HME & Pharmacy Reimbursement

 
Fax line & referral services are monitored and inbound documents routed per your guidelines. Service also includes qualification, document request & follow up, and data entry of patients & orders.

 
Financial responsibility is determined, insurance benefits scoped out, and need for prior authorization (PA) identified. PA is requested, followed up on, and appealed if necessary. Information is logged in your billing system.

 
Orders are taken and processed accordingly. This includes order entry, documentation review, EV/PA, and verification of orders paid prior to advancing the order in the workflow.

 
The consignment order process can be managed completely by us, allowing your team to manage only by exception. Service includes patient & order entry, documentation review, EV/PA, and order confirmation.

 
Order confirmation, the first back office step, involves a deep QA where all data elements and physical documentation are reviewed to ensure that the order is clean for billing.

 
Held and stopped revenue is managed by reviewing the holds & stops, obtaining PAs, reviewing hold reasons and requesting CMNs & RXs via fax.

 
Cash and denial posting is kept current. Both auto-posting and manual posting are handled skillfully & overnight. Our team posts for all payers, including patients.

 
Claims review of key data elements is performed, claims submitted to appropriate payers, and batch rejections are resolved. The front-end rejections queue is cleared daily.

 
Review and resolve denials for each patient. Actions include modification of the claim record, claim resubmission, document collection, and appeal submission. Manage A/R buckets to achieve a strong 90+ Aged A/R metric.