1 Pre-certification & insurance validation

Just share patient info and insurance details via email, fax, or secure FTP. Our team reaches out to the insurance company before appointments, ensuring hassle-free pre-certification for specialized services. We then send verified details to your facility.

2 Patient demographic entry

We expertly handle patient demographics: names, birthdates, addresses, insurance, medical history, and more. Details provided during visits are accurately recorded. For returning patients, we verify and update records in the management system, ensuring precision and consistency.

3 CPT and ICD-10 coding

Our adept coding team, staffed with multi-specialty AAPC-certified coders, follows strict CPT and ICD-10 Coding guidelines. Simply share superbills with or without codes and diagnostic notes. We'll verify existing codes to avoid any 'up-coding' or 'down-coding' issues, ensuring denials are a thing of the past.

4 Charge entry

We'll pre-load your fee schedules into our practice management system. Our experts input CPT and ICD-10 codes, meticulously reviewing each claim for comprehensive details before filing. Our charge entry process ensures that your billing process is seamless, thorough, and efficient.

5 Claims submission

We offer both electronic and paper claim submissions through our practice management system. A senior billing specialist conducts a comprehensive quality check before submitting. Any clearinghouse rejection reports trigger careful analysis, necessary adjustments, and efficient resubmission.

6 Payment posting

Share your scanned EOBs and checks for swift payment posting. Our team diligently records all payments within the system. To ensure accuracy, we perform daily reconciliations between EOB/check amounts and system entries. This process is transparently tracked in a daily log, keeping you informed every step of the way.

7 Accounts receivable follow-up

We assess all system claims, starting with close-to-deadline cases and then proceeding by age. We conduct regular follow-ups via phone, email, and online to track the status of each claim submitted to insurance companies. Your financial success is our commitment.

8 Denial management

Our experienced senior billing specialists handle denial analysis and partial payments. We proactively reach out to payors, patients, providers, and facilities to address denied, underpaid, or pending claims. Our thorough approach ensures proper resolution, with detailed documentation in the system for transparent tracking.

1 Reimbursement & underpayment analysis

Navigating medical billing charges can be challenging. Rely on our practice management consulting experts for a comprehensive fee schedule analysis. Gain valuable insights into your fees compared to Medicare and other payers, ensuring you're on the right track for optimal reimbursement.

2 Metric-driven performance

Upon contract initiation, our experts initiate benchmarking and deliver monthly reviews showcasing enhanced key performance indicators. This promotes transparency between the billing company and your practice. We meticulously track vital metrics, so you can expect a data-driven journey toward optimized success.

3 Progress reports

Our practice management consulting team is dedicated to delivering frequent reports, guaranteeing adherence to service level agreements and prompt provider payments. We keep your business processes as transparent as possible, so you can stay informed effortlessly.

4 Month-end reports

We'll provide you with detailed monthly performance reports, thoughtfully explained by your dedicated account manager. These reports highlight areas for improvement and chart the path forward, ensuring clarity and continuous progress. Your success is our commitment.

5 Robot process automation (RPA)

Harness our RPA expertise to streamline repetitive tasks vulnerable to errors. Experience improved accuracy in areas like manual data entry, pre-authorizations, and basic claim denials processing. Unlock enhanced efficiency with our cutting-edge automation solutions.

6 Data visualization

Our dashboard feature empowers you to effortlessly visualize your practice's key performance indicators. Easily interpret your practice's health on a daily, weekly, or monthly basis. Experience the impact of streamlined administration, as demonstrated in the efficiency of Accountable Care Organizations (ACOs).

1 Administrative support

Think of us as an extension of your practice. With us handling administrative tasks, you're free to prioritize patient care. Let us manage the administrative details while you focus on what matters most: your patients' well-being.

2 Document management

Sorting through various documents, whether mail or electronic, can be a hassle. Our team organizes them for quick review, aiding your decisions. Focus on what you do best while we handle the paperwork.

3 Eligibility benefits

We'll assist in verifying eligibility and benefits prior to visits. Enhance patient experience, expedite care, and boost on-the-spot collections. Streamline your operations with our support.

4 Provider credentialing and enrollment

Let us handle your payor credentialing and network enrollment. Minimize out-of-network denials and expedite care delivery. Focus on your practice while we handle the paperwork.

1 Patient attribution and panel management

We handle patient population analysis for your ACO quarterly. Our insights empower ACO management, aiding informed decisions. Let us manage the data while you focus on optimizing patient care.

2 Leakage analysis

We conduct in-depth analysis to reveal ACO spending outside preferred partners. Our detailed insights and extended analysis provide a comprehensive overview for informed decisions.

3 Utilization and cost reporting analysis

We provide detailed, multi-dimensional analysis of utilization and cost reporting across providers, facilities, and patients. Gain valuable insights into resource allocation and optimize your strategies.