Our financial processes are
designed to improve billing workflow, account for all anesthesia
service's revenue, benchmark against financial projections, reduce
AR and avoid compliance risks. The results for practices are higher
revenues and a greater opportunity to focus on quality and patient
care. Our billing professionals segment their operations into the
- Clinical Records Management: Development of
standardized forms management, Hospital systems data integration,
document scanning and report reconciliation to ensure services
rendered can be billed timely.
- Accurate Coding: All coders are CPC certified
and many have anesthesia specialty certification as
- Charge Capture: Charge verification occurs by
comparing the daily facility schedule to the patient charts. Case
reports are reconciled to ensure every charge is captured through
an exception reporting system. Any identified deficiencies are
resolved with the onsite staff.
- Eligibility Verification: Through the use of
automated eligibility databases of all of the major payors, we are
able to validate insurance demographics from our partner
institutions, manage exceptions and appropriately update patient
insurance plan information to proactively minimize denials. We also
use 3rd party proprietary systems to identify uninsured patients
that could have coverage.
- Claims Management: Our claims management
processes give feedback on claims status within minutes instead of
hours or days. Our practice management solution is designed to
ensure billing accuracy and minimization of denials through a
series of controls integrated with clearinghouse
- Payment Posting: Our goal is to maximize the
volume of ERAs and EFTs to improve cash flow and posting accuracy
with greater speed. Our team members are trained to identify paper
EOB variances and electronic exceptions so that they can be
reviewed and directly addressed by specialized
- Payor Contract Negotiations: We take
responsibility for payor contract negotiations to maximize
collections. Our regional footprint, coupled with our skilled
negotiators provides our customers with optimal reimbursement
- Reimbursement Tracking: We employ the use of a
contract / payments reconciliation system to ensure we receive
correct insurance payments & can appeal claims electronically.
This is an industry-leading solution which is not only integrated
with our clearinghouse for claims reconciliation but also has
embedded over 20,000 nationwide payor rules.
- Denial Management: By using a combination of
our reimbursement management system, clearinghouse tools and
customized posting reports, payor denials and zero payments are
placed into electronic work-flow queues. Trained insurance
representatives take aggressive and appropriate follow-up actions
to recover denied claim revenue thus minimizing AR.
- Audit Compliance: Internal compliance leaders
perform quarterly audits on our demographics, coding and charge
entry teams to ensure that we meet the highest level of program
integrity. We use these audits for both internal and external
efforts to align clinical documentation processes with revenue
cycle best practices for continual improvements.
- Reporting: We strive to offer our customers a
comprehensive customizable reporting and information toolset,
providing them detailed insight into their practice's financial
data. Additionally, we offer monthly reporting in a customized
format based upon each customer's particular requirements.
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