accurate payment, increased net revenue and improved cash flow.

Payment Posting:

Our highly skilled and analytical team enables timely and accurate posting of all payments from EOB’s (Explanation of benefits) and ERA’s (Electronic Remittance Advice). We balance the amount received by the Doctor by various means and verify the same, leading to no confusion.

Denial Management:

Minimizing payer denials and recovering lost revenue are some of the key core values in our process management.

Our highly skilled analysis Team works on all the denials received from various payers during payment posting and takes necessary action within 24 hours.

Our Team is specially trained:

To recover the collectibles from:

  • Commercial Insurances
  • Medicare
  • Medicaid

Accounts receivable Services include:

  • Receivable Analysis
  • Claim status
  • Underpayment analysis
  • Payer follow-up for denials
  • Appeals
  • Patient follow-up

Every payer in Medical Insurance operates on its own terms and schedule. For instance, if two receivables are 30 days old from different payers, a different action on each would be required. These kind of point to point actions are analyzed, managed and performed by our Team.

Traditionally, receivables are tracked based on 30-day increments, but different actions are scheduled depending on the receivable duration – 30 days old, 60 days old & 90 days old. The 30/60/90 days model does not apply at ProMaestro because we take necessary actions on the payer’s payment schedules during the time of cash posting itself and thereby reducing the receivable duration.

Actionable Reporting:

ProMaestro’s medical billing and coding report is actionable and it provides you with the information required to fully understand your practice and the actions needed to be taken to improve the performance.

Our reports are made on a daily, weekly, monthly & yearly basis.