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How we do ItHow we do It

Insurance companies aim to benefit more by slowing down the process at the physician’s expense!We aim to get you what is rightfully yours!!

We approach professionally to overcome the tactics being used to hold your money by insurance companies !!!

DOCTUS is your catalyst, cutting down receivables and accelerating your cash flow



ProfileDriven by People, Process and Technology, Doctus USA consistently provides quality motivated solutions and compounding value to our clients through outsourced Healthcare Administrative Support Services. The Doctus Team of trained and experienced professionals has actively serviced the North American medical markets for more than 7 years and is highly specialized in Medical Billing, Receivables Management, Indexing, Transcription and Digitization Services.

With North American based Management and world class domain knowledge in healthcare, enabled support services, software development and application delivery, Doctus are the trusted partner to several North American clients.



Our team

Our employees are our key players. They understand our clients demands and expectations and this allow us to guarantee service levels which is unmatched in the industry.

Our billing team consists of-

- Professional Coders certified by American Academy for Professional Coders (AAPC)

- Billing Specialists with experience in handling diverse specialties.

- Experienced AR Analysts and Denial Management Specialists



Patient Scheduling & Insurance Eligibility Verification

Medical Coding

Medical Billing

Patient Registration

Charge Posting

Claims Transmission

Payment Posting

Statement Processing

Denial Management

Accounts Receivable

Insurance follow-up

Patient follow-up

What we do



Hospital /Doc’s office

generatesSuper bills

Hospital /Doc’s office

generatesSuper bills

Insurance Company Releasing payments

Insurance Company Releasing payments

Clearing Houses For

Electronic Clearance

Clearing Houses For

Electronic Clearance

•Demo Entries•Charge entries•Medical Coding•EOB’s•Payment Postings•Denials•Claims Submission•A/R Analysis•Follow up’s•Insurance Calling•Patients Statement•Patient Calling•Customer Care

•Demo Entries•Charge entries•Medical Coding•EOB’s•Payment Postings•Denials•Claims Submission•A/R Analysis•Follow up’s•Insurance Calling•Patients Statement•Patient Calling•Customer Care

Claims



ACCESSSING SOFTWARE ACCESSSING SOFTWARE

PATIENT DEMOGRAPHICS ENTRYPATIENT DEMOGRAPHICS ENTRY

CHARGE ENTRYCHARGE ENTRY

REPORTS TO CLIENTREPORTS TO CLIENT

QUALITY AUDITQUALITY AUDIT

GENERATION OF REPORTSGENERATION OF REPORTS

ACTION ON DENIALS / REJECTIONSACTION ON DENIALS / REJECTIONS

TRANSMISSION OF CLAIMS THRU CLEARING HOUSESTRANSMISSION OF CLAIMS THRU CLEARING HOUSES

CASH APPLICATIONCASH APPLICATION

AR ANALYSIS / CALLINGAR ANALYSIS / CALLING

CASH TALLYINGCASH TALLYING

CLIENT IN USCLIENT IN US

SCANNING TO INDIASCANNING TO INDIA

CODINGCODING

Paid Claims for cash application

Unpaid ClaimsFor corrective action



Mail to India on Scan date, File name and directory path.

Mail to India on Scan date, File name and directory path.

US Office scans Patient Demographics, Charge Sheets,

Insurance Card Copies, etc.

US Office scans Patient Demographics, Charge Sheets,

Insurance Card Copies, etc.

Scanned copies would be saved as *.TIF (Tagged Image Format) file

and placed in FTP Site

Scanned copies would be saved as *.TIF (Tagged Image Format) file

and placed in FTP Site

In the FTP Site, Files would be placed in the common path which can

be accessible by India

In the FTP Site, Files would be placed in the common path which can

be accessible by India

Scanning Documents to IndiaScanning Documents to India Medical CodingMedical Coding

Log to be maintained with File name, Total charges, Specialty details, etc before Coding.

Log to be maintained with File name, Total charges, Specialty details, etc before Coding.

Coding of Diagnosis to the utmost specificity using ICD-9 CM Manual.

Coding of Diagnosis to the utmost specificity using ICD-9 CM Manual.

Coding of Procedures by referring toCPT / HCPCS.

Coding of Procedures by referring toCPT / HCPCS.

After Coding, files to be handed over to Charges Department for processing.

After Coding, files to be handed over to Charges Department for processing.



Patient #, Name(LFM), Address, SSN, Sex, Employer, Home Ph, Work Ph, Guarantor, Marital Status, Subscriber details, Doctor#, Insurance information etc to be entered in the system

Patient #, Name(LFM), Address, SSN, Sex, Employer, Home Ph, Work Ph, Guarantor, Marital Status, Subscriber details, Doctor#, Insurance information etc to be entered in the system

After entering, printouts to be taken and data to be checked

After entering, printouts to be taken and data to be checked

Log to be maintained with Total Patients, Patients entered, Pending details, etc.

Log to be maintained with Total Patients, Patients entered, Pending details, etc.

Patient Account Numbering to be done, if system does not generate automatically

Patient Account Numbering to be done, if system does not generate automatically

Documents to be sorted Patient wise before entering into the system

Documents to be sorted Patient wise before entering into the system

If any clarification is required, send mail to US office

If any clarification is required, send mail to US office

Demographics entry



Charge EntryPatient Demographics and Coding to be done before entering Charges

Patient Demographics and Coding to be done before entering Charges

Charge File to be sorted by Patient / Date of Service

Charge File to be sorted by Patient / Date of Service

Patient #, Doctor # , Place of Service, Type of Service, Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Referral , Prior Authorization, On Bill comments, etc. to be entered in the system

Patient #, Doctor # , Place of Service, Type of Service, Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Referral , Prior Authorization, On Bill comments, etc. to be entered in the system

After entering data, file to be given to Quality Audit for checking

After entering data, file to be given to Quality Audit for checking

After checking and corrections, Claims to be transmitted.

After checking and corrections, Claims to be transmitted.

After Transmission, Charges completion details to be sent to US office.

After Transmission, Charges completion details to be sent to US office.

If any clarification required, send mail to US office.

If any clarification required, send mail to US office.

If any incorrect details found, Charges department to be informed




Quality Audit for Patient Demographics and Charges before sending batch wise update to client

Quality Audit for Patient Demographics and Charges before sending batch wise update to client

After Quality Audit, files to be given to Supervisor / Manager for sending Batch Update to client.

After Quality Audit, files to be given to Supervisor / Manager for sending Batch Update to client.

If any incorrect details found, Charges Team to be informed of the same and correction done

If any incorrect details found, Charges Team to be informed of the same and correction done

Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Place of Service, Type of Service, Referral, Prior Authorization, On bill comments, Location, etc to be checked in Charges File

Date of Service, Procedure Code, Diagnosis Code, Modifier, Units, Value, Place of Service, Type of Service, Referral, Prior Authorization, On bill comments, Location, etc to be checked in Charges File

Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph, Guarantor, Subscriber details, Employer, etc to be checked in Patient Demographic File

Patient #, Name, Address, SSN, DOB, Home Ph, Work Ph, Guarantor, Subscriber details, Employer, etc to be checked in Patient Demographic File

Log to be updated with patients checked, charges checked, correction details, etc

Log to be updated with patients checked, charges checked, correction details, etc

Quality Check



After Quality Check is through, List of Electronic Claims to be separated

After Quality Check is through, List of Electronic Claims to be separated

Transmission processes to be accurately followed to avoid rejection

Transmission processes to be accurately followed to avoid rejection

Claims to be transmitted electronically through different clearing houses

Claims to be transmitted electronically through different clearing houses

After transmission, log to be updated with patient #, claim#, total claims transmitted, pending claims, etc.

After transmission, log to be updated with patient #, claim#, total claims transmitted, pending claims, etc.

Send mail to Charges department after completion of Transmission

Send mail to Charges department after completion of Transmission



Claim Transmission Electronic/Paper



If any incorrect details found or any details missing, follow up to be done with Insurance

If any incorrect details found or any details missing, follow up to be done with Insurance

Log to be updated with Total Checks, Total Value, Posted details, Pending details, etc

Log to be updated with Total Checks, Total Value, Posted details, Pending details, etc

After Cash Posting, Claim#, Patient Name and Value to be checked for tallying data with the EOB

After Cash Posting, Claim#, Patient Name and Value to be checked for tallying data with the EOB

Application of Payment, Deductible, Co-insurance, Adjustments, Write offs, etc in the Cash Posting

Application of Payment, Deductible, Co-insurance, Adjustments, Write offs, etc in the Cash Posting

In the EOB Copy, Claim#, Date of Service, Procedure , Units, Charges to be identified before posting

In the EOB Copy, Claim#, Date of Service, Procedure , Units, Charges to be identified before posting

Insurance Name, Check #, Total Check Value to be cross verified with the Check and EOB Copies

Insurance Name, Check #, Total Check Value to be cross verified with the Check and EOB Copies

Checks and EOB(Explanation of Benefits) to be arranged before doing Cash Posting

Checks and EOB(Explanation of Benefits) to be arranged before doing Cash Posting

Cash Posting



-Within 24 Hours on receipt of EOB Denied claims are worked on, rectified and resubmitted.

-EOB is posted on the same day and All Denials which require additional documentation, are sent to the Doctor’s office.

- we are well versed with using correct appeal procedures in knowing Healthcare Laws and we specialize in working on old Account Receivables.

Denial management

-Our A\R and Denial Management Specialists receive extensive training in AR follow-up.

-Aggressive follow-up starts 21 days after claim submission. - - Our Specialists are chosen for their analytical skills and are provided with access to all the documentation required to make sure that the claim is paid on the first call.E.g. When the Insurance rep says that the claim lacks authorization number, our Specialists are taught to immediately retrieve the authorization number from our database and fax it while they are still on the call.



Skill set

Software

•Medic (Misys PM / Tiger)

•MDS

•Excalibur

•Medical Manager

•Med plexus Medisoft

•PMC

•Lytec

•Sequel Med

•Geysers

•Kareo

•Vericle

•NextGen

•IDX

•Healthmatics Ntierprize

•Office ally

We expertise in most of the billing softwares. However, its is defined by our clients. We also use remote desktop applications or web based softwares.

Specialties

•Radiation Therapy

•Obstetrics

•Ambulatory Surgical Centre

•Orthopaedics

•Pathology

•ENT

•Family Practice

•Paediatrics

•Gastroenterology

•Podiatry

•General Surgery

•Gynaecology

•Radiology

•Infectious Disease

•Internal Medicine

•Cardiology

. .Neurology

•Physical Therapy



Phone : 1-408-625-7222Fax : 1-406625-7006

E-mail: [email protected]

For further information, please contact-