Quality Control - Perfecture's Medical Billing Specialists

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Perfecture recognizes the importance of Quality Control throughout the entire healthcare industry. For quality control to be effective, it has to be a part of the optimization cycle from the charge capture through to after the accounting service, and it has to have the commitment all of our medical billing specialists in the organization. Perfecture has developed a quality control process to deliver measurable value and continues to strive for perfection.

Perfecture's hiring standards and development methodologies are strict; our talent pool, developed over a decade, is multifaceted; and our senior development staff is highly accomplished offering:

Appropriate defined metrics based on your needs.
Certified coders and highly educated medical billing specialists ensure accurate data entry for progressive process, helping to prevent rejections.
Revenue Acceleration: If claims are not paid during a specified time period, we can follow up with the payer regarding the unpaid claim; all calls are logged. Based upon the information gathered, we will take necessary action on the unpaid claim to correct and resubmit it. If the denial is due to lack of information, we will call the provider to request the information required to resubmit it.
Denials: We will check the EOB's for the denial reason and will then take appropriate action based on the explanation. The solution could be as simple as a call to the payer, or requesting more information from the provider.
Patient Re-Verification: If there is a denial for non-eligibility the first step is to call the payer to confirm that the patient is not insured with them. Once confirmed, we will call the patient directly for eligibility re-verification and membership details.
Resubmission of Claims: Based on the information we receive from the payer or patient, we will update the information in the medical billing system and resubmit the claim with the necessary information and/or attachments.

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