Streamlining End-to-End Practice Workflow for Your Unique Needs
Healthcare revenue cycle management is a complex and multiple step process involving many stakeholders such as patient, physician, practice staff, payors, vendors and regulator. Our years of experience help us develop the most efficient end-to-end practice operations workflow customized to your needs.
1. Appointment & Scheduling
While provider staff takes the call from patients for appointment and scheduling, our team works in the background to text the patients using our partner www.ohmd.com platform for appointment reminders and pre-check-in procedure, no show reminders and well visit reminders. This helps reduction in calls for the practice staff and increased automation in appointment, scheduling and check-in.
2. Eligibility & Benefits Verification
A patient’s eligibility and benefits can change at any moment. Lack of follow up with insurance carriers prior to seeing a patient could lead to an increase in claim denials and a significant loss of revenue. Maintaining a consistent and accurate verification process is essential to maintaining a healthy revenue cycle. Our eligibility and benefit verification specialists routinely follow up with the insurance carriers to ensure that patient information is up to date and accurate at the time of the visit.
3. Prior Authorization & Referrals
Physicians must obtain advance approval before specific services are delivered to qualify for payment coverage. Referrals are commonly required from primary care doctors to see a specialists. Knowing who needs what and by when is a logistical quagmire. Free up your front desk staff to focus on patient care by letting our specialists in the field manage this process for you.
4. Patient Information & Check – In
The concept of patient Kiosks sounds great on the surface. Hand the patient a tablet and they verify their own personal information, update medical history, check insurance, and so on. This frees up your staff from having to do data entry. Unfortunately the reality is that patients are often confused and intimidated by the task, and even those that are not, are prone to data entry errors. Human intervention and oversight is still required. Eliminate the process all together by allowing our staff to take your old school clipboard, verify the data, cross reference with a scan of the insurance card and drivers license and enter the data for you.
5. Medical Coding
Tired of manually transforming those diagnosis, procedures, and medical services into billable claims on your own? We have a team of Certified Professional Coders ready to assist. Our staff stays up to date on the ever changing rules to ensure accurate medical coding enabling you to maintain a healthy, profitable practice.
6. Charge Capture
If you have a robust electronic health record you’re probably already taking advantage of templates and E&M coding tools within the note. Your staff then creates, reviews, and edits the information when the charge is created. While much of charge creation can be automated from data entered in the note, the review and edit process if done well can be time consuming and require above average attention to detail and coding skills.
7. Claim Submission
Daily Claims Submissions are scrubbed for accuracy prior to being submitted to the insurance carrier. Maintaining an industry leading first pass clean claims rate gets everyone paid on time the first time.
8. Denial Management
Its true that everyone needs to be aware of different payer rules and codes for effective denial management but what sets us apart from the rest is our focus on preventing denials in the first place. Our team will identify trends and provide constant feedback to the clinical team ensuring clean claims go out the first time around.
9. Payment Posting
We all know the importance of accurate and timely payment posting. Cash flow is what keeps the lights on. In addition to posting payments timely with exceptional attention to detail, our skilled payment posters can identify issues affecting revenue by identifying and resolving negative trends within your practice.
10. Credit & Refund
Resolution of overpayments is more than just a moral issue it’s a mandatory contractual issue with most payers. Procedures should be in place to provide for timely and accurate reporting to the insurance carriers. Its ironic that more effort can be put into giving money back than is required for getting paid but that is often the case. It is not uncommon for practices to simply wait for the payer to specifically request the funds or withhold them from future payments. Not only can our staff mange the unique refund process created by each payer but they can confirm the accuracy of the initial credit itself.
11. Account Receivables
No matter how hard you try to prevent claims from ending up on an AR aging list some things are just outside of your control. Slow to pay carriers, Electronic transmission issues, lost paperwork, and a multitude of other unforeseen events will pop up. A systematic AR follow up plan with detailed documentation must be done on every single claim. Yes this is time consuming but it must be done and our team has the process down to a science.
12. Patient Billing Support
Our dedicated phones team has an impressive combined experience working in private practice front office, Hospital billing centers, and with insurance carriers themselves. Patient billing inquiries and Credit Card Payments over the phone are handled promptly by qualified and caring staff.
217 Ward Circle, Brentwood,
4080 McGinnis Ferry Rd, #204 Alpharetta,