As the grace period for ICD-10 ended in October 2016, the coding errors and payer denials are consistently on the rise, steering to serious damage in the service provider’s revenue cycle. But the irony is that the medical billing outsourcing companies are still on a standalone pricing model where the customer pays for the errors that the companies make. And this is exactly where Quintessence Business Solutions & Services’ (QBSS) coding veterans who know the nuances of all types of coding specialties and its pitfalls make a strong statement by developing & deploying technology solutions that ascertain precision in coding by combining process knowledge, business expertise and human-tech interfaced coding technology (semi-automation processes). Banking on this, QBSS offers a contingency fee model (fee linked to outcomes) to its customers which help clients align their outsourcing strategies to their customer’s business.

The Perfectionism
Dealing with denials due to criteria such as eligibility, coverage, bundling, and necessity requires a deep understanding of the payer business rules and payer’s behavior.“Our mapping of past denials to successful actions and outcomes is a game changer for

our clients,” proclaims Nirmal Kumar Rajachandran, Co-Founder & CEO, QBSS. Furthermore, even though the electronic data interchange (EDI) transaction sets were mandated a decade ago, its usage and adherence is woefully short; QBSS is driven to enable a low coverage denial business by leveraging maximum out of this.

When it comes to coding, the company’s business and technical teams have built a platform that aids coders in coding faster and at a higher accuracy rate higher than client requirements

When it comes to coding, the company’s business and technical teams have built a platform that aids coders in coding faster and at a higher accuracy rate higher than client requirements. Such a platform helps train, and ramp up faster and bring in coders to desired level of optimal performance faster by 3 weeks. This also ensures consistency across coders and hence a higher level of compliance and reimbursement.

Depending on client’s strategic & tactical needs, the company works on an entire revenue cycle or on individual processes. Recently, a multi-specialty billing company witnessed QBSS ‘walking-the-talk’ moment when their outsourced bills were reduced by 30 percent, collections increased by 4.5 percent, and most importantly 85 percent (81 percent earlier) of their collections were pulled-in within the first 60 days.

Innovation - The Way to Go
Nevertheless, QBSS is pressing its footprint further by coming up with a gamut of novel innovations. A couple of those IPs are: Claims Profiling (a solution that identifies & attacks potential errors made by coders and thus eliminates the need to have a large QA team), and an algorithm (in progress) that predicts the chances of payment and reimbursement. Going forward, QBSS is focused on skilling its employees on very specific nuances of medical billing, coding and denial management.The coders even receive approximately 10 hours of mandatory compliance training before deployment. After its inception in 2011, this strictness is lucidly visible in QBSS’ growth pattern. “We grew 40 percent in 2016-17 and will accelerate in the coming years,” confirms Nirmal. QBSS is looking forward to further mitigate staffing hassles and salary inflation by leveraging its semi-automated process.

Key Management:
Nirmal Kumar Rajachandran, Co-Founder & CEO
A MBA- Finance from Anna University, Nirmal has over 12 years of experience in Revenue Cycle Management (RCM), Coding and other technology solutions. Prior to founding QBSS, he held the role of Vice President at e4e Healthcare Business Services, and immense business expertise in the areas of outsourced healthcare business environment, trends, profitability, pricing models, and scaling.

Offices:
Chennai (headquarter)

Offerings:
Revenue Cycle Management
Coding & Auditing
Claims Processing & DRG Pricing
HCC Coding & Retro Auditing