Process:

Pre-Sales Requirements Analysis: This process commences once BreakThrough receives Client approval to conduct process study and to submit a presentation on the benefits of business process management through outsourcing. During this process BreakThrough will conduct the Client Requirements Analysis Study. The study will involve specialties covered, required turn around time, type of files, reports requirement and formats to be followed.

Receipt of Files from client : BreakThrough receives scanned copies in “. tif ” format of patient registration sheet, superbill, and insurance card copies from the client through a FTP site.

Download and Allocation of Files: The files uploaded from the client using the FTP site will be downloaded by BreakThrough’s Medical Billing Team and allocated to the appropriate Demographics and Charge Entry Team.

Patient Demographics Entry: After the files are downloaded and allocated to the appropriate team, the Demographics team enters details such as patient first and last name, social security number, insurance and guarantor details.

Charge Entry: After the files are downloaded and allocated to the appropriate team, the Charge Entry team inputs all charges associated with the procedures those are coded into the billing system.

Claims Submission: On successful completion of the Charges Entry, a claim is submitted electronically from the client billing system to the insurance company. For paper claims, CMS 1500 or CMS 1450 forms are filed, scanned, and uploaded to the BreakThrough FTP site that is forwarded to the client to be mailed.

Client Feedback: On receiving Quality Feedback from the Client, BreakThrough shall work towards improvement and refinement in the Billing Process in order to provide the most accurate and reliable services.