Confirmation of Benefits
This approach guarantees that the essential procedures are covered by insurance. Our team of experts continues to enhance your process via quality and accuracy as the key to raising your clean claim rate.
Requests for Referrals
Patients in various HMO plans are required to obtain a referral from a PCP prior to any medical services and we ensure that this is obtained and recorded.
The most important component is to have a valid authorization number on file; failing to do so might mean the difference between a compensated claim and a write-off. Our staff ensures that your authorizations are on file and approved.
Our staff inputs the data while maintaining the highest accuracy rate, from demographics to superbills. Our experience within multiple systems is a key to accuracy and efficiency. Our data entry staff is dedicated to ensure that information is entered quickly and accurately into your practice management system.
Review of Charges
When assessing superbills for correctness, our billing professionals have a wealth of knowledge gained from working with multiple specialties.
Billed claims are reconciled against the appointment schedule to ensure all charges are captured.
This isn't just about checks and balances; our staffs are trained to go above and beyond. They contribute significantly to a manual denial management process ensuring the denials from EOBs/ERAs received are being addressed within 24-48hrs of receipt.
We also identify discrepancies between the contracted rates and actual allowable given in the EOB/ERA. Such discrepancies are reported and appealed as underpayment along with the contract.
Payments received are reconciled with the bank statement and clearing house ensuring all payments received are being posted accurately.
Our Denial Management team ensures that all denials received are addressed and corrective actions are taken within 24-48hrs of receipt. We monitor and act on denial trends and patterns to improve and decrease denial rate.
Root Cause Analysis
Our DM team analyzes denial trends and collaborates with the relevant Virtual Connect Team and with the client to prevent denials by fixing process loopholes occurring on the front end, including the front office flow work. Feedback are provided to the client on clinical related denials.
Unpaid claims older than 30 days are reviewed and payers are contacted where relevant in order to ensure the claims are processed appropriately. Claims follow-up is prioritized by timely filing limit, ensuring no room for timely filing denials. From submitting corrected claims to filing an appeal where needed, our AR team has it covered.
Primary goal of our AR team is to ensure that claims older than 90 days are below 12% of the total AR.
Our team will provide reports, dashboard and presentations per your requirement to represent the production, progress and financial health of the practice.
Key Performance Indicators (KPIs)
Our primary goal is to ensure the financial health of your practice by meeting or exceeding industry KPIs.