Revenue Cycle Management

Contract Negotiations

Compare the reimbursement rates offered by insurance agencies with the existing market rates and norms.

Periodically review the contracts at regular intervals, in line with the current situation.

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 until approval.

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.

Complete the necessary applications, perform EDI setups and interact with clearinghouse and payers until a 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

Handle 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 Follow-up

Handle patient calls with questions about their statements, making courtesy follow up on their outstanding balance.

Follow-up calls with patients via a dedicated phone line.

Patient Notification

Notify patients on no coverage or out of network provider which could result in Self-pay and reduce denials.

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.

Dental Coding

Our certified coders can handle coding for all the areas of Dental treatment from Endodontics thru Prosthodontics and Dentofacial Orthopedics.

Our Coders are trained in meeting ADA Standards for Dental coding compliance.

Risk Adjustment Coding

Retrospective coding for Medicare, Commercial/HIX and Medicaid using models: CMS-HCC, HHS-HCC, and State Specific Medicaid.

Assure the highest standards of coding quality, with quality checks occurring throughout the process.

Code Review

We have a perfect understanding of the requirements and regulations imposed by different payers to file & transmit claims.

With our updated knowledge, we observe and recommend Coding changes that will get you the reimbursements without any denials.

Clinical Documentation

Review of clinical documentation to ensure the level of service rendered and provide physician education to improve documentation.

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 Management

Each claim is meticulously tracked reviewed and followed up by our experienced A/R staff until the payment is received.

Committed to helping you increase net revenue and reduce the AR cycle while providing a high level of satisfaction.

Denial Management

Best practices for reducing the denials and putting strategies to increase the percentage claims getting paid promptly the first time.

An effective appeals process for improperly denied claims.

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.