Complete or Partial Revenue Cycle Outsourcing

• Patient Registration – we review patient demographic and insurance information to assure all necessary information is complete and validate it directly with payers
• Benefit & Insurance Verification – our support team confirms patient has active insurance, the exact product and patient financial liability.
• Pre-certification/ pre-authorization – we validate that carriers have certified required care before it is performed; assurance that the correct pre-certification/authorization numbers are present for billing so that payment will be received timely.
• Coding- our certified coders (CPC-H done by AAPC or CCS done by AHIMA) utilize the documented clinical information for the service codes. Coding includes both outpatient (APC) and inpatient(DRG) coding and can include both first time coding as well as auditing of codes already assigned by other coders, clinicians or professional staff.
• Charge Entry – we provide manual charge entry as well as validation of information into billing system of all patient demographics, insurance information, codes, locations, and other relevant data.
• EDI Claim Submission – our global teams help with enrollment, creation, submission and reconciliation of claims, working & tracking of rejections for clean resubmission
• ERA Payment Posting – this includes downloading, importing, posting and reconciling electronic payments; identification of enrollment opportunities
• Paper payment posting – we support manual posting of payments and denials from paper eobs, batching and reconciliation
• Correspondence – our team navigates through all provider correspondence, updating system and taking appropriate action
• Underpayment analysis – given access to payer contract information, the team can validate payments are accurate per contract and flag those that are paid inappropriately for further follow-up and additional payment as required.
• Insurance Accounts Receivable Follow-up – we confirm the status of submitted yet unpaid claims with all types of government, commercial and private insurance carriers. Our proprietary system assigns and prioritizes accounts to expedite and increase payment.
• Patient Accounts Receivable Follow-up – AR follow-up of all outstanding patient balances, implementation of budget plans, and generation of collection files as appropriate. This may include both outbound and inbound calls.
• Denial Management – our team provides systemic analysis of denials to both resolve them in a timely manner for quicker payment as well as for root cause analysis and reporting to help correct the problem. This ensures the denial from re-occurring.
• Refund and Credit Balance Management – we support reviewing and working credit balances and processing of refund requests as appropriate.