Revenue Cycle Management
New Patient Intake: Safeguarding PHI is equally important as perfecting the in-take process. Verification and pre-authorization of the patient’s insurance coverage is just one part of the process. Integrating and providing this data with the proper highlighted sections to the right caregivers, in and outside the system, is critical. We can help you securely streamline the process by analyzing your workflow to eliminate duplication, push the data where required and securely transmit this information to recipients outside the network.
Reminder Calls: “No shows” are not just an annoyance; they disrupt the entire process aside from lost revenue and rescheduling costs. We can help you decide if reminder automation is the right solution for your practice or streamline the current workflow. In either case, let us help you bring down your “no show” rates.
Electronic Data Interchange (EDI): Electronic data interchange goes beyond email; it is a structured method to transmit and exchange data, governed by standards designed for medical claims. Exchanging data in the medical and dental industries is complicated. EDI implementations save time and save money because the standards in place shepherd the process. The submission of supporting documents with an initial electronic claims submission helps providers and payors by reducing denials, rework requests, and an increase in ROI. We can review your EDI process or help you design a new EDI process, if required, to move away from paper wherever possible. Our process includes setting up a user and database on the EDI (Clearing House) website, testing and training with sample batches to ensure that the 837 and 835 EFT files are processed correctly and integrating the EDI with the billing system for ‘one touch’ transmission of claim batches amongst other processes and benefits to increase cash flow.
Insurance Eligibility Verification: Checking for insurance eligibility is common practice. Depending on the number of verifications, a practice must decide on the most effective provider to reduce the denial of reimbursement, which stems with inadequate or incorrect coverage information. The estimated cost per verification is $3 and $4. There are significant developments in technology, which drop the cost dramatically by moving away from the old X12 EDI interface. We can process verifications or help you determine what is best for your business. Whatever you save goes straight to your bottom line.
Charge Entry: The charge entry process is the point where your claim begins and it is critical to reducing errors in billing. The charges entered will determine the reimbursements for physician’s services. Our experienced team helps minimize charge entry errors that may lead to denial of claims or sanctions for “up coding.” Good coordination between the coding and the charge entry team will ensure maximum reimbursement while avoiding denials.
Valid 835: Both paper and electronic payments can be provided in Medicare compliant 835 EFT files. Using this standard data file eliminates hours of manual data entry during the posting process and improves cash flow by reducing wait time. If payments are in paper form, we can convert paper records into a valid 835 file. The value is fast reconciliation and better cash management.
Coding Review: One of the primary reasons for claim denials is medical coding errors. To prevent these errors, our team of AAPC (American Academy of Professional Coders) certified medical coders ensure the highest level of accuracy in medical coding. By exceeding industry standards and compliances without compromising on quality, we guarantee accurate coding.
EOB & ERA/Manual Posting, Reconciliation: We provide a turnkey service from posting to reconciliation. This process requires attention to detail and experience. Our process of posting payments from payors or patients in the medical billing system includes claim reconciliation. We post electronic payments to your practice management software and manually enter exceptions (fallouts) to ensure there are no missing payments. Posted ERAs are stored in either the practice management system or a Document Management system (DMS) for future reference. Timely accounting is another way to ensure practice efficiency and results in reducing waste, fraud, and abuse.
• Insurance AR Follow-up, Denials, Appeals: The goal is to follow up between 25 – 45 days from date of entry to ensure quick and efficient processing of claims.
• Aging AR evaluation, Re-filing, Completion: Our team works alongside your practice to analyze the accounts receivable and drive strategies to reduce bad debts and maximize collections.
• Collections: To assist in collections while maintaining goodwill in the community, we can provide your practice with experienced customer service teams who ensure collection agencies are the last resort.
Physician Credentialing: The process of credentialing to establish contracts between providers and health plans is not streamlined and often redundant. While payors are moving to electronic systems, many practices still manage this information manually or use databases, which do not readily communicate with other systems. A typical manual process requires submission of 18 forms requiring three hours of a physician’s time and an additional 20 hours of support staff. Unless you will move to a cash-only medical practice and forego privileges at hospitals and other facilities, there is no other choice. To reduce the overall effort, start early, develop a process, recognize key success factors, and determine interim steps. The next best alternative to managing the process is to call us to manage this process for you. It will free up your time and supporting staff and there is no disruption to the practice. Billing under a different physicians’ identification is not a good option either. Get started today by calling us.
Release of Patient Records: To ensure the release of records complies with HIPAA guidelines, we have a solution, which eliminates embarrassing breaches when sending records via fax, mail, or standard e-mail. It verifies patient authorization, manages billable fees, and ensures complete HIPAA compliance including a transaction log. Reducing administrative work frees you and your staff to focus on your practice.
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