Billing MANAGEMENT

We have accumulated over 15 years of extensive experience in collaborating with Medicare, HMO’s, PPO’s, Medi-Cal, Managed Care Plans, and a wide array of other insurance companies. Our deep understanding of these areas allows us to provide exceptional service tailored to meet the specific needs of our clients.

We work closely with you to ensure that all reporting and billing deadlines and essential tasks are being met in a timely manner, fostering an environment of collaboration and accountability.

Our dedicated staff diligently reviews provider notes across various areas of reimbursement opportunities to ensure thorough evaluation and optimization. We bill according to your specific schedule and make it a priority to focus on the unique needs of each individual client we serve.

We make certain to meticulously document all relevant information directly from your own Electronic Medical Record (EMR) system to ensure the highest levels of data accuracy while also establishing a timely reimbursement schedule for your practice.

RISK ADJUSTMENT FACTOR MANAGEMENT

We work closely and collaboratively with your office staff and management team to thoroughly address any discrepancies in documentation as well as reporting related to the HEDIS/STAR Measures. This partnership ensures accuracy and compliance, fostering a streamlined process for improved performance outcomes.

Our long-standing, positive relationship with numerous insurance companies and their respective representatives enables us to efficiently obtain fast and accurate data for our providers. This collaborative approach not only enhances our service quality but also ensures that our clients receive timely and reliable information. We proactively and directly communicate with various insurance companies on a regular basis to gather up-to-date information regarding the latest policy changes and developments in the industry. This ensures that we remain well-informed and can provide our clients with the most accurate and timely advice.

We take the necessary one-on-one time to work closely with our patients, ensuring that we thoroughly educate them on the important referral authorization process. Our dedicated team is not only experienced but also bilingual, making them accessible and ready to assist around the clock, 24/7, to address any client or patient-related questions or concerns that may arise.

We meticulously follow all referral authorizations to the letter and ensure that we completely “close the loop” on every case. This thorough process allows us to effectively meet the insurance policy requirements and ensures that our clients receive the best possible service.

All referral authorization notes are documented directly from your own Electronic Medical Record (EMR). In addition to this, we also log all referrals along with their current status on a comprehensive spreadsheet for you to easily review and monitor.

Referral authorization MANAGEMENT

annual wellness MANAGEMENT

Annual Wellness Reports are carefully compiled and pulled directly from the insurance companies. Our team works closely with their representatives to ensure that we consistently obtain the most up-to-date and accurate reporting available. This collaboration is essential in maintaining the quality and reliability of the provider’s daily schedule.

We work closely and collaboratively with the management staff to efficiently schedule appointments and diligently follow the established provider policy.

Our dedicated team is fully available to assist you in the collection of AWE documentation and will efficiently scan these important documents into your EMR system. In addition, we will ensure that you receive timely reports and detailed documentation sourced directly from your own EMR system.

INSURANCE ELIGIBILITY

We will coordinate with the management team to gain the necessary access to the various insurance portals, enabling us to efficiently verify eligibility for all patients. Eligibility is thoroughly verified prior to the patient's scheduled appointment to ensure that the patient remains active and eligible at the time of their visit. This process is crucial for providing accurate and efficient care.

Any patients that are determined to be not eligible will be flagged in the Electronic Medical Record (EMR) system, and the staff will be promptly alerted to ensure appropriate follow-up. Upon the provider's discretion, we can also take the initiative to reach out to the inactive patients and inform them about the recent insurance change(s). Additionally, we can gather their new insurance information and ensure that your EMR is updated accordingly to reflect these changes. This process ensures that your records remain accurate and comprehensive.

The eligibility reports, along with any pertinent notes and detailed documentation, will also be thoroughly recorded in your Electronic Medical Records (EMR) system for your convenience and reference.

other management consultant services

• In office & Virtual staff training

• Contract review and onboarding

• Medical records management & review

• Office Management Consulting