Outsourced Medical Billing Services

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Outsource your revenue cycle management headaches at 3% of collections

Provider Enrollment and Credentialing

Many denials can be attributed upstream to provider credentialing and enrollment. We maintain a credentialing matrix to stay abreast of the credentialing status for each payer, plan, provider. This ensures reduced denials.

We leverage a few of our technology solutions to help achieve the same and can help you with 855 forms, PECOS, CAQH.

Eligibility Verification & Prior Authorizations​

Not only do we verify eligibility, but we also coordinate with the scheduling team to ensure that all “appointments at risk” of billing issues are rescheduled on time.

We ensure all patient insurances are up to date obtain pre-authorization codes and PCP referrals as needed.

Patient Demographic Entry

More often than not, we find patient addresses, phone numbers are not up to date in client EMRs. We use the latest technologies to verify patient identities, update address information and ensure that patient demographics are up to date before the patient visits.

CPT And ICD-10 Coding

Some denials are based on CPT to ICD10 coding. We minimize those issues by using advanced software tools and pass on the savings to you. We can work with your superbills, completed visit notes or directly within your EPM as well.

Charge Entry​

With many clients, we find that their payer contracts are collecting dust in some cabinet. We review your contracts regularly and ensure that you never get underpaid. We will work with your fee schedules and ensure that they are as per state/provider contracts.Our team ensures that our clean claims rate remains at the highest levels.

Claims Submission

Most, if not all, claims are submitted electronically. If absolutely necessary, we can also submit paper claims. We ensure that rejections are corrected and resubmitted within 24 hours. We don’t charge you extra for this – less rejections reflects on our efficiency. We take it seriously.​

Payment Posting​

We post and reconcile ERA / EOB / Denials on a daily basis. If you are not enrolled in EFT/ERA, we ensure that your providers are EFT/ERA enrolled. This reduces the time wasted on paper checks and payments.We can work using your payment management system. We also have our own system.​

Account Receivables Follow Up

With many clients, we find that their payer contracts are collecting dust in some cabinet. We review your contracts regularly and ensure that you never get underpaid. We will work with your fee schedules and ensure that they are as per state/provider contracts.Our team ensures that our clean claims rate remains at the highest levels.​

Denials

We always start with your current denials, to help your revenue cycle management processes move to the next maturity model. For denied, underpaid, pending / no responses claims – our team will call patients, payers, 3rd party facilities as needed. Then our team takes the next corrective step to ensure that the current claim is paid for.​

Patient Collections​

We use our patient bill pay portal to automate most of this. We send out automated balance reminders to patients and make it easy for patients to just click on a link and pay via check or credit cards. We collaborate with our patient contact center team to monitor aged accounts, patient responses.​

Patient collections

Our team calls as first party collectors (on your behalf). We go above and beyond to make patients happy with the outcomes. This way, the patients pay their balances. At the same time, the relationship is still maintained for future visits.

Surgery Scheduling

Our outsourced surgery scheduling services team takes care of the annoying parts – ensuring that patients schedule and go for their pre-admission tests, get their medical clearances, obtaining prior authorizations for each surgery.

We prefer to use the HFMA MAP Keys for KPIs

  • Account Resolution
  • Financial Management
  • Patient Access
  • Pre-Billing
  • Physician Financial Management

Frequently Asked Questions

How does it work?

We consider proper credentialing and contracting to be at the heart of revenue cycle management success. Of these, CAQH is one of the most important aspects to get done correctly. Once you have that piece in order, everything else flows smoothly.

Our job is to make credentialing and compliance easy. Credentialing is not rocket science but it is complex and time consuming.

We cannot automate credentialing 100% of the time. However, we can automate a large portion of it.

We use our credentialing software to reduce human errors, auto populate forms, inform our healthcare providers about their status, TODOS and ensure that no party misses a deadline.

How we can help with provider credentialing, CAQH, compliance

We can help you add new providers and also if you are a start-up practice. For existing practices, when you need to add new providers or locations to health plans, we can outsource those processes for you as well.Credentialing Services
CAQH RegistrationAs we mentioned, this labor intensive process is at the core of getting credentialing done right. Many payers now require providers to have their credentials on file with CAQH. We will maintain CAQH accounts for your providers and upload all necessary documents on a timely manner.
If a payer panel is open for your specialty, we will manage the process of contracting with providers. We do this with both commercial and government health plans.Provider Enrollment
Medicare & Medicaid Provider EnrollmentHopefully you are accepting Medicare and Medicaid patients. In 2020, there were around 62 million Medicare beneficiaries. Out of those, nearly 39% are enrolled in Medicare Advantage plans. We handle everything involved in setting up your practice providers with Medicare and Medicaid.
For most surgeons, hospital privileges are a lengthy process. It’s arduous but not difficult to do. You just have to ensure that your forms, certificates etc are in order and that you do not make mistakes nor miss deadlines. We handle this process end to end for you.Hospital Privileges
Nisos Provider credentialing, compliance, CAQH services

How we handle Provider Enrollment

When you want to work with patients that carry insurance, your provider(s) would need to be enrolled and “par” with the payers.

Do keep in mind that your provider(s) need to be “par” with each payer whose patients they accept. In addition, they need to be “par” at the location of service.

This means that if you have multiple providers and multiple locations, you need to have your providers “par” at each location where they want to service patients from a particular payer.

Provider Enrollment involves credentialing and contracting with payers. The overall structure of the process is the same, however, each payer has their own “set of rules”.

Some payers start the credentialing process with a phone call. Other payers use standard forms and require online credentialing with updated CAQH profiles.

Just having a CAQH profile updated doesn’t really solve the problem.

Your credentialing team still needs to intervene (manual process) and follow up consistently with the payers to ensure that the provider enrollment process goes smoothly, on time.

Who we accept as clients

  • 3rd party billing companies (subcontract)
  • Physicians
  • Physician Assistants or  Nurse Practitioners
  • Physical therapy, Occupational therapy, and Speech-language pathology professionals
  • Podiatrists (DPM)
  • Chiropractors (DC)
  • Optometrists
  • Audiologists
  • Behavioral Health Providers
  • Hospitals

What process does we follow for provider enrollment?

We have standardized the provider enrollment process based on our experience.

We use our healthcare CRM software to manage all provider enrollment processes.

With each new provider group or practice client, we set up the enrollment process and details once.

Thereafter, our clients can request their providers to be credentialed with any payer (if the panel is open, of course).

There is no extra work needed to get this done as we handle paperless intake.

Which payer(s) do we work with?

  • Commercial Payers
  • Medicare and Medicaid (plus revalidation)
  • Medicare DMEPOS enrollment (physician groups)
  • PECOS
  • CAQH Registration

We also help with NPI Registration (Type I – provider individual and Type II – business entities )

What does our team do for you and your providers?

  • We assign a coordinator per client. They are your advocates with payers.
  • We ensure keeping your files current.
  • We give you access to the same Credentialing system that our team uses. This way, you can monitor the status of your credentialing and retrieve information and files.  
  • We ensure that you no longer have to deal with spreadsheets or paper printouts. 
  • We complete all credentialing applications on your behalf.
  • We submit all necessary information to your chosen payer networks.
  • We maintain your CAQH profile and follow up with each payer on your behalf. This ensures that your claims do not get denied (you can use our medical billing team as well)..
  • We maintain copies of all your executed contracts. This allows you to ensure continuity of coverage with payers PLUS it helps you with underpayment audit and recovery (we can do that for you as well).

What exactly does our surgery scheduling services do for you?

  • Setting up PAT with the patient’s PCP
  • Ensuring that the patients gets to the pre-admission test/medical clearance tests as scheduled
  • Getting history and physical from the patient’s provider, pre-admission testing (PAT)
  • Setting up pre-op, surgery and post op dates for the patient with your scheduling team
  • Pre-cert and prior authorizations for the CPT and ICD that your surgeons have indicated in the surgery booking form
  • Staying in contact with the patient through out the surgery process
  • Ensuring that the patient shows up for their pre-op appointment
  • No shows and cancellations are part of the surgery scheduling process. We ensure that we follow up with the patient to reappoint them
  • COVID – special considerations for your surgery scheduling process. We get the patient their COVID dates, coordinate with the lab.
  • Getting the COVID lab results before the surgery actually occurs