Outsource your revenue cycle management headaches
Starting from credentialing all the way to patient collections, we handle everything for you.
We handle it end to end
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.
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.
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.
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
We will keep following up on each patient and payment account to secure a finalized outcome. Our team ensures that our clean claims rate remains at the highest levels and we do not leave any monies as “Write offs”.
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.
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.
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.
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
- Physician Financial Management
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.
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.
Hopefully 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.
Medical billing companies
Mental & Behavioral Health providers
Eye care providers
Medicare and Medicaid
We assign a coordinator per client. They are your advocates with payers.
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 complete all credentialing applications on your behalf.
We maintain your CAQH profile and follow up with each payer on your behalf.
We maintain copies of all executed contracts.
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
We integrate our billing system with yours as needed (we use EMDEON/Change Healthcare in our system)
We get charge data from all your offices via a secure portal. We can also access your EMR system.
Our account managers communicate with you regularly via reports, calls, and keep you updated on financial performance plus issues (if any).
We monitor the primary and secondary insurance carriers, patient payments. You can route all billing related calls to us – calls from third-party payers and patients.
Our team follows up on delinquent patient accounts. These balances are handled through a 90-day series of statements. We also collect balances from patients.