Experience end to end revenue cycle management and software solutions for your specialty group.
“Our office has been very satisfied with the quality of service and constant feedback regarding credentialing, contracting and claim submission.”
- NEUROLOGY GROUP, NEW MEXICO
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.
ELIGIBILITY AND BENEFITS VERIFICATION
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.
QUALITY AND CLAIMS SUBMISSIONS
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.
DAILY DENIAL MANAGEMENT
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.
YOUR EXTENDED TEAM
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.
ENKI OFFICE SOFTWARE
A certified clinical and administrative platform for managing your medical specialty.
Certified cloud EHR
Go outdoors with your EHR
enki is a cloud based certified Meaningful Use compliant EHR. Being a web-based EHR, enki can be accessed anywhere via the web and iPad. Interoperability (or the ability to speak with other systems) is inbuilt. Use your iPad to document charts in front of patients, complete them on the web from home. Comply with Meaningful Use and track your progress on the move. Whether you are in office, hospitals, or on the road enki EHR gives you the access that your patients would like to have.
Suggestion based ICD-10/SNOMED codes
Coding in enki EHR is automated and accurate. Enter a part of a condition or problem and clinically pertinent suggestions are automatically populated with the correct ICD-10 codes. The selected codes automatically become a part of the medical records saving you time while ensuring compliance.
All the medical records in one place
Quickly upload and tag your patient charts on a secure cloud. Old charts, faxes, lab reports – upload them easily in enki EHR. This saves the hassles of searching through piles of paper for finding patient records. With enki EHR’s upload charts module, all the patient related documents are exactly where they should be – in your patient accounts. Record once saved gets linked with the patient account enabling the practice to go completely paperless.
Same EHR, different styles
enki EHR is built from ground up for simplicity and can be customized within minutes. You can design enki EHR to mimic your current paper records to suit your style of work. Presets of inbuilt functional modules can be dragged, dropped or moved around. You can also create custom pages and tabs to segregate modules as per relevance to you.
Certified eRx module
Connect with over 95% of pharmacies nationwide. enki EHR is Surescripts certified enabling you to send and receive prescriptions electronically. You can approve refills, change prescriptions or prescribe a different course of medications. You can also review and select the dosages, check for basic information of the drug all at once. The drug database in enki EHR is updated every day with industry approved drugs and dosages. Drug to drug and drug to allergy notifications are displayed real-time putting patients at the centre of care.
The smart medication module
enki EHR’s medication menu gives you options to add medications for your patients the way you like. You can enter multiple medications with relevant dosages using the quick list, or save medication orders or e-prescribe medications. On typical days with tight schedules enki EHR’s quick medication list lets you add all the patient medications quickly and real time. You can also save prescriptions as medication orders for later review or for our records. It’s easy, fast and useful.
Send and receive lab orders
enki EHR interfaces with all major labs nationwide. If your lab is not listed, our interface team can begin the process for you. Once connected to your lab, you can place orders and receive results directly into enki EHR using bidirectional lab connection. Map the results into the patient record to track patient health over time. The results are also instantly shared with the patient via the patient portal, thereby, helping patients be a part of their care delivery process.
Dashboards to calculate compliance every minute
If you have the urge to check your compliance regularly, you can, without running additional reports. Meaningful use and clinical quality dashboards automatically compute your compliance scores helping you seamlessly navigate the Meaningful Use program. enki EHR’s dashboards lets you do what you do best- practice medicine. Check how are you doing on your Meaningful use standards and do better. The dashboards dynamically track your compliance to the minute. It’s handy, it’s simple and it’s effective.
Monitor every change
The audit log in enki EHR is a list of historical data showing all the changes that were made into the system. Module level checker tracks when a change was made, on which patient and by whom – and it’s accurate to the millisecond.
Share medical records via multiple channels
Interoperability in the enki EHR is inbuilt. We believe the quality of patient care is much higher when there is a seamless flow of data between care givers. That’s what we have incorporated multiple modes of secure data sharing within enki EHR. The system lets you share your charts in the simplest way possible. Email, fax or patient portal, share your records with a few clicks.
Create specialty specific templates in minutes
enki EHR offers you the flexibility to document charts the way you like. You can fully create custom templates as relevant to you, so you can cart faster and yet ensure a through chart note. Template once created is automatically available on the iPad, so you can go around your day freely.
REVENUE CYCLE MANAGEMENT
There are just too many aspects involved in running a profitable business. From resource and expenditure management in large hospitals, to streamlining operations in surgery centers, to ensuring timely reimbursements for solo specialists, we bring our hands on experience in revenue cycle management to all healthcare settings to improve performance and reduce reimbursement turnaround time.
From evaluating EHR setup to calculating compliance percentages, we assist you across all the stages of Meaningful Use program to help you stay compliant. In case you are audited, we can help you navigate through the audit and demonstrate compliance by coordinating with vendors, gathering documentation and appealing to Centers for Medicare and Medicaid Services (CMS) if required.
Our vast experience working with different healthcare settings has enabled us to understand the specific regional and national quality requirements. We can help you setup periodic reporting standards for regional or national requirements such as PQRS and ASCQR quality reporting. We can also do this on your behalf.
NEGOTIATIONS AND AGREEMENTS
Whether it’s working with vendors to get better pricing on supplies or drug companies for competitive drug rates or with insurance companies on contract negotiations, we will work with you get you the best possible deal.
One client wanted us to replicate an entire patient demographics list from one practice management system to another. Another wanted an interoperability bridge between a practice management system and an electronic health records system. Yet another wanted an interface between a lab and hospital systems. Whether starting up or need enhancements, we can review and help you streamline your IT and software infrastructure and avoid bringing on a full-time IT person. Our deep understanding of functional and technical expertise allows us to be a unique bridge between the two.
We work with healthcare practices of all sizes towards developing quality protocols and undertake internal audits. If your practice is audited, we can help you through the audit process and meeting regulatory requirements. If you want to identify process gaps, we can conduct quality drills to help you get a complete picture of your business.
To help physicians and staff get a better understanding of ICD-10, we have designed a highly specific ICD-10 training program. The course helped our clients seamlessly transition to ICD-10 and encounter zero ICD-10 coding related denials. The curriculum constitutes introduction to ICD-10, anatomy of an ICD-10 code, specialty specific coding, coding scenarios and ICD-10 coding and billing support.
Specialty Groups Case Studies
The anesthesiologists continue to enjoy what they love. The administrator does not worry about the challenges of operations because of various systemic constraints. We customized the billing process by circumventing the constraints and maintain outstanding results such as weekly zeroing out of claims and keep A/R 90+ days at 5-7%, much below industry averages.MORE
Navigating the business of medicine can sometimes be tricky for doctors – from dealing with difficult vendors to operational issues to technology challenges, as was the experience with this client. What NextServices does is shoulder these responsibilities for doctors so that they can get back to practicing medicine.MORE