1. End-to-End Revenue Cycle Management

• Patient Registration & Eligibility Verification: Streamline patient intake and verify insurance eligibility in real-time. Ensure accurate patient data entry to avoid billing errors.
• Pre-Authorization & Referral Management: Handle insurance pre-authorizations and referrals to avoid claim denials.
• Claims Submission: Submit claims electronically to insurance companies for quicker processing. Handle all coding requirements (ICD-10, CPT, HCPCS) to ensure correct claim submissions.

2. Medical Coding Services

• Accurate Coding: Ensure correct ICD-10, CPT, and HCPCS coding based on documentation provided by healthcare providers.
• Up-to-Date Coding Practices: Stay updated with the latest coding changes and regulations to ensure compliance.
• Specialty-Specific Coding: Provide accurate coding services tailored to specific medical specialties like cardiology, orthopedics, or radiology.

3. Claims Follow-Up & Denial Management

• Real-Time Claims Tracking: Monitor submitted claims for timely processing and identify any issues early in the process.
• Denial Resolution: Provide detailed analysis and proactive resolution of denied claims to maximize reimbursement. Appeal denials effectively with thorough documentation and follow-up.

4. Insurance & Payer Relations

• Multi-Payer Support: Handle claims from multiple insurance providers, including private insurers, government programs (Medicare, Medicaid), and others.
• Payer Contracting & Negotiation: Assist healthcare providers in negotiating payer contracts to ensure fair reimbursement rates.
• Payer-Specific Requirements: Ensure compliance with payer-specific rules and documentation standards to prevent claim rejections.

5. Accounts Receivable (AR) Management

• AR Reporting & Tracking: Regular tracking and reporting of AR balances to provide insights into the financial health of the practice.
• Timely Payment Posting: Post payments quickly and accurately to prevent delays in revenue collection.
• Outstanding Balance Management: Manage and follow up on outstanding balances to ensure that providers are paid promptly.

6. Patient Billing & Collections

• Clear Patient Statements: Provide patients with easy-to-read billing statements and explanation of benefits (EOBs).
• Payment Plans: Offer flexible payment plans to patients who need assistance in paying their bills.
• Collection Services: Work with patients to resolve overdue balances and manage collections processes if needed.

7. Technology Integration

• EHR/EMR Integration: Integrate seamlessly with Electronic Health Records (EHR) and Electronic Medical Records (EMR) systems to streamline data flow between clinical and billing processes.
• Billing Software Integration: Utilize advanced billing platforms to improve accuracy, speed, and reporting capabilities.
• Automated Billing Solutions: Implement automation for routine billing tasks to minimize human error and increase efficiency.

8. Compliance & Regulatory Adherence

• HIPAA Compliance: Ensure full compliance with HIPAA regulations to protect patient data and maintain confidentiality.
• Regulatory Updates: Keep abreast of changes in coding, billing regulations, and payer policies to ensure compliance.
• Audit Support: Provide support for internal and external audits, ensuring that all billing practices are transparent and accurate.