Red Lake IHS Hospital

Business Office

The business office processes the billing and receipts of all claims to Medicaid, Medicare and Private Insurance. The business office has six (6) sections within the department. These sections include:
      • Registration
      • Coding, data entry & error resolution
      • Third party billing
      • Patient benefits
      • Accounts receivable
      • Admissions

Registration

We interview our patients to identify and obtain specific patient eligibility and demographic information, such as name, date of birth, address, next of kin and tribal enrollment in a Federally Recognized Tribe. Based on information we receive from the patient during the interview and other research, we also determine their eligibility for Contract Health Service or direct care only. We record all this information in the Registration package of the RPMS.

We also identify if our patients have any alternate resource, such as Medicare, Medicaid, Social Security, Veterans Benefits or private insurance. If our patient has an alternate resource we record this information and follow up with the insurer to ensure accuracy of the insurance information and eligibility. Accurate insurance information plays a vital role when referring patients for services outside our facility, and for billing purposes for outpatient and inpatient visits. If our patient does not have an alternate resource, we refer the patient to one of our Benefit Coordinators located in the facility.



Accounts Receivable

Accounts receivable handles all incoming checks by utilizing the IHS Accounts Receivable package. The checks are batched and sent to Aberdeen Area Office for further processing and depositing of the checks. Several of our payers utilize electronic funds transfer, which are electronic payments so we don’t have to deal with paper checks. Once the checks are batched, the patient accounts can be posted.

Accounts receivable also acts as our voucher examiner; verifies and monitors unpaid claims reports; Does follow-up and research on the claims and with insurance companies.



Coding, Data Entry and Error Resolution

The purpose of this section is to correctly and completely code the patient visits prior to entering them in to our database or if they are electronic health record visits, that they are analyzed and released in the coding queue.

The coders work closely with all providers to ensure that the codes are appropriately assigned.

Third Party Billing

IHS is authorized to bill private and public insurance.  This includes Medical Assistance, Medicare, all commercial insurance and auto insurance.

IHS has negotiated rates we bill Medicare and Medicaid. There are daily visit rates that we bill for services provided to patients.

Patient Benefits

The function of the Patient Benefits Coordinator is to assist patients with obtaining an alternate resource, provide assistance with completing applications and advocates for patients at various agencies, such as County Welfare and Social Security.

Admissions

The registration clerks do the necessary paperwork for admissions and update the patient registration data.