18/10/2017
Medical Claims and Case Management Service Provider Focused on EXCELLENCE
FOUNDER: Denise Barnes (Community Development Practice Educo Africa 2005) Email: denisecandicebarnes007@gmail.com Mobile: 0795398869
Services Include: Billing and Claims Submission Case Management of Service Provided Credit Control – following up and collecting outstanding claims Weekly and Monthly Reporting Medical Practice Administrative staff training Reducing Debtors Days and Improving Income Flow
Fees:
3% to 10% commission will be charge for all collected claims as at last day of each month according to practices bank statement. Commission is negotiated per practice based on each practices individual needs. Upfront private patient payments excluded from monthly fees. Fees charged for private patients’ accounts will only be based on Alt-Med’s collections for these claims
Vision
To be the preferred medical claims and case management service provider for all specialities of medical practice and allied health professionals. To be the pioneering consultancy of relationship building between funders and providers of medical services. To be the preferred service provider for Medical Practice administrative staff training. Delivering outstanding customer service not only to our clients but ultimately their clients - the patients. A relentless focus on building understanding of managed care principles and the alignment of these with best clinical practice established through medical research councils and forums.
Values
Client focused Team work Performance driven Excellence Centred
Mission Statement
Alt-Med will provide a HOLISTIC claims management service to providers of healthcare: Sub-Acute Facilities, General Practitioners, Specialists and Allied Health Professionals (Social Worker, Occupational Therapists, Physio Therapist, Private Nursing Practitioners, Psychologist, etc), using case management principles. Continuous Funder Relations Management through advocating on behalf of our clients where disputes arise to ensure that patient care is not compromised by disagreements due to funding.
Objectives
Streamlined claims management Reduction in debtors and overall increase in cash flow per practice / client Above average benchmark in collection vs. debtors days Effective management of available resources and time
Work flow Strategy
Accurate collection of patients information and services rendered Registration of future medical services by means of pre-authorisations process Coding of conditions as per patient condition and Dr’s diagnosis Billing of tariffs as per services provided Registration of PMB conditions Billing and Submission of claims Credit Control: following up of claims submitted/outstanding claims Case manage - clinical information exchange: pathology/radiology reports/initial & consultation reports Continuous monitoring of age analysis per practice Statistics and reporting on age analysis per practice Data collection for interpretation of clinical guidelines and treatment protocols per practice speciality
Case Management Process
All pre-existing conditions and complications will be provided to funders through ICD10 coding, providing insight into complication of patients’ management. Any adverse response to treatment will be communicated to funders. A process of continuous communication with funders for patients who are receiving chronic (long term) medical care will be established and used to ensure streamlined payments of related claims.
Practice Staff Training Information
Alt-Med will assist practices in developing a process flow and practice specific policies and procedures that will improve patient administrative process, ultimately improving practices cash flow. Alt-Med will continuously provide valuable information from the governing bodies in private health care: Council for Medical Scheme’s, BHF and Research Council’s
Alt-Med will provide training to administrative staff of existing well established practices in the following areas:
Reception process: Accurate recording patient information, Importance of copying medical scheme card, as well as patient and members identity documents
Billing Process: ICD10 coding rules, Accurate billing of services provided, Accurate usage of billing tariffs
Credit Control Process:
Best Practice process through claims submissions diary Registering practice on funder websites and utilising same to follow claims processing by funders Daily telephonic and email following up of claims Importance of reference numbers, time and person spoken to Using Case management process to ensure full payment of claims from funders Informing members of any short or non-payment of claims and members role in ensuring funders pay claims in full.
Providing Empowerment information to members of Medical Scheme’s
Access to PMB legislation Access to International Clinical Guidelines through links shared on website
