AbacusConsulting - About Us

Medical Billing

As a Medical Billing service provider, we have complete understanding, knowledge and expertise to accommodate all the complexities of the US health insurance industry in an efficient way, and as economically as possible. Our services help clients achieve maximum automation of their claims resolution processes, while being fully compliant with HIPAA-mandated regulations for privacy and confidentiality.

We are a group of highly dedicated, thoroughly trained medical professionals bringing along an average of four years of medical billing industry experience. We have developed a most comprehensive medical billing workflow process on the basis of analysis and review of health insurance's most complex taxonomy of patient intake / registration, diagnoses and treatment plans, claims submission and financial tracking, third party reimbursements, individual patient responsibilities, and so on.

Before commencing any work on a new project, we undertake in-depth study and analysis of client's existing business function. On the basis of this analysis, we work out a most comprehensive solution at a highly reasonable pricing package. We will then implement a strategy that parallels client's requirements and sets in place a tangible tool to measure success. This enables our clients to have industry standard quality services coupled with 33% to 50% cost savings while they have adequate time and peace of mind to concentrate on their core business functions.

Service Offerings

We offer complete medical billing and insurance claims processing services including; downloading and verification of charges, data entry of charges, accounts receivable follow-ups with private and public carriers, and payments postings.

In addition, our scope of work includes new member and provider enrollment, conversion of HCFA and UB92 forms; medicare remittance and medicare summary notices; explanation of medical benefits (EOMB) and repricing documents.

Medical Billing Workflow

Types of claims processed by AbacusConsulting BPO

Sectors Served

• Payers
• Providers
• Third party administrators

Payers

Our Payer services include the following processes:

• Mail room management
• Document scanning
• Document management using search and retrieval
• Claims processing and adjudication
• Exception and pended claims processing
• Claims payment
• Customer support call center
• Government compliance audit and support
• Claims processing knowledge management
• Customer relations management (CRM) support
• Inbound network medical services provider support

Providers

• Pre-service: Appointment scheduling, pre-verification check, physician referral and patient registration
• Claims Preparation: Coding, charge entry, billing and payment posting and claims submission
• Account Receivables Management: Collection follow-up, reimbursement analysis, denials management and claims reprocessing
• Customer Service : Inbound customer service, outbound calls, web customer support, clinical trial enrollment and customer support call center

Third Party Administrators

Our Third Party Administrator services include the following processes:

• Mail room management
• Document scanning
• Document management using search and retrieval
• HIM coding
• Claims preparation
• Re-pricing claims
• Rejected and recycled claims management
• Payment reception
• Collection handling
• Customer support call center
  

Accounts Receivable Management Process

Turning over accounts receivable into cash requires a systematic, planned and focused approach. Each effort must be aimed at eliminating or resolving the problem instead of merely gathering information. Documentation of the findings is critical as it helps as a reference tool for the future.

Please click on the link A/R Management Process to learn more about the A/R management process followed at AbacusConsulting BPO.

The problem researched by A/R agents could be an internal data entry error, incorrect information on the claim, non-covered benefit, unauthorized procedures and services, procedure or service not medical necessity, pre-existing condition, termination of coverage, failure to obtain preauthorization, out-of-network provider used, lower level of care could have been provided, etc.