Our Services
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Billing
We understand billing regulations along with coding differences. We are capable of working with your EHR system along with your secondary scrubber in order to maintain compliance in billing claims. Our team can help identify billing issues and resolve them to increase your clean claim rate and bill in a timely fashion according to your contract.
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Denials
The presence of a denial on an account doubles the chance that the account will go to bad debt. We are able to drill down to identify root causes of denials and how to resolve it quickly. We are also able to work with your clinical departments to identify billing problems such as: charging, revenue code, or processing edits.
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Aging
We specialize in your aging Accounts Receivable in order to identify trends, billing errors, and coding issues. Once we’ve identified trends, we work to resolve them quickly and efficiently to avoid future denials and lower your aged Accounts Receivable. We prioritize according to your organization’s needs and timely filing requirements.
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Appeals
We have a staff of clinical consultants and appeals specialists that work with both Milliman and Interqual to apply clinical criteria in our appeals. Our turnover rate with appeals is between 70-80%. We use ERISA regulations as well as self-funded, federal, and state regulations to get the claim overturned and capture the money your facility deserves.
Our commitment to you and your patients
An elderly patient was admitted as an inpatient and was brought by ambulance. He had several co-morbidities with severe pain which was unrelieved by narcotics. He could not transfer from his chair or ambulate.
The patient’s criteria of care was appropriate. The insurance denied first for no authorization and then for medical necessity. We appealed with the appropriate criteria and were able to overturn the insurance company’s adverse benefit decision.
We believe you give good care to your patients and should be paid for that care. We advocate for your patients through our appeals processes.
Why appeal accounts?
Because a denied account takes an average of 85% longer to resolve
Because a denial on an account doubles the chance of write-off or bad debt