Revenue Cycle Management
Eligibility Verification
Checking patients’ eligibility and benefits is a crucial part of the billing process. There should be no issues related to their benefits coverage, deductibles and co-pays. We take the effort to verify each of these factors. Our verification team will adapt with the rules set by insurance companies about verifying their clients.
Sometimes insurance authorization is a must for your patient, no matter what the other services are. We will handle that for you.
We can verify in a coherent manner if a pre-authorization is required and will in turn contact the insurance carriers to obtain one for you.
Within 24hrs of procedures or receiving demographics, we process all the information, followed by claim preparation and electronic claim submission. Our state of the art system checks claims for errors and ensures a 99.99% pass rate with the clearing house.
This process is followed 48hrs later by a claim status revalidation process, which ensures the claims are successfully submitted from the clearing house to insurance carriers and not sent back with errors.
Demographics Processing and Claim Submission
Follow-Up and Claims Management
Each claim is checked and followed up on a weekly basis by our team of specialists. We monitor the claim's status, whether payment has been issued or is in the process of being issued, or if the claim has denied, full or in partial. If the claim is pending a resolution, we address the problem in real time, and ensure the claim is send back for reprocessing the same day. This method has proven to increase revenue while minimizing claim processing time.
Payment Posting
Our team will process all paper EOB’s, and ERA’s, on a daily basis, and update the Practice Management system. Paper denials of partial payments will be reprocessed within 24hrs. Posted payments and copies of all records will be made available for a period up to 7 years, and provided upon request.
We love to provide reports. From simple Patient Account reports, to Payer Mix Analysis, we provide it all. But what we love the most is to dive deep and analyze what’s driving your business. We look at factors like Referring Providers and their volume, their Payer Mix you’re being referred, the type of procedures and what’s paying the most, their deductibles, average collections per case, etc.
We believe information is out there. It is our job and responsibility to find it, analyze and interpret it, and inform you about these driving factors, so that you can make the right decisions for your business.
Reporting and Business Analytics
