Practice Management System
Revenue Cycle
  • Patient Registration
  • Eligibility Verification
  • Authentication Check
  • Claim Generation
  • Claim Submission
  • Medical Coding
  • Charge Entry
  • Cash Posting
  • A/R Denial Management
  • A/R Collections
  • A/R Follow-up
  • Medical Billing
  • Patient Follow-up
  • Third Party Payment

Claimat Practice Management improves productivity

Claimat includes practice management functionality for billing and scheduling, all in one integrated system. More specific capabilities include claims management, claims submission and a powerful reporting system. Capture more revenue for your practice by reducing claims errors before submitting a claim for payment. With Revenue Cycle Management, you will counter lower claim denials and get paid much faster.

We are pleased to inform the services we offer:

Patient Registration

Appointment and Scheduling. The system is able to enter patient demographics information and register a patient, followed by appointment scheduling in the healthcare facility.

Eligibility Check

The system be able to do an Insurance eligibility check or verification which also covers an Authentication check.

Claim Generation

System be able to generate claim for a particular patient for the services provided.

Claim Submission

System be able to accept professional and institutional claims in any format. The claims should cross the extensive system of edits and be able to track claims to eliminate loss of claims by reporting when claims are received, delivered and accepted by the payers. The documents or forms will be examined for billing errors and the generation of EOBs (Explanation of Benefits). The claims are submitted and filed with the insurance company and the amount receivables and follow-up process is conducted.

Claim Management

Claims management is a tedious process involving a number of steps to be followed. The PMS system aims at simplifying the overall process of claims management. It identifies services upfront that medicare won´t cover and reviews claims for medicare compliance before they´re submitted. The system provides a broad range of features to simplify and expedite the process of claims management.

Medical Coding

Medical coding is to experience an increase in returns and a reduction in the number of denials as comply with the ICD-9-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)].

Charge Entry and Cash Posting

System be able to process charges for multiple specialties and be able to work according to regulations related to Medicare, Medicaid, Managed Care, Third Party Liability, Workers Compensation, Preferred Provider Organizations and Indemnity Insurers. Cash posting includes comprehensive financial services offering superior payment convenience and flexibility. This includes the collection of co-payments, co-insurance, and deductibles while enabling the scheduling of automatic payments from a patients credit card*.

A/R Denial Management

Denial management Process tracks every claim that has denied 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 utilizes claim rules and edits that are specific enough to dramatically drive up the first pass claim acceptance and stop the flood of denied claims.

A/R Collection and Claim Follow-up

  • 14% of all claims submitted to the payers are denied and have to be resubmitted, appealed or written off by providers.
  • 50% of denied claims are never re-filed.
  • 50-70% of denied claims have higher chance of being recovered.

The submission and re-submission of claims will be on priority basis

  • High Dollar high age - These claims would be processed on priority as the claims need to be followed up before we exceed the filing limit.
  • High Dollar low age - Next focus would be on high dollar claims with low age as the chances of collection are higher.
  • Low Dollar low age - These claims have higher probability of collection. However, need many more resources to follow-up.
  • Low Dollar high age - These claims are given last priority as these claims have less chances of collection and need high number of resources to follow-up.

Medical Billing

Medical Billing is the process of submitting and following up on claims to insurance companies in order to receive payment for services rendered by a healthcare provider. The level of service, once determined by qualified staff is translated into a standardized five digit procedure code drawn from the Current Procedural Terminology database. The verbal diagnosis is translated into a numerical code as well, drawn from a similar standardized ICD-9-CM database. These two codes, a CPT and an ICD-9-CM, are equally important for claims processing.

Charge Capture   Coding

Charge capture and coding is same as Medical coding and medical billing. In charge capture the physician can record procedure and diagnosis codes on their mobile devices and transfer information.

Patient Follow-Up

Third Party Payment Compliance

This follows if a payment gateway is integrated in our system. The system has to be complying with norms according to the PCI-DSS (Payment Card industry Data Security Standards). These standards are created to help payment card industry organizations that process card payments prevent credit card fraud through increased controls around data and its exposure to compromise. The standard applies to all organizations that hold, process, or exchange cardholder information from any card branded with the logo of one of the card brands.

ICD 10

Coding rules framed by ICD-10 will help healthcare service providers, physicians, or other coding agencies to make their coding process efficient by reducing errors and inconsistencies. Thus, healthcare providers are likely to see a significant increase in their collection rates by switching to ICD-10.

ICD 10 will reduce errors in diagnosis coding, improve tracking and response to health issues. However it also requires a lot from both you and your RCM software vendor.

At Claimat we are committed to to make your transition to ICD-10 less painful. Claimat RCM is ICD-10 compliant, with all ICD codes pre-programmed into the database.

Electronic Remittance Advice (ERA)

What is Electronic Remittance Advice (ERA)?
Electronic Remittance Advice (ERA), or the 835, is the HIPAA-compliant detailed explanation of how a submitted health care claim was processed.

What are the benefits of ERA?
ERA can help improve your business office workflow and productivity. The ERA can be automatically loaded into your accounts receivable system, which can:

  • Help reduce costs
  • Save time
  • Reduce posting errors
  • Shorten the payment cycle

Save time and money! With Claimat ERA feature; you can get your claims auto-posted and your payments directly deposited into your bank account.