Offering a flat-fee service per patient, we specialize in comprehensive Insurance Eligibility and Benefits Verification. Our team diligently verifies coverage and benefits, ensuring all details are accurately captured and reflected in your patient portal so that you are ready to serve the patients as they come in.
- +440-98-5298
- info@example.com
- 121 King Street, Melbourne
Insurance Eligibility & Benefits Verification
Medical Coding
Our experienced team of coders, proficient in multiple specialties, excels in abstracting from both paper and electronic records. Skilled in coding validation, they assign ICD, CPT, and HCC codes with precision. All our coders are thoroughly trained and/or certified, ensuring adherence to AMA and ASA guidelines. They not only identify documentation issues but also provide insights for enhanced reimbursement compliance. With extensive expertise in areas like Cardiology, Radiology, Gastroenterology, Emergency, Audiology, and Ambulance services, our coders bring a wealth of knowledge to every task.
Charge entry
When clients require manual charge entry, our skilled staff steps in to meticulously handle the process. We maintain an accuracy rate above 98% for charge entries, crucial for ensuring the correct CPT Service codes are assigned to the appropriate patient. Accuracy is key, as incorrect entries can lead to significant compliance issues, such as mismatched patient information or erroneous diagnosis or procedure records, potentially compromising the patient's health history with their insurance carrier. To minimize errors, our data entry procedures undergo rigorous multi-level audits. Our team, experienced in all aspects of the billing cycle, offers more than just data processing—they provide expertise and diligence at every step.
Claims Rejections
Submitting clean claims is essential for practices to achieve timely and first-time payments, minimize follow-up costs, and maximize reimbursements. We prioritize scrubbing claims for accuracy and making necessary corrections before transmission. Our team stays constantly updated on the latest payer billing rules and CPT changes, ensuring that every claim meets the highest standards for prompt and efficient processing
Payment posting
Accurate payment posting is crucial for effective follow-up, accurate accounts receivable management, minimizing credit liabilities, and ensuring correct balance billing to patients and secondary carriers. Our team is constantly trained on AR principles and is well-versed in various reimbursement types, including Government programs, Managed Care, Fee for Service, and both In-Network and Out-of-Network policies. Our payment posters, regardless of their experience, are trained in RCS methods for calculating allowances, deductibles, and patient responsibilities. They also receive in-depth training in handling line item denials, write-offs, and adjustments. To tailor our services, we use a client-specific questionnaire to create a decision tree for payment posters. Our process encompasses Electronic Remit, manual insurance, and patient payments posting, ensuring EFTs are balanced with electronic remits and other transactions, while also managing rejections and daily book reconciliations
Denials & Accounts Receivable Management
Insurance payers frequently update their payment rules, leading to denials that can delay or completely deny payments. We adeptly handle a variety of denials, underpayments, and instances of non-payment. We understand the critical importance of timeliness in the follow-up process and manage aging accounts accordingly. Our approach includes segmenting accounts receivable (AR) by denial and insurance types. For denials related to medical necessity, our coders conduct reviews and file written appeals when necessary. Our agents are proficient in making effective phone calls to payers, aiming for immediate resubmissions wherever possible. We are more than just a claim status team; we are driven to take decisive actions for efficient revenue recovery. Our ultimate goal is to achieve a onetouch AR process that leads to swift payment.
Credit Balance Management
We specialize in targeted clean-up projects and ongoing Credit Balance management. Our team has Credit Balance specialists, trained in the fundamental accounting principles of debits and credits, and expertise in handling various scenarios leading to credit balances. These include accounting or posting errors, miscalculations in coinsurance amounts, and duplicate payments from the same or different insurers. Our experts are also skilled in distinguishing credit liabilities from adjustments, posting corrections, or coordination of benefits (COB) scenarios. Regardless of the cause, they follow precise procedures to efficiently resolve any credit issues.
Medicare Risk Adjustment
We specialize in providing comprehensive Medicare Risk Adjustment (MRA) services. Our team ensures accurate assessment and coding of patient health statuses, essential for determining appropriate risk scores under the Medicare Advantage plan. By managing this process, we ensure you will receive fair and accurate reimbursements, reflecting the true health risk profile of their patient population. Our MRA service is designed to streamline this crucial aspect of healthcare financing, ensuring compliance and optimization of revenue for you.
Credential and Contracting
We manage the intricate processes of provider credentialing and ensure seamlesscontracting with insurance networks. This service is designed to simplify the complexities involved in establishing and maintaining provider credentials, as well as negotiating and securing advantageous contract terms with payers. By handling these essential elements, we enable healthcare providers to focus on patient care while we ensure their optimal positioning within insurance networks for maximum revenue efficiency.
Merit-based Incentive Payment Systems (MIPS)
As part of our tailored point solutions in Revenue Cycle Management (RCM) services, we offer specialized support in navigating the Merit-based Incentive Payment System (MIPS). Our expert team assists healthcare providers in understanding and fulfilling MIPS requirements, ensuring accurate tracking and reporting of performance metrics across the Quality, Cost, Improvement Activities, and Promoting Interoperability categories. By optimizing MIPS performance, we help providers enhance their Medicare reimbursement potential, align with value-based care standards, and maintain a focus on delivering highquality healthcare. Our MIPS services are designed to simplify this complex process, allowing providers to concentrate on patient care while we manage the intricacies of MIPS reporting and compliance
Practice Audit
Our Practice Audit service in Revenue Cycle Management is a thorough examination of a healthcare provider's current operations, designed to deliver a comprehensive performance report. This analysis not only uncovers areas of challenge and potential improvement but also highlights missed opportunities in revenue collection. Crucially, it offers providers a clear understanding of their operational efficiency in comparison to industry benchmarks and peer practices. This insight is invaluable, as it equips healthcare providers with the knowledge they need to optimize their processes, enhance their revenue cycle, and ultimately, elevate the standard of their patient care.
Management Reports
Our Management Reports service offers comprehensive financial insights for healthcare practices, segmented by site, provider, insurer, and care type. We perform extensive analytics, including RCM data extraction and aggregation, high-level practice summaries, and analysis against industry KPIs and best practices. Our reports cover a wide range of areas: denials, appeals, payments, performance review, coding and billing optimization, revenue leakage identification, and key metrics like DSO, Payment Ratio, and Net Collection Rate. Additionally, we provide E&M Coding Audits, MIPS Validation, Denial, Payer Mix, Facility, and Provider Analysis, alongside assessments of FFS vs CAP, adjustment data, CPT utilization, and AR Aging. These reports are vital tools for management to enhance financial health and align operations with industry standards
Recovery Audit
Our Recovery Audit service examines your billing and payment records to identify and reclaim any due but unreceived funds. This crucial process involves detecting overpayments and underpayments, ensuring compliance with healthcare regulations, analyzing denied claims, andcorrecting discrepancies. Our goal is to recoup lost revenue and provide insights to enhance future billing practices, thereby improving your financial efficiency and maintaining the integrity of your billing processes. Trust our expert team to safeguard your financial interests and optimize your revenue cycle
Managing overflow phone calls
Ensuring no call goes unanswered, we will handle all your overflow calls through our dedicated call center, operating in your time zone. Available 24x7, we provide continuous support, guaranteeing every patient and customer receives timely and professional attention.