Frequently Asked Questions

Yes, we are partnered with state of the art PM/EMR system and clearing house, we will take care of your electronic as well as paper claim submission.

We submit claims within 24-48 hours from the charge receipt time. You will have access to the lag days through the PM/EMR system as well as through several reports.

Yes, based on your request, your staff will be provided with full access to the system where you can review your claims and payments.

You will have a dedicated account manager who will be available on email and phone.

Yes, you will be receiving daily emails on the billing and collections.

The clearing house, payer rejections and denials gets worked on daily basis and gets shared with practice on weekly basis in a consolidated report.

Yes, we reconcile all the ERAs/EOBs and it gets posted on daily basis.

You will have full access to the reporting module of the billing system and any and all customized reports can be shared with the practice on request. Once decided these reports will be shared with you in the scheduled intervals. Our reports include but not limited to: charges Vs payments, patient volume, CPT volume, payment per encounter, payer mix charges, payer mix payments, provider/location wise reimbursement reports, payroll reports, outstanding insurance and patient AR reports etc.

Yes, statements are sent to patients on regular intervals . The billing cycle can be customized based on your business requirements.

We have dedicated customer service experts working based out of our South Carolina office and they will assist the patients on their questions on bills and payments.

We have a partner collection agency based out of South Carolina and we also work with collection agencies of your choice.

We take the appointments from the scheduler 3 days in advance and will provide you the benefit details via email and also the notes will be posted to the PM/EMR system which practice can access.

We assist practices on-add on patients within few hours from the time the patient gets added in the scheduler.

Practice will be alerted on these issues few days in advance so that they can contact the patients and make necessary arrangements.

The partnered PM/EMR system has real-time eligibility capability and practice will be provided access to this where they can run eligibility within a few seconds.

Yes, we do provide the Eligibility by CPT code, for eg: in Behavioral health we provide the benefits for evaluation, therapy services and TMS services by CPT codes.

We work for a wide range of specialities like Pain Management, Podiatry, Orthopedic, Cardiology, OT/PT, Speech Therapy, Mental Health, Dermatology, Rheumatology, Ophthalmology, Endocrinology etc.

Yes, you will get an alert within the PM/EMR system as well as by us when an authorization is to be expired. We also keep a track of this and initiate the prior authorization before they expire.

It typically takes 2-3 days for the charge to be removed from your debit/credit card/bank. From our end it is voided immediately.

No. It comes with a disclaimer saying, ‘This is not a guarantee of payment’. It totally depends upon the discretion of your insurer

If you think your pre-authorization was wrongly denied, you can always file an appeal with your insurer. This works best when your doctor endorses that the coverage you seek is justified and necessary for your treatment.

Credentialing is the process of obtaining, verifying, and assessing the qualifications of a medical practitioner to provide services for a healthcare organization. Credentials are essentially documented evidence of license, education, training and experience.

A typical credentialing process consists of four steps, namely; Onboarding, Application, Follow-up and Completion.

It is the process by which a health insurer assesses a care provider’s qualifications and competencies through the submitted documents along with the CAQH profile.

A Credentialing specialist is supposed to maintain active status of all providers by successfully completing initial and subsequent credentialing packages as required by care centers, commercial and federal payers.

Owing to its intensive verification processes, this may take 3-6 months based on the insurance companies.

The team of certified coders are well versed with several EMR systems and we do review the charts/medical records in the EMR and code the claims right from there.

Yes, certain specialities involving specific CPT/ ICD codes choose to code the claims and our team reviews the codes based on which feedback is provided as needed. We also add appropriate modifiers to the claims, which would be compliant and can get you maximum reimbursement.

Yes, we do review the denials, make the corrections and resubmit the claims with appropriate changes to CPT, ICD, POS, Modifier, etc. while also being compliant.

We cover most of the specialties based on the practice requirements (Hospital coding, Pain Management, Internal Medicine, Orthopedics, DME, Behavioral health, Spravato, OBGNY and many others.

We typically code the charts within 24 hours from the time the medical records get signed by the provider.

It is the process of assessing historical & current claims and ensuring that claims are submitted in compliance with Local and National Coverage Determinations and payer-specific guidelines(LCD).

There are four main phases of the entire compliance audit cycle. They are Preparation, Performance, Reporting & Follow-up.

Encryption of emails protects the contents of the email and the content of the attachments when it reaches unintended recipients. We mandate emails to be encrypted and passwords to be protected in our organization as increased security and compliance measures.

It is an appropriate audit trail. It ensures appropriate follow-up action is taken. It tracks and establishes trends of potential billing and/or coding problems. This report can be utilized for account analysis as well.

Education, feedback and more education. You must be persistent and follow through to show your commitment. We audit doctor’s medical records and any inconsistency is taken as an education source to educate physicians.

You can use the ROS, past medical, social & family history. The provider’s documentation should support that they reviewed the ROS and PFSH documented by the ancillary staff. The history of present illness needs to be taken and documented by the physician.

Employees working in various healthcare roles, including coding and billing, should be trained in appropriate areas (HIPAA, HITECH, etc.) immediately upon hire and at least annually thereafter. Employees should be trained when existing regulations change or are updated and when new regulations are put into place. Our experienced training team ensures this is being followed to all our employees on board.

Resources that included for references are: OIG, the Centers for Medicare & Medicaid Services, the U.S. Department of Health & Human Services, and AAPC. These organizations provide informational articles, auditing software, news about updates and alerts, compliance ideas, and more.

It is a strategic consulting service offered by us which covers all aspects of your business. Right from medical billing, medical coding, eligibility benefits & pre-authorizations to compliance audits, process mapping, resource allocation, medical transcription & contract negotiation. We enable your business by providing end to end management of your revenue cycle.

Yes, we help you select the right mix of technologies, and then implement them to upgrade your entire tech infrastructure.

Yes, we do help businesses by re-imagining workflows & processes to do away with inefficiencies. We help organizations with innovative resource allocation strategies to optimize processes and minimize costs. The strategies are customized and varies from business to business.

Yes, your business data is 100 percent secure with Practolytics. All our solutions are HIPAA compliant and we take special care dealing with the privacy & confidentiality of the user data.

Yes, we do the Practice Consulting on site by reviewing the work flows, reviewing the documentation and Standard Operating Procedures built by the practice, having conversations with the employees etc.

Provider agreement is a contract between a healthcare provider and an employee benefits plan. The agreement states that the provider will accept payments from the plan for services provided to patients covered by that plan.

A negotiated or an adjusted rate is the amount an insurer is obliged to pay under contract for all the procedures and services a doctor or medical facility covers.

We make sure that you do not have to pay an attorney to negotiate contracts ever. We take care of the entire process to give your business a positive outlook.

You must review contracts well ahead of their expiry dates. You should notify the company if you want any changes or cancellations.

It typically takes 3 to 4 months to get a favorable outcome, based on the practice location, demographics, suite of services provided by the practice etc.

We provide end to end medical transcription services covering all aspects of your practice. For example, medical history transcription, patient chart transcription, physical report transcription, surgery notes transcription, discharge summary transcription, clinical summary transcription, emergency room report transcription, progress notes transcription, etc. You name it, we do it.

Yes, absolutely. We are a HIPAA compliant organization. All our processes and technology integrations are leak proof. Data security is paramount to us.

Yes, we totally can. We have a lot of doctors dictating from different locations. We have experienced programmers who create custom workflows to complement your requirements.

Typically, it takes us about 120 minutes to transcribe about 75 percent of our jobs. However, if you seek a custom TAT, we also offer that. It doesn’t take more than 24 hours for us to share the transcription copy with you.

We provide you with a secure login to your dashboard where you can access all your transcribed medical records. You can use any browser to access them.