The following represents our services line, which can include one, or many of the services listed below. If there is another aspect of your practice that we can satisfy, either through a service line addition, or a relationship with a valued professional services provider, we will work on trying to help find a solution.
Our Revenue Cycle Management services are comprehensive and dynamic, focusing on the unique requirements of each client partner. We are agnostic to the IT Infrastructure you have (our system or yours), and agnostic to provider Specialty. We work closely with you and your team to ensure we are completely aligned, with an open line of communication (HIPAA secured communication), ensuring we are enhancing workflows to produce clean claims, resulting in strong cash flow, multiple revenue streams, and mitigating aged receivables.
Our experienced engagement representatives are dedicated to the pursuit of your clean workflows, and understand how to bill. Certified coding, RVU structure, CCI Bundling/unbundling, modifiers, HCPCS, and all other tricks of the trade are included in this value proposition. The goal is strong cash flow, mitigating receivables, and each payer has different requirements that we must remain aware of. We follow trends related to coding and will work with our providers to ensure they understand how to maximize reimbursement for procedures.
Appealing denials is concentrated responsibility of our team of engagement representatives. Since we are commission based, we have a stake in the game as well, and we fight for every opportunity to reverse the disposition of a denial. We utilize a suite of resources to assure we understand how to most effectively appeal denials.
Payers, depending on region, never reimburse at the same rate, and never adjudicate claims at the same pace. Understanding payment cycles by insurance allows for effective methodologies to be followed to aggressively ensure your reimbursements are maximized. Our goal is 50% of entire insurance aged accounts receivable is current (0 – 31 days). If your aged accounts receivable has a current status of 50%, then your revenue streams are strong, and revenue forecasting will be realistic.
Consequently, our goal is to have only 20% of the entire aged accounts receivable be 120 days or older. After 120 days, we will know the disposition of the claim, and if/when it will be paid. Even Medicaid claims should be followed up on, and appeals on disputed adjudicated claims should have results. Accounts Receivables that even monitor claims beyond 121+ are irrelevant. This is your revenue, and it should be aggressively pursued.
Patient Accounts receivable is important as well. Our billing cycles run weekly or monthly depending on volume. We offer every patient a unique link that allows them to make payment to their account via the internet through a secure portal. After 3 attempts of patient statements, we will compile a list for your disposition. At that point, we adjust to bad debt, or batch and send to collections (yours or ours). All Bad Debt is reported back, and we have portal access available to your staff at all times, so they can check patient balances for POS collection opportunities.
Communication, like any relationship, is the key to any alignment effort. We encourage a strong communication structure with you and your staff. We need to ensure that we are precise with our requests, and responsive to all inquiries (office, patient, attorney, insurance).
Patient relationships are instrumental in the growth and development of any practice. The patient experience extends beyond the quality of care received from their provider, and includes all complementing facets including billing.
Our Pre Collections service is in collaboration with an attorney in an attempt to make a final attempt at collecting a patient balance, prior to releasing the account to a Collection Agency. This is a letter, with dunning language, informing them that their account is being considered for Collections, and we are offering a last opportunity to satisfy the debt.
Provider network participation with payers consistent with a practice’s desired payer mix is one of the fundamental goals in establishing pristine workflows. Specialists aligning their payer mix with their referral base, Primary Care aligning their payer mix with the Hospital and the Community demonstrates a responsible effort to ensure the patient experience is valued. We work with our Accounts Receivable teams in helping to find deficiencies in claims adjudication, and work with payers to ensure the roster of providers for your practice are participating and in good standing.
As insurances change, products are added, PHO contracts held, or internal Departments attain Delegated Status, the goal is still to make sure providers are in-network with the plans/products their patients have.
Portal subscriptions can be maintained, and attested, by us, to ensure profiles are current, and deficiencies are eliminated. Regardless if the profile is for new enrollment, or recredentialing, we hold the information required to ensure participation standards are met, and local/area reps are notified of loading for group or individual payer contracts.
Payer mix is discussed with all new client partners, and strategies will be structured to compliment billing and collections. Payer mix is discussed ad hoc as well, if claims are being adjudicated stating providers are not participating, then we collectively need to act.
Accounts Receivable review. Investigate payer mix, research provider participation, look for bottlenecks with claims delivery, and how claims are being reconciled. Determining where challenges are with inflated aging with regards to insurance, and even patient, receivables.
Strategies relative to tax opportunities
Building a financial path for Junior Partners/Partners
Practice Valuation (Buying or Selling)
We will work with you to understand the need, and will propose the appropriate services line, or service professional if we are unable to satisfy the need internally.