Our services
How We Can Help?
Appointment Reminder
Insurance Verification
Medical Billing And Coding
360* Revenue Cycle Management
Accounts Receivable Management
Denial Management
Payment posting
Our services
How We Can Help?
360* Revenue Cycle Management
Paygenix Healthcare is a committed service provider of revenue cycle processing and receivables management services to hospital, physician, labs & billing company, or a practice. Our prime focus is to minimize as many clericals work your staff has to spend, so you can focus only on patient care and business development.
We are learned to manage the entire revenue cycle of practice right from the appointment reminder, submission and reconciliation of claims and payments to patient’s statement follow up. By allowing us to manage your billing cycle, you can free yourself from the hassles of billing and follow up, and leverage that time to treat your patients.
By outsourcing to Paygenix Healthcare you are rest assured to achieve the following benefits:
- Big relief from time spending on licensing and credentialing
- No expenditure on training your staffs on compliance and audits.
- Structured workflow
- Transparency to your financials through timely reports
- Accelerated cash flow.
- High percentage of first pass billing and payment collection ratio
- Periodic monitoring of every aspect of revenue cycle
Appointment Reminder
Patient care is not just providing treatments, it starts from a personal care to inform patient well in advance about their appointment and do provide them some idea about out of pockets and various ways of payment modes.
Paygenix Healthcare Inc provides a wide range of medical billing services that facilitates a healthcare providers in improving the functioning of their overall revenue cycle as well as their customer service that is patients’ experience.
Appointment reminder is one important service which enhances customer service to patients and there by increased cash flow before the procedure than waiting on collection agencies to chase the patients on a accumulated bill.
Of course, it does sound courteous to patient on receiving a call from Doctors office to hear reminder of their appointment. Paygenix Healthcare would extract appointments scheduled 2 weeks in advance to reach out to patients to place the reminders, followed by text messages at preferred intervals by the practice.
This practice not only minimize number of NCNS (No call No Show) but also provides a chance to patient to reschedule their appointments on the same call. It will also eliminate NCNS charges from the AR report, as they must be eventually written off by the provider.
Paygenix Appointment Reminders streamline patient communication and enhance medical billing efficiency. These reminders help
reduce no-shows, ensuring that patients attend their scheduled appointments, which directly impacts revenue and operational efficiency.
Insurance Verification
Paygenix Insurance Verification streamlines the process of confirming patient insurance coverage, ensuring accurate and efficient
billing.
The current health care system has created confusion about health insurance -not only among healthcare providers but also among patients. Patients are confused over why their plans come up with higher out of pocket expenses, despite opting for a low-cost premium plan.
Research has shown that most of the claims are denied or delayed due to gaps in patient information. This may be linked to incorrect form-filling during their visit, or failure to update the patient demographics of the patient at the front-desk/reception, expiry of insurance cover, lack of pre-certification or Prior- Authorization.
Above mentioned problems can be minimized or even Zeroed if every physician practice imbibes the proverb “Prevention is better than Cure”.
Paygenix Healthcare believes and practice this principle and that is why we dedicate emphasized resource and time on performing Insurance Eligibility and Benefit verification.
A tidy verification process helps achieving three important things that defines any practices Success and cash flow.
- Better up-front collections of out-of-pocket expenses
- Decreased claim denials due to Prior Authorization, No coverage etc.
- Eventually improved First pass collection rates.
Medical Coding
Apart from Patient Demographic & eligibility related denials, Coding related denials too are important as it is directly proportional to practices integrity and using appropriate ICD/CPT for services provided to patients is no less significant.
PaygenixHealthcare have mastered the art of generating clean claims for the providers to accomplish the goal of getting paid through the first submission by diligently reviewing each chart to come up compatible ICD/CPT combination that meets medical necessity of both NCD and LCD, meeting MUE limits and CCI edits too.
Besides this, we have also invested in using high profile medical coding scrubbing tools and partnered with leading US based medical coding consultancies to ensure fast changing Billing and Coding regulations are educated and implemented by both our staffs and the practice.
This process is very crucial since payers have become highly vigilant in adjudication and reimbursement of claims.
By leveraging Paygenix’s medical coding services, healthcare providers can achieve greater billing accuracy, enhance revenue cycle
management, and ensure regulatory compliance, leading to improved financial outcomes and operational efficiency
Claim Processing Services
Paygenix Health Care offers comprehensive claim processing services designed to streamline the management of healthcare claims, ensuring accuracy, efficiency, and compliance with industry regulations. Our services cater to various healthcare providers, insurance companies, and patients, with a focus on delivering timely and accurate claim adjudication.
At Paygenix, we understand that the claim processing landscape is complex, involving multiple steps such as claim submission, validation, adjudication, and reimbursement. Our expert team is equipped to handle this process from start to finish, minimizing errors and reducing the time it takes for claims to be processed. We employ advanced technology and automation tools to ensure that every claim is processed efficiently, reducing the burden on healthcare providers and allowing them to focus on patient care.
Our claim processing services include detailed verification of patient information, accurate coding of medical services, and thorough review of insurance policies to ensure that claims are correctly processed according to the terms and conditions of each policy. We also manage appeals for denied claims, working diligently to resolve any discrepancies and secure the appropriate reimbursement for our clients.
Paygenix Health Care is committed to maintaining the highest standards of data security and confidentiality, adhering to all relevant regulations such as HIPAA. We provide transparent reporting and analytics, giving our clients insight into claim statuses and trends, helping them make informed decisions.
By partnering with Paygenix, healthcare providers can expect a reduction in claim processing times, improved accuracy in claim submissions, and a decrease in administrative costs. Our goal is to optimize the claim processing experience, ensuring that our clients receive the maximum reimbursement they are entitled to, without the hassle of navigating the complexities of the claim process.
Accounts Receivable Follow-up
Paygenix Accounts Receivables offers a comprehensive solution to manage and optimize the accounts receivable (AR) process in
medical billing, ensuring efficient revenue collection and financial management.
The primary goal of Paygenix AR is to ensure that the healthcare provider receives timely and accurate payment for services rendered. AR follow-up is a critical part of the revenue cycle management process, where Paygenix focus on ensuring that all claims
sent to insurance companies and patients are paid promptly and correctly. We Paygenix AR follows process includes:
Claim Status Verification: Regularly checking the status of submitted claims to determine whether they are pending, denied, or paid.
This can be done through payer portals, phone calls, or electronic clearinghouses.
Denial Management: Investigating claims that have been denied or underpaid by insurance companies. The billing team identifies the
reason for denial, corrects errors, resubmits the claim, and ensures compliance with payer requirements.
Timely Follow-Up: Insurance companies and government payers have strict filing deadlines (usually within 90-180 days of service)
for submitting claims or appealing denials. Failure to meet these deadlines results in claim rejection and a loss of revenue. Paygenix
closely monitors deadlines to ensure that claims are followed up and re-submitted well before these time limits. Working on aging
reports to prioritize claims that are overdue or approaching the payer’s filing limit. This helps avoid claim write-offs due to time
restrictions on payment.
Insurance Follow-Up: Proactive communication with insurance companies is essential. This involves checking the status of claims,
determining if they have been processed, and finding out why any payments have not been issued. Some claims may require
additional documentation, such as medical records or corrected billing codes, before they can be processed. Paygenix ensures that the
necessary information is provided on time helps expedite payment. For denied or underpaid claims, follow-up ensures that the
necessary corrections (e.g., coding errors, missing information) are made, and the claim is resubmitted. Engaging in frequent
communication with insurance companies to resolve outstanding issues, clarify discrepancies, or escalate delayed payments.
Patient Billing: AR follow-up for patient collections includes sending statements, making phone calls, offering payment plans, and,
in some cases, referring the balance to a collection agency if not paid in a reasonable time. Clear communication with patients about
their responsibility, timelines, and payment options is key to successful collections.
Payment Posting: Ensuring that payments received from payers or patients are accurately posted in the medical billing system. This
step is critical to maintaining up-to-date financial records and reducing outstanding AR.
Reporting and Analysis: Reviewing AR aging reports and financial data to assess the performance of the revenue cycle, identifying
trends in denials, delays, or non-payment, and adjusting strategies accordingly
Key Features: –
Systematic automation of follow-up actions for outstanding invoices and denied claims. – Provides real-time visibility into outstanding balances, payment status, and aging reports. – Efficient handling of claim submissions, denials, and resubmissions. – Seamlessly integrates with EHR and practice management systems for synchronized financial data.
Benefits: –
Accelerates payment collections by streamlining the follow-up process and reducing delays.
– Shortens the time it takes to convert receivables into cash through proactive management and automation. – Minimizes errors in billing and claim submissions, reducing the number of denied or delayed payments.
– Offers comprehensive reporting and analytics to monitor AR performance and identify trends or issues. – Reduces administrative overhead by automating routine AR tasks and follow-ups.
By utilizing Paygenix’s accounts receivables solutions, healthcare providers can achieve more efficient revenue cycle management,
improve cash flow, and enhance overall financial health.
Denial Management
Paygenix Denials Management streamlines the process of handling denied or rejected insurance claims, ensuring quicker resolutions
and improved revenuerecovery.
Paygenix Denials Management offers a sophisticated approach to managing and resolving denied or rejected insurance claims. The
solution provides automated tracking and categorization of denials, ensuring that each claim is systematically reviewed and
addressed. By leveraging advanced analytics, Paygenix identifies root causes of denials, such as coding errors, eligibility issues, or
documentation deficiencies. This detailed analysis allows for targeted improvements in billing practices, reducing the frequency of
future denials.
With efficient claim resubmission processes, Paygenix helps healthcare providers correct and resubmit claims swiftly, improving the
chances of successful reimbursement. The integration with EHR and practice management systems ensures seamless access to all
relevant data, facilitating accurate and prompt follow-ups. Additionally, Paygenix delivers comprehensive reporting on denial trends
and resolutions, providing valuable insights to enhance overall revenue cycle management.
By implementing Paygenix’s denials management, healthcare practices can significantly enhance their claim recovery efforts, reduce
administrative costs, and maintain a healthier cash flow, all while minimizing the impact of denials on their revenue.
Payment posting
Enlist Paygenix Healthcare’s top-notch cash posting and payment posting services designed to boost accuracy and efficiency and help you stay on top of your finances. Our team of certified experts are well-versed in medical billing and coding and have years of experience working with physicians and billing offices across the specialty spectrum. We understand the unique challenges and complexities of medical billing and possess the know-how to traverse the system to fetch you the results you need.
Our cash and payment posting services ensure that all payments are accurately recorded and deposited to their respective patient accounts on the same day. We post, balance and reconcile all payments received – within 12-24 hours of receipt. By utilizing the latest technology, we streamline your payment processes for faster and more efficient payments. Through a daily reconciliation process, we ensure smooth month-end closing and that all payments received for the month are accurately accounted for and matched to actual deposits.
Our end-to-end payment posting services encompass the entire payment process, from receipt to posting. We carefully review each payment to ensure accuracy, and we handle any issues that may arise. This means you can focus on what you do best – providing exceptional medical care to your patients – while we take care of the financial side of things.
Reports and Audits
Reports and analysis in medical billing are essential tools for ensuring accuracy, compliance, and financial health within healthcare
organizations. Here’s a breakdown of each:
1.Accounts Receivable (AR) Aging Reports:
Paygenix AR Aging Report provides a detailed analysis of accounts receivable (AR) by categorizing outstanding invoices based on
the length of time they have been unpaid. This tool is essential for effective financial management and ensures timely follow-up on
overdue accounts.
2.Claim Rejection/Denial Reports:
Paygenix Claim Rejection/Denial Reports provide an in-depth analysis of denied or rejected insurance claims, offering valuable
insights to streamline and improve the revenue cycle. These reports deliver a detailed breakdown of denials by reason, payer, and
frequency, allowing healthcare providers to identify and address recurring issues effectively. With automated, real-time reporting,
Paygenix eliminates the need for manual tracking and consolidates data from EHR and practice management systems for a
comprehensive view of claim status.
3. Paygenix Payment Posting Reports offer a streamlined solution for managing and reconciling payments in healthcare billing.
These reports provide a detailed summary of all payments received, including insurance reimbursements, patient payments, and
adjustments. By integrating with EHR and practice management systems, Paygenix ensures accurate and real-time posting of
payments, reducing manual entry errors and speeding up reconciliation processes.
4. Paygenix Financial Summary Reports provide a holistic view of a healthcare practice’s financial status, offering essential
insights into revenue generation and expenditure. These reports compile and analyze key financial metrics, such as total revenues,
outstanding accounts receivable, claim denials, and payment collections. By integrating seamlessly with EHR and billing systems,
Paygenix ensures that the financial data is accurate and up-to-date.
5. Paygenix Insurance Analysis Reports provide a detailed examination of insurance claims and payments, offering valuable
insights into the effectiveness of a healthcare practice’s billing and revenue cycle processes. These reports analyze key insurance
related data, including claim approvals, rejections, payer-specific patterns, and payment trends.
Our services
How We Can Help?
360* Revenue Cycle Management
Paygenix Healthcare is a committed service provider of revenue cycle processing and receivables management services to hospital, physician, labs & billing company, or a practice. Our prime focus is to minimize as many clericals work your staff has to spend, so you can focus only on patient care and business development.
We are learned to manage the entire revenue cycle of practice right from the appointment reminder, submission and reconciliation of claims and payments to patient’s statement follow up. By allowing us to manage your billing cycle, you can free yourself from the hassles of billing and follow up, and leverage that time to treat your patients.
By outsourcing to Paygenix Healthcare you are rest assured to achieve the following benefits:
- Big relief from time spending on licensing and credentialing
- No expenditure on training your staffs on compliance and audits.
- Structured workflow
- Transparency to your financials through timely reports
- Accelerated cash flow.
- High percentage of first pass billing and payment collection ratio
- Periodic monitoring of every aspect of revenue cycle
Appointment Reminder
Patient care is not just providing treatments, it starts from a personal care to inform patient well in advance about their appointment and do provide them some idea about out of pockets and various ways of payment modes.
Paygenix Healthcare Inc provides a wide range of medical billing services that facilitates a healthcare providers in improving the functioning of their overall revenue cycle as well as their customer service that is patients’ experience.
Appointment reminder is one important service which enhances customer service to patients and there by increased cash flow before the procedure than waiting on collection agencies to chase the patients on a accumulated bill.
Of course, it does sound courteous to patient on receiving a call from Doctors office to hear reminder of their appointment. Paygenix Healthcare would extract appointments scheduled 2 weeks in advance to reach out to patients to place the reminders, followed by text messages at preferred intervals by the practice.
This practice not only minimize number of NCNS (No call No Show) but also provides a chance to patient to reschedule their appointments on the same call. It will also eliminate NCNS charges from the AR report, as they must be eventually written off by the provider.
Insurance Verification
The current health care system has created confusion about health insurance -not only among healthcare providers but also among patients. Patients are confused over why their plans come up with higher out of pocket expenses, despite opting for a low-cost premium plan.
Research has shown that most of the claims are denied or delayed due to gaps in patient information. This may be linked to incorrect form-filling during their visit, or failure to update the patient demographics of the patient at the front-desk/reception, expiry of insurance cover, lack of pre-certification or Prior- Authorization.
Above mentioned problems can be minimized or even Zeroed if every physician practice imbibes the proverb “Prevention is better than Cure”.
Paygenix Healthcare believes and practice this principle and that is why we dedicate emphasized resource and time on performing Insurance Eligibility and Benefit verification.
A tidy verification process helps achieving three important things that defines any practices Success and cash flow.
- Better up-front collections of out-of-pocket expenses
- Decreased claim denials due to Prior Authorization, No coverage etc.
- Eventually improved First pass collection rates.
Medical Billing And Coding
Apart from Patient Demographic & eligibility related denials, Coding related denials too are important as it is directly proportional to practices integrity and using appropriate ICD/CPT for services provided to patients is no less significant.
PaygenixHealthcare have mastered the art of generating clean claims for the providers to accomplish the goal of getting paid through the first submission by diligently reviewing each chart to come up compatible ICD/CPT combination that meets medical necessity of both NCD and LCD, meeting MUE limits and CCI edits too.
Besides this, we have also invested in using high profile medical coding scrubbing tools and partnered with leading US based medical coding consultancies to ensure fast changing Billing and Coding regulations are educated and implemented by both our staffs and the practice.
This process is very crucial since payers have become highly vigilant in adjudication and reimbursement of claims.
Claim Processing Services
Paygenix Health Care offers comprehensive claim processing services designed to streamline the management of healthcare claims, ensuring accuracy, efficiency, and compliance with industry regulations. Our services cater to various healthcare providers, insurance companies, and patients, with a focus on delivering timely and accurate claim adjudication.
At Paygenix, we understand that the claim processing landscape is complex, involving multiple steps such as claim submission, validation, adjudication, and reimbursement. Our expert team is equipped to handle this process from start to finish, minimizing errors and reducing the time it takes for claims to be processed. We employ advanced technology and automation tools to ensure that every claim is processed efficiently, reducing the burden on healthcare providers and allowing them to focus on patient care.
Our claim processing services include detailed verification of patient information, accurate coding of medical services, and thorough review of insurance policies to ensure that claims are correctly processed according to the terms and conditions of each policy. We also manage appeals for denied claims, working diligently to resolve any discrepancies and secure the appropriate reimbursement for our clients.
Paygenix Health Care is committed to maintaining the highest standards of data security and confidentiality, adhering to all relevant regulations such as HIPAA. We provide transparent reporting and analytics, giving our clients insight into claim statuses and trends, helping them make informed decisions.
By partnering with Paygenix, healthcare providers can expect a reduction in claim processing times, improved accuracy in claim submissions, and a decrease in administrative costs. Our goal is to optimize the claim processing experience, ensuring that our clients receive the maximum reimbursement they are entitled to, without the hassle of navigating the complexities of the claim process.
days and maximize collections.
Accounts Receivable Follow
Our team of A/R experts, AAPC and AHIMA certified coders, and billers follow a field-tested holistic approach designed to maximize revenue and minimize your administrative burdens. Our A/R process includes:
- Patient Billing and Invoicing: Once you render a service to your patient, we generate and send out bills and invoices on your behalf. These invoices include details regarding the services provided, date of service, amount owed, and payment options.
- Insurance Claim Submissions: After the patient has been billed, we submit clean claims to the appropriate insurance company. The submitted claims are audited to ensure it contains all relevant medical codes and specialty-specific modifiers, procedural, diagnoses, and treatment-related information, as well as any necessary attachments such as medical records, medical necessity, and other supporting documents.
- Claims Follow-up: Once the claims have been submitted, we frequently follow up with the insurance companies to ensure that they are processed and paid in a timely manner. This involves tracking the claims and identifying any issues or delays that may arise, as well as resolving any errors or discrepancies.
- Denials and Appeals Management: In some cases, insurance companies may deny claims, either partially or in full. When this happens, we perform root-cause analysis to identify the reasons for the denial and develop an appeal plan to challenge the decision. This involves providing additional documentation, working with the insurance company to clarify misunderstandings, or pursuing legal action if necessary.
- Collections: When patients fail to pay their bills or when insurance companies do not cover the full cost of medical services, we work to pursue collections. This involves sending out past-due notices, negotiating payment plans with your patients, or engaging with collection agencies to recover outstanding debts.
Denial Management
Denial Management is one of the most important processes that can make or break the smooth functioning of a practice’s revenue cycle. There are two financial aspects to a denied claim – first is the “lost” revenue due to the improper prior authorization or the lack thereof and the second is the cost associated with reworking a denied claim, which entails a lengthy appeals process. Recent studies indicate that physicians spend anywhere from $30 to $100 or upward to rework a claim – costing the practice $14,400 (lowest estimate) annually based on 40 denied claims per month, not including the preliminary cost of submitting a claim.
The prevention of denials is always better than having to rework them – but this is easier said than done for most practices due to limitations in staff, time, and resources. Which is why we offer end-to-end denial management solutions to help maximize your revenue and minimize your administrative burdens.
At Paygenix Healthcare, our proven process begins with a thorough analysis of low-pays, no-pays, and current denial trends and patterns to identify root causes. Our AR team works in close consultation with our coders to formulate and deploy specialty-specific guidelines that effectively resolve coding-related denials. We also assist your team with implementing strategies and SOPs designed to prevent any denials that may arise in the future to help shrink your AR days and maximize collections.
Payment posting
Enlist Paygenix Healthcare’s top-notch cash posting and payment posting services designed to boost accuracy and efficiency and help you stay on top of your finances. Our team of certified experts are well-versed in medical billing and coding and have years of experience working with physicians and billing offices across the specialty spectrum. We understand the unique challenges and complexities of medical billing and possess the know-how to traverse the system to fetch you the results you need.
Our cash and payment posting services ensure that all payments are accurately recorded and deposited to their respective patient accounts on the same day. We post, balance and reconcile all payments received – within 12-24 hours of receipt. By utilizing the latest technology, we streamline your payment processes for faster and more efficient payments. Through a daily reconciliation process, we ensure smooth month-end closing and that all payments received for the month are accurately accounted for and matched to actual deposits.
Our end-to-end payment posting services encompass the entire payment process, from receipt to posting. We carefully review each payment to ensure accuracy, and we handle any issues that may arise. This means you can focus on what you do best – providing exceptional medical care to your patients – while we take care of the financial side of things.
days and maximize collections.
Reports and Audits
Paygenix Healthcare report and audit focus on evaluating the current RCM processes, identifying areas for improvement, and providing recommendations for optimization.
Current State Analysis: The RCM at Paygenix Healthcare encompasses patient registration, insurance verification, coding, billing, payment processing, and accounts receivable management. The system currently handles a significant volume of transactions, ensuring that claims are processed accurately and timely, minimizing the risk of denied claims.
Audit Findings:
Patient Registration and Insurance Verification: The audit reveals that while the patient registration process is streamlined, there is room for improvement in the insurance verification process. Delays in verification can lead to billing errors and payment delays.
Coding and Billing: The audit identifies a high accuracy rate in medical coding, which is crucial for ensuring proper reimbursement. However, occasional discrepancies were noted in billing, primarily due to coding errors or missing documentation.
Payment Processing: Paygenix’s payment processing is efficient, but there are opportunities to further automate the reconciliation process to reduce manual errors and enhance cash flow.
Accounts Receivable Management: The audit shows a well-maintained accounts receivable process, with a low percentage of overdue accounts. However, implementing stricter follow-up procedures could further reduce outstanding balances.
Recommendations:
- Enhance Insurance Verification: Implement advanced verification tools to reduce delays and improve accuracy.
- Coding Accuracy Training: Regular training sessions for coding staff to minimize errors and ensure compliance with the latest coding standards.
- Automation of Payment Reconciliation: Invest in automated systems to streamline payment processing and reconciliation.
- Strengthen Follow-Up Procedures: Introduce more rigorous follow-up protocols for overdue accounts to improve cash flow.
How We Can Help?
Our services
How We Can Help?
360* Revenue Cycle Management
Appointment Reminder
Insurance Verification
Medical coding
Claim Processing services
Account Receivable Follow-up
Denial Management
payment posting
Reports and audits
Should you Consider Outsourcing to Paygenix healthcare services
Outsourcing accounts receivable (A/R) management services can provide many benefits for healthcare providers. Here are some reasons why you should consider outsourcing to Paygenix Healthcare Services
Improved cash flow: A/R management services can help providers collect payments faster and reduce the number of days outstanding, resulting in improved cash flow and increased revenue.
Cost savings: Outsourcing A/R management can be more cost-effective than hiring and training in-house staff to manage it. Providers can save on salaries, benefits, and other overhead costs associated with hiring additional staff.
Expertise and resources: A/R management companies have specialized expertise and resources in revenue cycle management. They stay up-to-date with industry regulations and best practices and have access to the latest technology and software.
Reduced administrative burden: A/R management can be a time-consuming and complex process. Outsourcing it to a billing company can free up providers’ time and resources to focus on patient care and other critical aspects of their practice.
Increased transparency and reporting: A/R management companies provide regular reports and analytics to help providers monitor their financial performance and identify opportunities for improvement.
Outsourcing A/R management services allow healthcare providers to improve their financial performance, reduce administrative burden, and focus on delivering high-quality patient care.
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