Hospitals

Hospitals

We have helped specialist departments in some of the world’s largest hospitals improve profitability through process re-engineering, cost management and greater focus on high dollar claims. Greater profitability can give you the flexibility to invest in better patient care.

“NextServices has provided us a vehicle to stay ahead of the ever changing and challenging healthcare demands and reimbursement issues and for that we thank you.”

- ASC IN NEW YORK
ELIGIBILITY VERIFICATION

Non-coverage of services translates to loss of revenues even after rendering quality care. We avert this problem by proactively pursuing benefits verification for all scheduled patients. Some information we gather include, type of plan, coordination of benefits, copays and deductible, covered services and out-of-pocket information. This process helps you get a better sense of coverage and enables you to confidently render services.

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CLAIMS SUBMISSIONS

We benchmark ourselves at submitting claims as soon as they are received. This accounts for a consistent revenue cycle and a regular cash flow. We do this by using intelligent scripts that automatically extract CPTs and ICDs from super bills, check coding compliance, modifier usage and enter them into a Practice Management System. The otherwise monotonous task of manually entering charges is replaced by automations while ensuring greater efficiency. This saves us time and resources to do more.

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TWO TIER QUALITY CHECK

We have crunched our expertise and knowledge into executable actions in the maximum possible areas of the revenue cycle management. This includes charge entries, eligibility verifications, online claim status and quality checks. Prior to submitting claims to carriers the claims are scrubbed across a proprietary rules engine to verify accuracy and flag inconsistencies – this is the first tier of quality analysis. After scrubbing, the claims are again verified manually line by line – this is the second tier of quality analysis and it helps us achieve a first pass ratio of greater than 95% upon first submission.

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A/R MANAGEMENT

With each additional day from the date of service, it becomes more difficult to get reimbursed. Most hospitals struggle with resource crunches, technical know-how and even lack of time when it comes to regular claims submissions. By the time actual claims submissions start, some claims already enter the 60 or 90 day buckets and it gets tough to recover the balances. Depending on insurance, we follow up on claims as early as the fifteenth day from the date of service. This enables us to get accurate status on claims and gives us a head-start in resolving those denied and predict revenues for the practice.

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DAILY DENIAL MANAGEMENT

We follow daily denial management process to ensure claims reconciliation happens as quickly as possible. Our teams are cohesively tied together. Whenever a denial is encountered, it is flagged and instantly sent to the accounts receivables team for resolution. Both the teams are in constant coordination with each other until proper denial resolution is achieved. This avoids accumulation of accounts receivable, reduces A/R days and increases collections.

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PROCESS OPTIMIZATION

We work with hospitals to help them streamline their operations. Whether you need help with managing your resources or struggling with expenditure, we can assist you across all tangents. When we get started with a hospital, we review the existing workflow, right from how patients are checked in to the depth of administrative documentation at the hospital. We then identify functional gaps and provide recommendations on fixing those.

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NEGOTIATIONS AND AGREEMENTS

Whether it's working with vendors to get better pricing on supplies or drug companies for competitive drug rates or helping you manage your inventory efficiently, we will work with you to get you the best possible resources and results to help you function better.

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BILLING MANAGEMENT

Most hospitals struggle with high denials and huge backlog of claims pending to be submitted. We review claims, fee schedules, claims submission timelines, payment trends, denials, and help simplify billing management.

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TECHNOLOGY ASSISTANCE

We can help your hospital implement the best possible technology solutions. A hospital we worked with was still struggling with paper medical records and was seeking help in digitizing records, another wanted us to integrate biometric fingerprint recognition systems with their clinical and yet another, wanted us to review their existing technology infrastructure. Our vast experience with healthcare technology and our understanding of the market, helps us deliver efficient and implementable solutions.

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Hospital Case Studies

Consulting in a hospital setting

We provided several recommendations related to pre-visit and check-in, billing and drug inventory management focussing on areas covering ‣ Process understanding ‣ Inventory understanding ‣ Reimbursement trend ‣ Expense/cost analysis

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Consulting at a surgery center

‣ Collected approx. $2.2M in first 5 months
‣ Renegotiated contracts by 300%
‣ Established patient insurance eligibility and authorization process

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Changing the business of healthcare

Our purpose as an organization is to make healthcare delivery simple for all its stakeholders.

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