Revenue Cycle Management

Credentialing Services

Create and Manage CAQH profile with periodic review and attestations. Reporting expires, re-credentialing dates, licenses & DEA.

We assign you a dedicated credentialing specialist who will work on your behalf to handle all the communication.

Provider Enrollment

Complete all necessary credentialing requirements for the preferred payers and plans and follow through completion.

Review the contract, reimbursement rates, responsibilities of participation and ensure the provider understands the terms prior to the agreement.

EDI Enrollment

Evaluate the EDI enrollment needs, coordinate with the clearing house and the payers to facilitate the process.

Fill up the necessary applications on your behalf, perform EDI setups and interact with clearing house and payers through successful transmission.

ERA/EFT Enrollment

Identify the ERA/EFT enrollement requirements, verifies current provider ERA/EFT setup and co-ordinate with the provider for recommended changes.

Fill up the necessary applications on your behalf, interact with payers through successful ERA transmission and bank deposits.

Consulting Services

Analyzes all the disciplines of revenue cycle to identify potholes, root causes and recommend the best practices to fix issues, streamline process and maximize revenue.

Recommendation and implementation of new billing systems after a complete study of the current business set up and requirement.

Appointment Scheduling

Centralized appointment scheduling to handle scheduling, rescheduling and canceling appointments to reduce no-show rates.

Understand the billing requirements and manage appointments accordingly to reduce denials and unpaid claims.

Patient Registration

Registration of new patient with accurate and complete patient demographic and insurance details, etc.

Follow up with the patient on obtaining the accurate information and notify patients on COB requirements.

Eligibility & Benefits

Verify coverage on all primary and secondary using WebMD, payer websites and phone calls to payers.

Gather information on deductibles, co-pays, out-of-pocket maximums and benefit limitations of specialties accordingly.

Referrals and Authorization

Identify requirements of Referrals and Authorization and notify the provider prior to the appointment.

Co-ordinate with the provider and initiate the request through phone calls or online forms. Follow up though approval.

Patient Notification

Notify patients on no coverage or out of network payers or plans which could result in Self-pay prior to service.

Share information on patient’s Co-pay, co-insurance rate, and remaining deductible and reduce bad debts.

Professional Coding

We can help you improve accuracy with ongoing, periodic or one-time coding assistance across all medical specialties.

We guaranteed accuracy and turnaround leading to accurate and appropriate reimbursement.

Facility Coding

Expertise across diverse chart types including inpatient, emergency departments, ambulatory care, radiology, and surgery centers.

Special expertise in complex, high-value coding such as interventional radiology and cardiac catheterization.

Coding Audit Services

Accuracy review of your current coding process, which will identify mistakes and help prevent future coding-related denials.

Coding auditing services, including coding compliance, provider documentation and reimbursement audits.

Charge Capture Analysis

Identify opportunities for process improvement in order to maintain a current, comprehensive and compliant CDM.

Charge capture review to identify and correct breakdowns in the charge capture process.

Clinical Documentation

Review of clinical documentation to support diagnosis capture and to ensure the level of service rendered to all patients is appropriately recorded.

Maximize reimbursement by improving your documentation and protect you against the risk of RAC audit liability.

Charge Capture

A higher level of accuracy and zero lost charges reduce compliance risks and improve patient satisfaction thereby.

Reducing denials, increasing revenues and prepared for an audit by CMS or the OIG.

Scrubbing & Submission

Reviewing each transaction of claim to ensure the accuracy of coding and billing methods prior to submission.

Confirm patient demographics and insurance information ahead to reduce reworks and improve faster payments.

Payment Applications

Accurate payment posting is sustained to gain clarity on outstanding AR and credit balance for Patients.

Both Insurance and patient payments are managed to track refunds, offsets and forward balance.

AR and Denial Management

Each claim is meticulously tracked reviewed and followed up with the payers, processing units or IPAs through resolution.

Identify root cause and implement best practices to fix denials, improve efficiency and reduce AR.

Insurance & Patient Follow-Up

Timely follow up on all unpaid claims, ensuring that no time is lost on pursuing every reimbursement possibility.

Courtesy follow up with patients on the outstanding balance and answer any queries on the billing statements.