- Comprehensive Payer Contracting Service for Reimbursement
- Provider Credentialing & Enrollment Services with
- Validated Demographic & Charge Entry Services
- Claims Management & EDI Structuring for Clean Claim
- Increased Collections Through Process Reporting for All Revenue
- Flexible, Accurate, Consistent & Timely Reporting
- Improved Regulatory Compliance
Development of standardized forms, facility systems data
integration, document scanning and report reconciliation to insure
services rendered can be billed timely in an expeditious
All coders are CPC certified and many have anesthesia specialty
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.
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
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.
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.
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.
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.
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.
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.