MEDICAL A/R and BILLING
Your healthcare facility’s revenue cycle relies on medical billing best practices. ECLAT Health Solutions provides medical A/R and billing solutions to hospitals, physician offices, Independent Practice Associations, and a variety of other healthcare providers. Our medical A/R and billing solutions reduce errors, improve collections speed, and increase cash flow.
Our all-inclusive Revenue Cycle Management solutions will give you the freedom to focus on your facility’s highest priority: providing excellent patient care. Our solutions optimize all aspects of revenue cycle management, including Provider Enrollment and Credentialing, Insurance Verification, Payment Posting, Accounts Receivables, Denial Management and much more.
Our billing experts have at least 10 years of experience and always maintain HIPAA, HITECH, CMS, In-Network, Out-of-Network compliance. We keep meticulous records of all your payments to maintain the highest standards of accuracy, privacy, and security. While other RCM companies may implement a one-size-fits-all model, ECLAT customizes A/R and billing solutions to meet and exceed individual facility needs. ECLAT is one of the top medical A/R and billing companies - not only do our billing experts process your claims, but we investigate the source of the issue to identify and remedy any errors in your billing processes.
To learn more about our revenue cycle management solutions and apply the ECLAT Advantage to your facility, explore ECLAT’s medical coding solutions, HCC coding solutions, ICD-10 third-party auditing solutions, and CDI solutions.
Comprehensive End-to-End Revenue Cycle Management
Provider Enrollment and Credentialing
- ECLAT Health is a “one-stop” solution for all your RCM needs. We are equipped with trained and certified professionals to provide a complete solution.
- ECLAT has expertise in providing professional services to providers in all 855 forms, PECOS (Provider Enrollment Chain and Ownership System) and CAQH’s (Council for Affordable Quality Healthcare) ProView system.
- ECLAT supports our clients in the credentialing and re-credentialing of Medicare and commercial payers.
- Add physician(s) into an existing group, changing from one practice to another.
- ECLAT provides ERA / EFT set-up and assistance.
- Assistance for Insurance contracts, evaluation and negotiation.
Pre-certification (Authorization) & Insurance Eligibility Verification
- We streamline the procedure upon receiving the copy of the insurance card prior to appointment for services which require pre-certification / authorization.
Patient Demographic Entry
- ECLAT’s Demo Team (EDT) enters patient demographic details such as name, date of birth, SSN, address, phone #, insurance details, medical history, guarantor, as provided by the patient at the time of the visit to the doctors’ office on the PMS.
- Partner with our auditing specialists to capture Social Determinants of Health data buried in demographic information to secure against risks and preventable revenue losses.
CPT and ICD-10 Coding
- Our coding team works in accordance to CPT and ICD-10 Coding Compliance.
- Our billers receive superbills with diagnostic notes with or without ICD and CPT codes. If codes are already provided on the superbill, they are validated by our coding team to check and prevent any ‘Upcoding’ or ‘Downcoding’ to avoid denials.
- The fee schedules are generally pre-loaded into the PMS.
- Our billers ensure that the fee schedule is as per the state / provider insurance contract.
- Our billers ensure all patient demographics have been provided in the claim and are ready to be filed.
- Our billers ensure that the claims are submitted electronically. Paper can be used as an insurance requirement within a 24 hour window to the clearing house or insurance.
- With ECLAT you can expect all clearing house rejections to be resubmitted on the same day.
- EFT/ ERA enrollment to all providers to avoid delays in the payments.
- Our billers post and reconcile ERA / EOB / Denials (Based on the PMS) to the PMS on a daily basis.
Account Receivables Follow-up
- We can provide a unique follow-up on a weekly, bi-weekly, and/or monthly basis through your preferred method of communication depending on the filing limits and buckets of aging.
- After a detailed analysis on denials and partial payments, ECLAT’s Account Receivable (EAR) team calls payers, patients, providers, facilities and any other participants to follow-up on denied, underpaid, pending and any other incorrectly processed claims.
- Notes are posted / documented in the PMS on each account to analyze trends in payments and denials.
- Once the provider authorization is completed, our team will contact the appropriate patient to obtain information as required for billing such as Insurance Identity number, coordination of benefits and other requirements.
- Our (EAR) experts also work on secondary / tertiary / paper claims and follow-ups.
- ECLAT’s Appeals Team (EAT) appeals on denials once a reply is received from the payers.
- ECLAT’s team will call accounts that are overdue to collect the balances and offer a payment plan for balances that exceed client-determined thresholds.
- Our team will review the patient’s demographics and verify information such as the mailing address, email address, alternate phone number, etc.
- If an invoice was missed or not received, our team can offer a variety of methods to deliver the invoice to the patient or direct the patient to the patient portal to make payment.
- ECLAT will verify that patient balance is correct per the EOB/ERA posting.
- ECLAT will provide a toll-free call back phone number for any patient questions that may follow.
- Our Billing and AR team will alert clients of any posting issues or patient pending payments.
- ECLAT’s billing team can accept various forms of payment (Debit/Credit card, auto-pay, etc.) and process the payment with receipt confirmation to follow.
- Our team goes above and beyond to maintain a positive patient experience during the collections process.
- ECLAT’s monthly invoice will be accompanied by a monthly AR Status Report
- Ambulance Services
- Cardiovascular Surgery
- Durable Medical Equipment
- Emergency Medicine
- Family Practice
- General Surgery
- Hematology / Oncology
- Internal Medicine
- Mental Health
- Motor Vehicle Injuries
- Obstetrics / Gynecology
- Pain Management
- Physical & Occupational Therapy
- Sleep Disorders
- Workers Compensation