Complete or Partial Revenue Cycle Outsourcing

• Appointment Scheduling and Patient Reminders – we provide this critical service across specialties, and can customize based on needs of the group, while providing special instructions to patients prior to service
• Benefit & Insurance Verification – this service confirms patient has active insurance, the exact product, determines the co-payment (primary & specialist) and co-insurance amounts, number of visits covered for certain specialties (e.g. physical therapy)
• Coding- our certified coders (AAPC) utilize the documented information from the clinical visitor service codes. Coding includes both CPT and ICD-9 coding and can include both first time coding as well as auditing of codes already assigned by other coders, clinicians or professional staff. We bring coding proficiency with E&M and procedure codes with appropriate use of modifiers.
• Claims scrubbing – our support teams edit claims as required, in conjunction with client to assure clean claims are billed timely, identifying issues to aid in better use of the scrubber as relevant
• EDI Claim Submission – we help with enrollment, creation, submission and reconciliation of claims, working and tracking rejections for clean resubmission
• Physician Credentialing – our team support validating group and provider numbers with carriers to ensure provider/group numbers/ NPIs are accurate to assure proper, timely payment
• 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 – where 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 – we offer 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.