• Comprehensive Payer Contracting Service for Reimbursement Improvement
  • Provider Credentialing & Enrollment Services with Tracking
  • Validated Demographic & Charge Entry Services
  • Claims Management & EDI Structuring for Clean Claim Throughput
  • Increased Collections Through Process Reporting for All Revenue Cycle Functions
  • Flexible, Accurate, Consistent & Timely Reporting (FACT)
  • Improved Regulatory Compliance

Clinical Records Management

Development of standardized forms, facility systems data integration, document scanning and report reconciliation to insure services rendered can be billed timely in an expeditious manner.

Accurate Coding

All coders are CPC certified and many have anesthesia specialty certification.

Charge Capture

We verify that all procedures rendered and received are billed by comparing daily facility schedules to demographics and charts via several transport methods. We reconcile case reports to ensure accuracy through exception reporting and deficiencies coordination with staffs onsite throughout each monthly closing cycle.

Eligibility Verification

Through the use of automated eligibility databases of all of the major payers, we are able to validate insurance demographics from our partner institutions, manage exceptions and correct patient insurance plans prior to submission. We also use 3rd party proprietary systems to identify uninsured patients that could have coverage.

Claims Management

Our processes give feedback on claims status within minutes instead days. Our practice management application is maintained with attention to billing accuracy and minimization of denials through a series of controls aligned with clearinghouse functions and payer companion guide edits.

Payment Posting

Our goal is to maximize the volume of electronic remittance advice and EFTs to improve cash flow and posting accuracy with greater speed. Staffs are trained to identify paper EOB variances and electronic exceptions so that they can be reviewed by specialized staffs. We have implemented a medical banking solution to improve posting accuracy and expedite denial management through a special rules based platform.

Reimbursement Tracking

We employ the use of a contract / payments reconciliation system to insure we receive correct insurance payments & can appeal claims electronically with attachments as necessary. This system is best in industry KLAS and is tied directly to our clearinghouse medical banking platforms.

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 prioritized form ROI and turnaround efficiency. Trained insurance representatives take follow-up actions to recover denied claim revenue with minimized receivable aging.

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 client's a comprehensive customizable reporting and information tools that allows them to view their practice's financial data on their own time. Additionally, we offer a monthly reporting in a customized format based on that particular visibility or metrics requirements.