Areas of Specialty
Services & Education
Pre-Claim Services
Contract Negotiations
We compare your reimbursement with local market rates and negotiate your contracts with carriers. We periodically review your contracts and monitor renewal dates to manage risk of lost revenue.
Credentialing Services
We monitor and complete all payer credentialing requirements for each provider, and facility. We provide dedicated, expert, credentialing specialists that will represent you.
Provider Enrollment
We complete all applications and necessary documents on your behalf with all major and local payer networks. Our tenured contracting staff will maintain and update your CAQH profile.
EDI Enrollment
Our electronic claims billing experts will analyze your payer mix to identify and facilitate the enrollment processes with payers on your behalf. We perform the EDI setup process and interact with payers for enrollment related matters.
EFT/ERA Enrollment
Our electronic reimbursement team will identify and assist in meeting enrollment requirements and establish provider and facility EFT/ERA setup. We handle all contact, follow-up, and application submissions required to establish a more efficient and secure reimbursement process.
Consulting Services
We analyze your entire workflow through every step of the revenue cycle process to help you identify areas of opportunity and implement solutions to maximize revenue. We provide training in all areas of revenue cycle and assist in implementation of new software and systems.
Patient Access Services
Appointment Scheduling
Centralized appointment scheduling with extended hours of appointment scheduling to meet the needs of your organization. We have an extensive training and quality audit process to ensure your appointments are scheduled accurately.
Patient Registration
97% Financial clearance rate 24 hours prior to patient visit. 98% Accuracy on patient demographic information, MSP forms, and patient liability counseling with your mission statement in the forefront of our interactions in your community.
Eligibility & Benefits
Our workflow ensures complete and accurate, up to date information regarding carrier, claims mailing addresses and contact information as well as plan benefits, patient liability, and coverage requirements for first pass clean claim success. Coordination of benefits risk assessment applied during the eligibility phase for reduced denials waiting for patient completion of forms or incorrect payers.
Prior Authorization
Turnkey all-inclusive prior authorization services (Authorization Request + Follow-up + Approval). We boast a 96% authorization rate prior to service dates.
Patient Follow-Up
Our caring staff keeps your mission statement at the forefront of all communications while handling inbound patient inquiries regarding their statements and outbound calls for outstanding balances. We provide you with a dedicated 800 number and record all calls for peace of mind in quality of service.
Patient Notification
Our patient billing and collections team will send statements and generate automated call reminders to patients. Patient share estimation provided prior to service during the pre-registration process.
Clinical Revenue Integrity Services
Professional Coding
We can help you improve accuracy with ongoing, periodic or one-time coding assistance across all medical specialties. Guaranteed accuracy and turnaround leading to accurate and appropriate reimbursement.
Facility Coding
Expertise across diverse chart types including inpatient, emergency departments, ambulatory care, radiology, and surgery centers. Special expertise in complex, high-value coding such as interventional radiology, Anesthesia and cardiac catheterization.
Coding Audit Services
Accuracy review of your current coding process, which will identify opportunity for improvement and help prevent coding-related denials. Coding auditing services, including coding compliance, provider documentation and reimbursement audits.
Risk Adjustment Coding
Retrospective coding for Medicare, Commercial/HIX and Medicaid using models: CMS-HCC, HHS-HCC, and State Specific Medicaid. Assure the highest standards of coding quality, with quality checks occurring throughout the process.
Charge Capture Analysis
Our certified coders identify opportunities for process improvement in order to maintain a current, comprehensive and compliant CDM. Charge capture review to identify and correct breakdowns in the charge capture process.
Clinical Documentation Improvement
Review of clinical documentation to support diagnosis capture and to ensure the level of service rendered to all patients is appropriately recorded. Maximize reimbursement by improving your documentation and reduce the risk of RAC audit liability.
Billing and Denial Recovery Services
Charge Capture
Higher level of accuracy and maximum reimbursement coding to reduce compliance risks and improve revenue. Our strict adherence to correct coding initiatives reduce the risk of audit by CMS or the OIG.
Scrubbing & Submission
Our certified coders take pride in reviewing each claim on a line-by-line basis to ensure proper coding and complete data. Our custom solution will reduce undercharges and improves your cash flow.
Payment Applications
Our accurate payment posting strategy helps analyze revenue cycle for improvement opportunities to maximize revenue. Our guarantee is that manual and electronic payments will be posted within 24 hours of receipt.
AR Management
Each claim is meticulously tracked and followed by our experienced A/R staff until payment is received. Our Denial Recovery Specialists are committed to helping you increase net revenue and reduce AR. Our licensed nurses have over 100 years combined experience in writing appeals specific to carrier requirements and have a 70% turnover rate for denials related to medical necessity and level of care.
Denial Management
We apply industry best practices to reduce denials and implement strategies to increase initial submission reimbursements. Our detailed analytics help pinpoint precise areas of focus to drive change for tangible results in short windows.
Insurance & Patient Follow-Up
Timely follow up on all unpaid claims, ensures that filing and appeal deadlines are not exceeded. Our caring patient billing staff provides regular follow up with patients to resolve outstanding balances.
Compliance and Analytics Services
Risk Analytics
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Key Metrics
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Predictive Analysis
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Performance Reporting
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Comprehensive Denial Analysis
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Process Measures and Audits
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Education
Our Mission
HBS Center of Revenue Cycle Excellence is an academic community composed of students, faculty, and professional staff. The mission of the school is to prepare capable women and men for all positions in Revenue Cycle Operations; to provide individuals with the background necessary to pursue advanced study; and to provide the larger community with opportunities for professional and organizational growth in the business of healthcare.
Center of Excellence
We understand that today's healthcare providers are challenged with meeting the demands of an ever-changing healthcare landscape, especially with the implementation of ICD-10 and major components of the Affordable Care Act. The Center for Revenue Cycle Excellence was established to be your premier training provider so that staff is prepared to handle forthcoming regulatory and policy changes affecting all healthcare providers since the inception of the Medicare and Medicaid programs.