Services

Coding & Billing

Whether paper or electronic, data processing is essential to the success of our collection process.  QMACS billing services begin with data retrieval. Collected data is immediately sent to our Coding Department where the code is assessed by our Certified Professional Coders, and then audited for accuracy.  After the CPT codes, modifiers, and diagnosis codes are attached, it is handed off to our Charge Posting team, where it is once again audited and then posted, balanced, and batched for submission into our choice of national clearinghouse, RealMed.

RealMed immediately runs batches for eligibility check and error management including HIPAA compliance, and NPI.  Eligibility and payer errors are returned in real-time in an electronic format for our revenue cycle management team to analyze and work.

Once claims are paid through RealMed, the claims are then sent to our Receipt Posters to once again be audited against the contracted fee schedule and posted to the applicable account.

The QMACS revenue cycle management team is constantly following up on all unpaid claims, screening self pay patients for Medicaid eligibility, following up on $0 paid claims, submitting appeals for medical necessity, bundling rejections, and processing refunds and mail correspondence from insurance companies and patients.

QMACS maintains more than 70 incredibly valuable employees on staff.  50 of these employees work the back end of claims and also perform the necessary work on the front end to insure that claims reach the insurance carriers for prompt payment on the initial submission.  It’s the diligent work of these professionals that in turn result in the City being paid quicker than it would realize by doing business with other billing companies.

Through this attentive work on the front end, QMACS insures a majority of claims receive payment within the first 30 days. All remaining claims receive the necessary consideration in the form of insurance and patient follow-up, appeals, and resubmission in an effort to maximize reimbursement amount and speed.

QMACS Advantages:

  • CPC Certified Coders
  • Organized Functionality
  • 24 Hour Posting
  • Electronic Submission

CASE STUDIES

ICD-10

The US Department of Health and Human Services (HHS) has mandated the replacement of the ICD-9-CM code sets used by medical coders and billers to report health care diagnoses and procedures with ICD-10 code sets, effective Oct. 1, 2013. ICD-10 implementation will radically change the way coding is currently done and will require a significant effort to implement.

The QMACS Coding department is trained and ready for ICD-10 Implementation.

HIPPA 5010 Compliance

Beginning on January 1, 2012, a federal mandate requires health plans, clearinghouses, and providers to use new standards in electronically conducting certain health care administrative transactions at the heart of daily operations, including claims, remittance, eligibility, and claims status requests and responses. Upgrading from the current HIPAA 4010A1 transaction standards to the new 5010 standards addresses several key goals:

Increase Transaction Uniformity
Support Pay for Performance
Streamline Reimbursement Transactions

As the deadline approaches, affected health care organizations need to upgrade and test their claims management systems to accommodate 5010 and prevent operational disruptions.

Education and Training

Our key staff members attend approximately 100 coding and billing training sessions each year to ensure processing of current information.  The entire staff is updated on constantly changing government rules, regulations and payor specific guidelines.  Formal training modules have been developed for each job classification addressing specific needs for each component, and we offer a plethora of coding bulletins, manuals and newsletters for careful review of all information relative to coding and billing.

QMACS holds education and training up as one of our most valuable assets; it’s ingrained in our culture.  QMACS takes the training and ongoing education of our staff and our partners very seriously.  Your Department will realize this when they choose to partner with QMACS.  Whether we are offering Continuing Education Credits to coders or Continuing Education classes to EMS professionals, we ensure that our partners and our staff are the best in their field.

Eligibility Check

RealMed, one of the top-rated electronic national clearinghouses, allows us to verify insurance eligibility across all carriers which reduces the burden of collecting insurance information by field personnel.  Insurance information can be obtained, if needed, with only a name, date of birth, and social security number.

RealMed is equipped with an automated eligibility feature which allows for near-instantaneous, systematic checking of coverage information. All eligibility and coverage information is displayed in a consistent format, which increases operating efficiency and staff proficiency

RealMed is the all-in-one revenue cycle management solution that provides everything we need to speed up the claims submission process to payers. Our partners have experienced a dramatic reduction in errors – up to 47% in the first week, in some cases.  We’ve seen claim denials reduced by more than 60%, and days in A/R have dropped dramatically.  

Technical Expertise

Technology in recent years has become a common denominator in all of QMACS’ business lines.  Our information technology (IT) staff is led by a senior executive that has extensive experience in multiple technological disciplines, including public safety information technology and land mobile radio.  The IT group is comprised of individuals with a number of specialized skill sets including networking, server administration, desktop administration, software development, and a 24 hour a day help desk that supports our operations and the operations of our clients.

Security

QMACS maintains strong controls over the vast amount of confidential data that we deal with on a daily basis and retain during the course of our business.  Our security controls include both physical and electronic measures to ensure data security coupled with strong policies that encourage employees and business partners to safe guard all data that they handle on a daily basis.  

All of the data that we store and utilize in our secure computing environment is encrypted and stored in such a manner that only authorized users have access to the data they need to complete particular job functions.  This limited visibility to private and or confidential data limits the opportunity of the miss-use of data.

The physical security of QMACS data is provided by limited access to computing resources.   This physical limitation specifically prevents unauthorized access to the QMACS datacenter, provides only authorized users authority to utilize computing resources, and prevents the extraction of data to devices such as USB thumb drives.

QMACS maintains logs and tracks the use of private and confidential data so that we can proactively respond to any potential security breach.

We have adopted several companywide policies that ensure that QMACS handles data in a manner that is consistent with HIPPA, Red Flag Guidelines, Federal and State regulations.  The safeguarding of confidential data is woven into the culture of QMACS.