We Assist

Patient Scheduling and Appointment Management

Effective scheduling is crucial for capturing patient volume and ensuring timely appointments. Our scheduling team is dedicated to:

• Reducing Cancellations and No-Shows: By managing physician schedules across multiple specialties and departments.
• Utilizing Omnichannel Communications: To collect and validate patient information, ensuring accurate and efficient appointment scheduling.
• Pre-Registration: Streamlining the process by collecting necessary information before the patient’s visit, which minimizes delays and enhances patient satisfaction.

Eligibility & Benefits Verification

Accurate insurance verification, eligibility, and benefits checking are vital for the revenue cycle's success. We:

• Verify Coverage: Ensure patients are covered for specific procedures and estimate out-of-pocket responsibilities before the visit.
• Check for Specific Clauses: Including non-covered procedures, co-payments, deductibles, co-insurance, pre-existing conditions, and maximum benefits.
• Obtain Prior Authorization: When required, leveraging our payer-specific capabilities to ensure necessary approvals are in place before the patient’s visit.

Referral & Authorization Management

Ensuring referrals and prior authorizations are obtained timely is critical for reimbursement:

• Payer-Specific Competencies: Ensure all necessary referrals and authorizations are received before patient visits to avoid reimbursement issues.

Financial Clearance

Providing clear and accurate financial information before patient visits is essential for smooth financial transactions:

• Validate Patient Responsibility: Communicate payment responsibilities and provide flexible payment plans and charity care options as per the facility’s arrangements.
• Improve Revenue Capture: By ensuring that financial aspects are handled promptly, which leads to improved patient satisfaction and operational efficiency.

Patient Registration

Streamline the registration process to enhance front-desk efficiency:

• Automated Workflow: Implement automated processes for patient registration and coverage verification, reducing errors and wait times.

Medical Coding

Our Medical Coding services include:

• Medical Coding Audit Services: We conduct thorough chart reviews and audits of codes assigned by onshore coding teams, aiming to eliminate coding errors and ensure accuracy.
• Coding Denial Management: Our team addresses coding denials by reviewing documentation, correcting codes, and re-filing claims to secure reimbursement.

Service Inclusions:

• ICD-10-PM, CPT, HCPCS, and ICD-10-PCS Coding: Comprehensive coding services for various coding standards.
• DRG Coding: Diagnosis-Related Group coding for inpatient services.
• Chart Audits and Code Reviews: Detailed audits to ensure coding accuracy.
• HCC Coding: Hierarchical Condition Category coding.
• Offshore Coding Audits: Audits conducted by our offshore teams.
• Payer-Specific Coding Requirements: Adherence to specific payer guidelines.
• Coding Denials Analysis: Identification and resolution of root causes of coding denials.

Benefits:

• Certified Coders: Access to a pool of AAPC, AHIMA, or AAHAM certified coders.
• Ongoing Training and Education: Continuous education framework for coders.
• Autonomous Capabilities: Independent coding operations.
• Mature Quality and Compliance Framework: Robust quality assurance and compliance standards.
• Revenue Leakage Identification: Experienced coders who can identify revenue leakage in DNFB cases.
• Performance Guarantees: Quality and turnaround time assurances.

Health Information Management (HIM) Services

Our HIM services focus on ensuring complete clinical documentation, identifying revenue leakage, and increasing reimbursements. We work as an extension of your HIM department to support:

• MS-DRG and APR-DRG Validations: Validation of Diagnosis-Related Groups.
• Compliance Reviews: Ensuring adherence to coding and documentation standards.
• Coding Education and Audit Services: Ongoing education and audits to maintain high standards.

Service Inclusions:

• Audit and Review of Coding Quality: Evaluation of inpatient, outpatient, and emergency department coding.
• Publishing KPI Results: Detailed reports on HIM and CDI process Key Performance Indicators (KPIs).
• Review of Coding Quality: Regular reviews to ensure accuracy and compliance.

Benefits:

• Accuracy in Coding: Detailed chart reviews to ensure precise coding.
• Tailored Clinician Education: Programs designed to address specific needs and reduce revenue leakage.
• Ongoing Education: Continued education initiatives for coding and HIM teams.
• Coding Guidelines and Policies: Development of comprehensive guidelines and procedures.

Clinical Documentation Improvement (CDI)

We5 healthcare is dedicated to creating top-tier CDI programs for hospitals, physician groups, and healthcare systems. Our CDI services are designed to enhance clinical documentation practices and support overall revenue integrity.

Service Inclusions:

• Consulting Services: Assessment and development of CDI programs.
• Operational Support: Assistance with coding and HIM functions.
• Coding Audits and Clinician Education: Regular audits and educational support for clinicians.
• Reporting and Benchmarking: Reporting CDI scores and developing performance benchmarks.

Benefits:

• Compliant Coding: Improved compliance and accuracy in clinical documentation.
• Enhanced Financial Outcomes: Optimized financial results through better documentation practices.
• Reduced Revenue Leakage: Minimization of revenue loss through effective CDI strategies.

Charge Capture and Clinical Revenue Integrity

We5 healthcare provides comprehensive solutions for charge capture and clinical revenue integrity to ensure a compliant revenue-generating process.

Service Inclusions:

• Development of Charge Description Master (CDM): Creating and maintaining a detailed list of charges to ensure accurate billing.
• Charge Capture: Accurate and timely capture of all charges for services rendered.
• Specialty-Focused Charge Capture and Coding: Dedicated teams for outpatient services and DRG coding specialists for inpatient services.
• Audit Services: Regular audits to ensure compliance and identify missed charges.

Benefits:

• Fee Schedule Review: Align CDM with payer standards to ensure correct billing.
• Improved Accuracy: Enhanced charge capture and coding accuracy.
• Clinical Documentation Improvement: Educate and involve clinicians to improve documentation.
• Revenue Leakage Identification: Detect and address areas of revenue loss.
• Enhanced Turnaround Time (TAT) and Quality: Improved efficiency in charge capture and revenue management.
• Denial Prevention: Shift focus to prevention by managing clinical denials effectively.

Claims Submission - Rejects Management and Work Edits

Over 10% of healthcare claims face quality and reconciliation issues. We5 healthcare addresses these issues through a robust rejection management process.

Service Inclusions:

• Clearinghouse Edit Management: Handle edits and rejections effectively to ensure smooth claims processing.
• Handling of Rejections: Manage and rectify rejected claims to improve submission quality.
• Electronic Claims Submission: Submit claims electronically via a clearinghouse.
• Payer, State, and Specialty Issue Management: Understand and address top issues by payer, state, and medical specialty.

Benefits:

• Cost Reduction: Save 30-50% through our global delivery model.
• Improved First Pass Rates: Avoid denials by addressing clearinghouse rejects.
• Reduced Days in A/R: Accelerate cash flow and reduce accounts receivable.

Payment Posting

Efficient payment processing is crucial for reconciling patient accounts and obtaining a clear view of A/R.

Service Inclusions:

• Patient Payments: Reconcile point-of-service payments for co-pays, deductibles, or non-covered services, and process self-pay payments.
• Insurance Payments: Process Electronic Remittance Advice (ERAs) and paper Explanation of Benefits (EoBs) using our echopay platform, which includes OCR capabilities.
• Denials Posting: Post denials to maintain current A/R reports and determine payment responsibilities.

Benefits:

• Efficient Payment Processing: Lower operational costs and improved accuracy.
• Guaranteed Turnaround Time: Assured delivery and processing accuracy.
• Process Automation: Enhanced efficiency through echopay - our EOB processing tool.

Accounts Receivable Management

Efficient A/R management ensures rapid conversion of receivables into revenue, reduces A/R days, and accelerates cash flow. Our A/R follow-up solutions include:

• Follow-Up with Insurance Companies: We use omnichannel methods (Website, IVR, Phone) to obtain claim status updates. Our echorev solution automates claims status processes, reducing follow-up costs and improving website adoption.
• Effective Action Plan: Beyond just obtaining claim status, we refile claims and appeals with comprehensive documentation.
• A/R KPIs: We adhere to HFMA and MGMA benchmarks to ensure optimal A/R performance.
• A/R Policies and Procedures: We help develop and implement A/R follow-up, denial management, and reporting procedures. We also manage old A/R and move it into collections processes as needed.

Denial Management Services

With over 65% of claim denials going unappealed, effective denial management is crucial. Our denial management services include:

• Denials Processing: Understand and address denial reason codes (ANSI and payer-specific), analyze the root cause, file appeals, and manage secondary insurance or patient responsibilities.
• Trending and Automation: Track denial trends, create automated workflows, and perform denial analysis and underpayment reviews.
• Clinical Denials Review: Correct medical codes, provide clinical documentation, and file appeals in payer-specific formats.
• Appeal Templates Automation: Streamline the appeal process with automated templates.
• Training: Educate clinicians and revenue cycle teams on denial prevention and root-cause analysis.

Denial Prevention

We focus on identifying and preventing the top reasons for claim denials:

• Root-Cause Analysis: Address and correct root causes of denials through iterative improvements.
• Clinical Denials: Correct coding errors and improve clinical documentation with our expert coding team.

Payment Variance and Credit Balance Services

Optimize revenue recovery through our comprehensive services:

• Lost Revenue Assessment: Analyze services against contracts to identify contractual underpayments using contract management software and experienced auditors.
• Underpayment Recovery Services: Appeal underpaid claims and recover due amounts from payers.
• Retrospective Underpayment Review: Assess historic underpayments to understand overall impact.
• Refunding Credit Balances: Process and refund patient and payer credit balances to ensure compliance and satisfaction.

Self-Pay and Patient Follow-Up

Enhance patient engagement and streamline payment collections:

• Patient Statement Services: Generate and mail/print patient statements as per a planned cycle, ensuring timely communication and ongoing revenue flow. We ensure statements are patient-friendly and compliant with billing guidelines.
• Self-Pay Follow-Up: Evaluate and bill patients for co-pays, deductibles, and other responsibilities. Address support requests and billing queries.
• Patient Portals: Implement advanced patient portals for secure payment processing and improved patient experience.

Benefits:

• PCI-DSS Compliance: PCI-DSS Compliance: Ensure secure payment processing.
• Omni-Channel Contact: Utilize email, phone calls, chat, and mail for patient communication.
• Secure Payments: Process payments securely over the phone.
• Defined Collections Model: Adhere to state and federal regulations for collections.

Revenue Cycle Analytics

Our analytics services provide deep insights into your revenue cycle performance:

• A/R Analytics: Analyze A/R data across dimensions such as days in A/R, performance by facility or specialty, aging buckets, and denial reasons.
• Denial Analytics and Underpayment Review: Review denial data by payer and issue to focus on denied and underpaid accounts.
• Operational Productivity Benchmarks: Measure productivity and performance to drive revenue cycle success using our proprietary technology, echosmrt, and other reporting tools.

End-to-End Revenue Cycle Management Services

We provide a full suite of revenue cycle management (RCM) services designed to cover every aspect of the revenue cycle, from front-end processes to back-end functions. Our end-to-end services ensure a seamless and efficient revenue cycle, reducing operational costs and improving revenue capture.

Efficient Medical Coding Services

Leverage our extensive pool of medical coders to manage and streamline coding tasks. Our team is experienced in:

• ICD-10 Coding
• CPT and HCPCS Coding
• DRG Coding
• HCC Coding

We handle coding for inpatient, outpatient, and emergency department settings with accuracy and compliance.

Clinical Documentation Improvement (CDI)

Enhance the quality of clinical documentation through:

• CDI Program Development
• Operational Support for Coding and HIM Functions
• Coding Audits and Clinician Education

Our CDI services focus on improving documentation quality, reducing denials, and ensuring accurate revenue capture.

Improved Visibility and Reporting

Gain better insights into your operations with customized reporting and metrics. We provide:

• Detailed Reports: Track performance across multiple providers with specific metrics.
• Dashboards: Intuitive visualizations to monitor trends and KPIs.

Application Services

Optimize your workflow and data management with our technology solutions:

• Workflow Optimization: Streamline processes and integrate systems for better efficiency.
• Data Flow Management: Ensure smooth and accurate data exchange across platforms.
• Knowledge Management: Enhance information access and utilization.

Comprehensive Revenue Cycle Management

Our end-to-end services cover every aspect of the dental revenue cycle:

• Front-End Services: Streamline patient scheduling, eligibility verification, and insurance authorizations.
• Mid-Revenue Cycle Services: Handle charge entry, coding, and documentation improvement.
• Back-End Services: Manage claims processing, accounts receivable, denial management, and payment posting.

Expert CDT Coding

Ensure accuracy and compliance with our dental coding services:

• CDT Coding: Expert coding for all dental procedures to align with the latest CDT codes.
• Coding Audits: Regular audits to identify and rectify coding errors, reducing the risk of denials.
• Compliance: Adherence to the latest coding guidelines and payer requirements.

UCR Fee Schedule Design

Optimize your fee schedule to improve revenue and reduce claim denials:

• Fee Schedule Analysis: Develop and maintain an effective UCR fee schedule based on market data and industry standards.
• Revenue Optimization: Align fee schedules with payer reimbursement rates and patient payment capabilities.

Efficient Patient Payment Processes

Enhance patient payment processes to improve cash flow and reduce bad debt:

• Upfront Payment Collection: Implement strategies to collect co-pays, deductibles, and other patient responsibilities at the time of service.
• Patient Financing Options: Offer flexible payment plans and financing options to improve patient satisfaction and revenue capture.
• Billing and Collections: Streamlined billing processes and effective follow-up on outstanding patient balances.

Effective Denial Management

Reduce claim denials and recover lost revenue:

• Denial Analysis: Identify root causes of denials and implement corrective actions.
• Appeal Management: Prepare and submit appeals for denied claims, focusing on documentation and coding accuracy.
• Prevention Strategies: Develop processes to prevent common denial reasons and reduce overall denial rates.

Technology-Driven Solutions

Leverage advanced technology to enhance revenue cycle efficiency:

• Automation Tools: Utilize automation for coding, claim submissions, and follow-up processes.
• Data Analytics: Analyze revenue cycle data to identify trends, inefficiencies, and opportunities for improvement.
• Integrated Systems: Ensure seamless integration between practice management systems and billing platforms.