Whether considering switching your billing company or starting from scratch, we ensure smooth operations from the very first day. Before on boarding, we meticulously plan entire transition process to ensure that the whole team focuses on avoiding billing disruption. The rollout happens in a phase wise manner where, we identify software and administrative requirements, data transfer requirements, take decisions on old AR, manage vendor coordination and interface setups. We also work with the practice staff for tracking schedules to determine missed visits, fulfilling complete clinical information to get paid, conducting varied analysis, setting payment plans for patients, administrative policies and so on.

Specialty focus is fundamental to how we approach revenue cycle management. We bring several years of clinical and administrative expertise to the seemingly straightforward task of billing for all specialties. We develop and refer to coding guides such as Local Coverage Determination (LCD) and National Correct Coding Initiative (NCCI) across all specialties we work with for accurate claims submission. Our clients encountered zero ICD-10 related denials. We constantly observe your denial trends and keep a close eye on industry updates to ensure billing is clean and up-to-date.

Major carriers (including some of those in Insurance Exchanges), patients are not entitled for out of network benefits. This translates to loss of revenues even after rendering quality services. We avert this problem by proactively pursuing benefits verification for all the patients. As a process, we complete patient benefits verification for all scheduled patients two days prior to the date of service. Some information we gather include, type of plan, coordination of benefits, copays and deductible, covered services and out-of-pocket information.

We understand that the time and resources invested in persuading an insurance company to cover a medication or procedure is an expensive and annoying process. It often causes distraction from providing quality care for your patients. We undertake the task in-house for you. We complete procedure authorizations for all patients and report the authorization details to you five days prior to the date of service.

We benchmark ourselves at submitting claims within 48 hours from the date of service. This accounts for a consistent revenue cycle and a regular cash flow. 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.

We help you receive payments quickly and electronically by establishing electronic gateways with insurances. We constantly work and coordinate with clearing houses and carriers to set up Electronic Remittance Advice (ERA) and Electronic Fund Transfer (EFT) utilities with all possible carriers. Setting this infrastructure ensures quick payment reconciliation and accurate revenue projection. Our team checks payment gateways everyday and reconcile electronic payments as soon as they are received and balances are matched on the same day. Manual payments are posted in batches as and when received. Pending patient balances are applied and adjusted regularly to avoid accumulation of unapplied payments. Apart for these, we also update and assist practices on payment recoupment and reversals.

With each additional day from the date of service, it becomes more difficult to get reimbursed. As crucial as it may sound, some practices typically decide on day/s of the week to work on denials. By this time 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.

It is crucial for practices to keep a track of denials. We follow daily denial management process to ensure claims reconciliation 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 AR days and increases collections.

When you sign up with us, you get more than just our billing expertise. We work in unison with you and your team to get quality outcomes for your business. Any issue you encounter, whether billing or technical, we are readily available to help you serve better.