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SERVICES
easy workflow for a better business
Credentialing Services COMING SOON!
CODING
We offer professional coding for each encounter to ensure accuracy and compliance has been met per required coding guidelines. Utilization of AMA CPT Professional, ICD-10-CM Expert, HCPCS Level II, encoders and any additional resources as necessary. This service will help provide clean claims, which results in fewer claim denials.
Coding
BILLING & CLAIM SUBMISSION
Billing & Claim
We offer billing and submission of all claims. Each claim is analyzed for accuracy according to payor policy before submittal to ensure clean claim processing. Claims will be submitted electronically and/or via paper submission to all primary insurances. Follow up of each claim will be provided to confirm acceptance and processing. Once primary insurance has allowed and/or paid their portion, the claim will be forwarded on to the secondary insurance per per policy and guidance. Our process decreases denials by insurance companies which guarantees increased revenue.
A/R MANAGEMENT
A/R Manage
If PCRS is providing billing services for you, all claims that are outstanding over 30 days will be tracked. Appeals will be made according to payor policy for any claims submitted and denied and followed up until a final decision is made.
We also offer A/R Recovery services. If you are struggling to recover your revenue or it has just gotten out of hand and need help, we will be glad to set up a special project to help you recover what you are eligible for and get your A/R in good standing.
PAYMENT POSTING
Payment Posting
Part of payment posting is making sure your EHR is set up to work efficiently, providing you with less manual entry of payments. For our payment posting services, we offer Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) setup along with posting of any incoming insurance and patient payments. This process will provide less room for human error. Account management can also be provided, assuring any overpayments due the patient and/or insurance will be processed.
AUDITING
Auditing
Medical auditing is critical to compliant and profitable physician practices. Medical audits can provide a mechanism for:
• Reviewing quality of care provided to patients.
• Educating providers on documentation guidelines.
• Ensuring all services are supported, and all appropriate revenue is captured.
• Defending against external audits, malpractice litigation, and health plan request and denials.
With our knowledge of medical documentation, fraud and abuse based on government guidelines and coding concepts, we can provide different types of audits for your practice.
Chart Audit- is an examination of claims data and medical records to determine if the documentation for a particular claim is compliant, if the claim is correctly coded, and if all charges are captured.
Internal Audit- is one that is performed by members within the organization. If we are your billing company and/or part of your team, we can perform internal audits for you.
External Audit- is one performed by an individual or group not a part of the organization or the practice. If you need a company to only do external audits for your practice, we can perform those quarterly, annually, or biannually, depending on the results of the baseline audit.
Focused Audit- is one that looks at one item, one type of service, or one provider.
Random Audit- is just as the name implies: The selection will be totally random, and each service within a particular item frame has just as much chance of being selected for audit as any other service.
Prospective Audit- is performed prior to claim submission. This type of audit allows variances in the coding to be corrected prior to claim submission.
Retrospective Audit- is performed on data from claims already submitted for payment and processed by the insurance carrier.
CONSULTING SERVICES
Consultants are experts in their field. Every practice needs a consultant they can rely on to provide them with accurate information that will help them along the way. When you sign up for our consulting services, you will gain access to a monthly newsletter and have many consulting options such as, education, trainings, analytics and reporting, EHR and practice management & much more.
Consulting
PROVIDER & STAFF EDUCATION & TRAINING
We all know how much the rules and guidelines change within the Healthcare industry. We can keep you up to date by provide education for coding and billing guideline changes and updates to any necessary staff members. We offer trainings to help your staff members gain knowledge and experience, as well as improve your overall revenue. Maybe there is a certain area that needs additional training such as insurance eligibility, basic coding, basic billing and understanding the explanation of benefits (EOB) which would also help when patients' call with questions. Provider documentation is so important. The golden rule is, "if it isn’t documented, then it wasn't done". There are so many pieces to a patient's visit that must be documented to complete the entire puzzle of a patients' medical record. Showing within your documentation that each code and charge you are submitting and billing to insurance was medically necessary, is imperative to meet your compliance expectations. We provide clinical documentation improvement education to ensure the medical necessity has been documented and supports all codes and charges.
DIAGNOSTICS
Are you getting your money's worth out of your EHR and is it doing all of the work it can for you? Are you having specific issues that you and/or your staff just simply do not have the time to do?
One of our strong skills is being able to maneuver around any EHR software, diagnosing and fixing any issues you may be having. Simplifying processes to make them run smoother and more efficiently for everyone is something this company takes pride in.
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