Procedures and diagnosis are coded based on details given in the charges sheets / super-bills and forwarded to the entry team.
The claims data entry personnel create a charge, according to billing rules pertaining to the specific carrier and location, check for any data entry errors and forward the same to the audit department.
The keyed charges are 100% audited to ensure that they conform to carrier billing rules and guidelines. This greatly avoids the claims get unpaid / denied and pave path for a quicker reimbursement.
The charges get created into claims are then forwarded to the transmission department.
The claims that reach this department fall into two categories; those to be sent on paper, and electronic claims. List of claims in each category are prepared. The paper claims get printed out and dispatch to the insurance carriers. The electronic claims are transmitted through a commercial clearinghouse to the various insurance carriers on a daily basis.
To completely avoid “Timely Filing” issues, the AR department follows up on the paper claims after 30 days from the date of dispatch. The electronic claims are followed up after 15 days from the date of transmission.
Daily cash files, ERAs, comprising copies of checks representing payments from insurance companies are received in the mail or online storage. These check copies are received with the Explanation Of Benefits (EOBs) pertaining to the payment attached to them. Deposit slips or line item sheets showing the total cash and the number of checks deposited on a particular day are also received. Cash in posted to patient accounts and the deposits reconciled on a daily basis. Overpayments, identified during cash posting , are immediately marked and the necessary documents prepared for the processing of refunds after obtaining the required approvals. Patient billing, write offs and adjustments are done under strict supervision of account managers.
AR Analysts examine carrier denials and rejections, identify claims for appeal and re-submission and initiate the appeal process, Analysts also forward denied claims, with their analysis report, to the appropriate departments for corrective action and re-submission. Each team of analysis is fully informed on billing rules and situations pertaining to specific geographic areas.
The compliance department, which also maintains a Billing Library, educates billing staff on compliance. Members study manuals, newsletters and carriers updates and keep the various departments informed on changes in billing rules and compliance.
The AR Insurance telephone crew follow-up on status of claims with the various insurance companies, request clarifications on billing and reimbursement procedures and act on work orders issued by various departments needing carrier assistance.
One team of telephone caller is assigned exclusively to handle in-bound patients inquiries and call up patients regarding their balances.
Based on the client needs the reports are tailor made to suite their requirements and forward to them on a daily, weekly and monthly basis.
Sr. Manager – RCM
Neelaveni comes with nearly 10 years of experience in the healthcare industry spread across home health, In-Patient, Out patient, anesthesiology and radiology environment. Her specific areas of expertise are Revenue Cycle Management and Managed care contract negotiations. Prior to joining BlissMD Healthcare Solutions, she has spent a considerable amount of time working in Banking sector, Life Insurance and Health Insurance companies.
Neelaveni has a solid understanding of all aspects of revenue cycle management with a focus on best practices and expected outcomes to bring and show value at the client level, she has immensely contributed towards BlisMD’s continuous growth, innovation and expansion. Her strength includes client co-ordination, process enhancements and handling escalations, which comes from spending a significant amount of time in managing all billing processes resulting in increased savings and process improvements for the clients she has managed. She has completed a Bachelor’s degree in Mathematics and Science.
Founder and CEO
Elanchezhiyan is the Founder and a Chief Executive Officer at BlissMD Healthcare Solutions. He has more than 15 years of experience in US Healthcare industry. Elan created the company in the year 2013 and through his brilliant track record in leadership, management, and operational experience; He made BlissMD a cost effective, client centric, client oriented and most preferred Revenue Cycle Management service provider.
As a CEO of the Company, He oversees the strategic direction of the organization and upholds the company’s position at the forefront of the industry. Under his direction, the Company enjoys a rapid growth and achieves higher rate of customer retention, employee’s satisfaction and add new talents every day.
As a Founder of BlissMD, Elan brings an incredible amount of industry knowledge and relationships that he has built through the years while working in senior management positions in various US-based healthcare services companies. Personally, He is a peace loving Man. He likes playing chess, practicing yoga and Meditation.
Sr. Manager – Coding operation
As an accomplished healthcare professional with nearly 13 years of experience, Qurathul Zahira has successfully managed the operations, deliverables and audit functions for BlissMD’s coding department. Qurathul has been with BlissMD Healthcare Solutions since its inception. Qurathul is a certified professional coder. She holds a Master’s degree in physiotherapy (M.P.T) and has previously served as a physiotherapist in hospitals and nursing homes. Her Knowledge and understanding of Hospital and Professional fee coding has helped the organization cater to niche demands from clients.
Qurathul is also a subject matter expert of HCC Coding and regulations and this has helped BlissMD support payer side of business. In her current role, She plays a key role in planning overall organizational strategy, growth and customer satisfaction within coding services and Technology. Her client centric work ethic coupled with her focus on streamlining processes has helped BlissMD manage, retain and grow new and existing coding accounts.
Sr. Manager – IT and Compliance
Rajiv Manoharan leads the IT and Compliance dept at BlissMD Healthcare Solutions. He and his team acts as BlissMD’s technical safeguards. Under Rajiv’s supervision his team monitors the patient’s electronic ePHI to keep it safe from any threats and control the access to it. He ensures all HIPAA technical safeguard standards are implemented strictly in the organisation without any breach. He ensures his team is kept updated to face any new security challenges.
Rajiv also takes the responsibility of managing full project lifecycle right from accessing the requirements of the project in accordance with the IT strategy, architecture, analysis and building solutions in line with customer requirements, testing, deploy and end-user training (technical and non-technical audiences).
He specializes in IT data security and project management. He has nearly 16 years of experience in the IT and web content management domains and brings in his creative problem-solving and analytical skills to the table. Prior to joining BlissMD Healthcare Solutions, He worked with organizations such as Chettinad Academy of Research & Educations., Dpro Technologies Pvt Ltd, etc.
Manager – Accounting and Finance
Revathi is one of the key decision makers for BlissMD’s over all administration. Revathi ensures the organization is in full compliance with the Law. Under her leadership the company’s Accounting and Finance department executes company’s receivables, payables, payroll, financial controls and financial reporting as per industrial standards. She is a BTech graduate and holds an MBA in accounting. Prior to joining BlissMD, she has spent a considerable amount of time working as a chief accountant in a reputed organization.
As a part of BlissMD’s leadership team, she has been one of a driving initiative to build a skilled and united workforce. She meticulously maintains and up skills the organization’s standards by implementing and evaluating the employees relationship policies and programs. She is known as a high energetic and a positive leader, who loves to face challenges and works smart to achieve it.