Patient Demographic Entry

Capturing demographic entry is the first step of claims reimbursement cycle. It is very important patient demographic and insurance information captured accurately.

ChallengeMed understand inaccurate capture of patient demographic could results zero or reduced reimbursement and impact the collections.

Our team focuses on capturing high quality patient Demographic and Insurance data in the billing software to reduce claim denials & improve clean claim submission. We ensure all the information received is entered into the software within 24 hours from the time of receipt.

Eligibility Verification

Numerous errors occur due to the lack of proper eligibility and benefit verification. These include delayed payments, increased errors, nonpayment of claims and patient dissatisfaction. To avoid these problems, ChallengeMed provides a solution for Eligibility Verification. ChallengeMed deploys expert staff, accessible via a toll-free number, and working remotely with the objective of delivering high-quality cost effective patient insurance eligibility and related services.

Medical Coding

ChallengeMed follows the medical coding-billing process through a structured methodology which has worked well for US clients. Our Certified professional team will help our clients to experience an increase in returns and a reduction in the number of denials as we comply with the ICD-10-CM Official Guidelines for Coding and Reporting, AMA Guidelines from CPT-4 Code Manual, & CMS (HCFA) Guidelines [CCI (Correct Coding Initiatives)] and [LMRP(Local Medical Review Policies)].

Our team of AAPC (American Academy of Professional Coders) and AHIMA (American Health Information and Management Association) certified medical coders, who continue maintaining highest level of accuracy in medical coding to assist our client needs. ChallengeMed team assures accurate coding and complete satisfaction to our clients.

Charge Entry & Electronic Claim Submission

The charge entry process plays a crucial role in overall billing management. Charge entry is a process where an actual claim is created for a particular date of service. A claim is a document submitted to the payer for getting a reimbursement. We give high importance to accurate charge entry to submit clean claims

We can capture data from charge sheets, scanned documents and can review charges entered in EMR / EHR for accuracy. Our team has the experience to analyze and ensure to enter all the required information to submit a clean claim. We link appropriate diagnosis codes to the procedures to eliminate denials. We help you to streamline all your data entry processes.

Superbill / Encounter Forms are used to capture details like Date of Service, Referring Physician, Rendering Physician, Place of Service, Type of Service, CPT Codes, ICD Codes, Modifiers, Authorization or Referral Details and Co-pay Details.

Our high-quality team ensures that we capture all the procedures performed along with the required modifiers. Our experienced billers know each payer's requirements and process the entries based on their specifications. We consistently keep track of industry changes and regulations, which enables us to submit clean claims.

Charge entered claims are transmitted to different payor sources electronically. Where required, paper claims are printed remotely or shipped to our partners' offices. Claims that encounter transmission problems are fixed with a high priority. Submit all your claims electronically within 24 hours of receipt of your files. By submitting claims electronically, we speed up the overall claim processing times. It also confirms that your claims have reached the payer on time.

Payment Posting

ChallegeMed provide high-quality, accurate and efficient payment posting services. ChallengeMed post all your payments (Paper EOB, ERA & Patient Checks) to respective patient accounts on the same day and balance and reconcile all payments received within 12-24 hours. Our daily reconciliation process assures smooth month-end closing. All payments received for the month are accurately accounted for and matched to actual deposits.

Denial Management

ChallegeMed’s Denial Management approach decreases your AR days and increases your collections. Our specialty-specific guidelines are designed to resolve denials effectively. We study and analyze zero-pays and low-pays and get to the root of the problem. Our experts team not only fix a denied claim but proactively make changes to our processes to avoid future denials. Our AR team works very closely with our coders to fix and eliminate coding-related denials.

ChallengeMed track every denied medical claim and can report this by payer, by CPT, by physician and by diagnosis. This information is presented in a manner that allows fast identification of trends. With this powerful combination in hand, the practice / provider of medical service can then utilize claim rules and edits that are specific enough to dramatically drive up the first pass claim acceptance and stop the flood of denied claims. Our in-depth analysis described above also allows payers that are habitual violators of Clean Claim Rules to be identified and pursued. The data and analysis will allow many opportunities for process improvements and revenue enhancement for the practice.

Our Denial Management Solution helps you optimize your medical billing, speed up your cash flows and hence increase your collections.

Accounts Receivable Management

One of the key areas in medical billing that directly impacts the cash flow is Accounts Receivable Management. Therefore, it is only logical that a system of internal controls to properly manage medical billing AR follow-up is designed and put in place.

ChallengeMed, the AR management team is structured to be a complete solution provider to address difficulties that occur in cash flows and is operated as a part of the medical billing team. The goal here is to recover the funds owed to the client as quickly as possible. We aim at accelerating cash flows and reducing the Accounts Receivable days by submitting error free clean-claims, proper analysis of denied claims and regular follow-ups with insurance companies and patients for outstanding claims and dues.

ChallengeMed can ensure the client get paid on all the claims in a most efficient and timely manner under our Account Receivables Management service. We adhere to an efficient denial management process based on your payer mix and outstanding account receivables.

Old A/R Cleanup - Our services help you to collect on all your unpaid claims. We do appeals and follow up on unpaid balances aggressively. We can perform these services on your billing software without disturbing your regular work-flow.

Patient Statements

ChallengeMed provides comprehensive patient billing solutions. We understand the importance of collecting every dollar and bill patients on time. Prepare and send Patient statements in time for Unpaid balance, co-pays, non-covered services, deductibles & out of pocket expenses. We generate patient statements every 15 days to ensure quick payments.

Our on time patient billing and statement generation services help you to optimize your collections. Our services help you to accelerate cash flow and also ensure good customer services. All patient payments received are immediately posted into the accounts.

Healthcare Data Entry

ChallengeMed pay great attention to details during data entry for insurance claims and take steps to make sure these claims are compliant to various regulatory standards

ChallengeMed have expertise in handle data entry of general insurance claims, demographic information, medical insurance claims, CMS 1500, UB04 and flexible spending claims.

Delays in transaction processing will lead to the end customer dissatisfaction leading to a loss of customers, which could have a negative impact on revenues and growth.

The following type of Claims supported:-

• CMS1500
• CMS1450
• Dental Claims
• Prescription Claims
• Vision claims
• Superbills
• Other non standard forms

Electronic Data Interchange

EDI is an abbreviation for Electronic Data Interchange, an innovative electronic communication technology. It is a structured way to transmit data between computer systems using established message formats and standards. Healthcare EDI provides secure electronic data interchange between healthcare institutions, care providers, and patients, and allows for more secure and efficient data processing, including healthcare claims processing.

We provide the following EDI services:-

• Claims and encounters information (837)
• Enrollment and disenrollment (834)
• Payment and remittance advice (835)
• Claims status (276/277)
• Eligibility (270)
• Referrals and authorizations (278)