Whether you’re looking to streamline your healthcare operation, realize productivity gains, implement new services, advance your compliance, we can help you achieve your vision. We specialize in transforming healthcare delivery through innovative management solutions. Our company can help you streamline operations, enhances patient care, and drives efficiency, ensuring your organization not only meets regulatory standards but also thrives in today’s dynamic healthcare environment.
Consulting and Administrative Oversight
For established companies looking to grow their business – Become a more strategic stakeholder
For dynamic companies with more complex needs
We specialize in providing accurate, efficient, and transparent billing solutions tailored to your unique needs as healthcare providers. Our expert support ensures that you receive maximum reimbursement while maintaining compliance with industry standards. By partnering with us, you can focus on delivering exceptional patient care, knowing that your billing operation is in expert hands. We can offer different types of contractual arrangments and consulting solutions so you can receive the highest value to your specific needs.
Eliminating rework, accurate patient data entry ensures prompt reimbursements and decreases the number of days in accounts receivable.
Improper benefit information verification is one of the major sources of claim denials. Prior authorization and insurance eligibility verification are the first and most important step in the medical billing process.
To guarantee that the charges recorded are accurate, all procedures are invoiced for, and the codes assigned are compliant.
Claim denials, underpayments or future overpayment recovery may result from missing or inaccurate codes. Coding errors can be expensive and even cause unnecessary compliance issues.
The process of collecting a fixed fee from patients at the time they receive healthcare services. This fee is predetermined by the patient’s health insurance plan.
Our strict procedure allows to identify incorrect claims and gives medical billers the chance to correct them. Obtain greater and faster reimbursement with our 48–72 hour turnaround time increasing output, and claim accuracy, Reduce claim rejections and maximize your reimbursement.
Electronic Remittance- Manual posting- Denial Posting-Patient Payments- Our solution assures 98% accuracy and 48-72-hour turnaround time.
Our denial management activities examine the rationale behind each claim’s denial . They are focused on fixing the problem to resubmit denialed claims to the insurance company timely and in some cases where appropriate file an appeal throught the process established by each Payer.
We help our providers reduce days in A/R with our timely follow-up services that ensure you clearly understand the reasons for delays in accounts receivable and promptly follow-up with insurance companies and patients. Practices frequently find themselves in circumstances with old accounts receivable (A/R), such as not having the employees to follow up besides inadequate write-off policies, resulting in a backlog of insurance claims totaling millions of dollars in old A/R. With a highly solid procedure, we undertake A/R backlog cleaning as one-time assignments if needed.
Provider enrollement and credentialing is the process by which all healthcare services providers become enrolled with Insurance Companies, HMO entities or Healthcare Facilities . Only verified providers are included in the network to serve patients. Our services also includes Credentialling Document Management Services compliance.
Streamline the onboarding process for your new staff, ensuring compliance with our Learning Managment System. Standarize the Onboarding and Training Process: Our support centralizes all your relevant training needs. Role Specific Onboarding – Online Training and Retraining including Policy Ackowledment.
IT Overview and Training:
Administration Overview and Training:
Human Resources Orientation:
Contract negotiation is a process through which the reimbursement value for the respective services can be established or revisited. The request will be submitted in the form of a letter that explains the services he provides and the reason for the proposed fee value. We will make sure to include aspects such as: Fee For Service review that incorporates the operational components of your specific organization. We understand the complexities and nuances of insurance contracts in the healthcare industry.
Electronic Medical Record and Practice Management System oparation is a never-ending process. There is no end point because there is always the possibility of optimizing workflows or improving data use. Our Team and external consultants help you navigate the numerous challenges to full adoption, implementation, and system improvement and optimization.
Government, payers and other stakeholders are increasingly looking to quality metrics to hold providers accountable for the standards in which they deliver patient care. Our model will prepare you for the evaluation process–and keep your organization achieving accreditation standards every single day. We have a deep understanding on accreditation bodies.
This involves ensuring that all required documentation are accurately compiled and submitted. For accreditation bodies.
These are activities to prepare for the actual accreditation or evaluation site visit. They help identify any gaps or areas needing improvement. Involving both internal and external reviewers can provide valuable aligned with HEDIS, STARS, and other quality programs mandated by health insurance for quality review.
A systematic review of your program’s performance over the past year. It includes assessing outcomes, identifying areas for improvement, and setting goals for the next year.
Support in reviewing and updating your policies and procedures ensures they remain compliant with accreditation standards and reflect current best practices.
CMS and private HMOs are moving towards value-based care (VBC) and shifting away from traditional fee-for-service (FFS) models by embracing the latest advancements in risk-sharing arrangements to deliver value and high-quality healthcare. The coming years are expected to witness a continued focus on VBC initiatives across the healthcare sector. In the years ahead, a sustained emphasis on value-based care (VBC) initiatives is anticipated throughout the healthcare sector. We are here to help you manage the transition.
Identify improvement opportunities, with success defined by specific and measurable KPIs and milestones. Transitioning to value- and risk-based models. Redesign managed care department and infrastructure.
Contracting decisions must now account for for value-based reimbursement and clinical integration along with payer readiness for administering new contract methodologies. We help to develop the payer strategy assessing value-based readiness of the practicve, analyzing reimbursement and conducting contract modeling for Capitation, Global Payments and/or Shared Savings.
Assisting organizations in understanding and managing financial risks associated with VBC. Creating financial models to support the shift to risk-sharing arrangements.
Evaluate potential financial risks associated with VBC models, including patient volume variability, cost fluctuations, and quality performance metrics. Quantitative Analysis: Use actuarial techniques to quantify risks, including scenario modeling and sensitivity analysis.
Create comprehensive financial models that reflect the organization’s VBC strategy, including projected revenues, costs, and risk-sharing arrangements. Utilize historical data and statistical methods to forecast financial performance under various VBC scenarios.
Clinical Integration, Care Coordination Protocols, Staffing Levels Assessment, Pay for Performance Practices, Organizational Structure, Productivity measurement/reporting KPIs, Education and Training.
Productivity Benchmarking, Skills Set Assessment, Opportunity Identification and Quantification, Technology Assessment, Support Services Review. Cross-Functional Teams: Engage finance, clinical, and operational teams to ensure comprehensive risk management and financial knowledge for sucess
