Your organization, Our Priority

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Our purpose in serving your company would be to streamline your revenue cycle processes, ensuring you capture all appropriate revenue and reduce any inefficiencies that are causing financial leakage.

Hiring us provides the following benefits:

• Expertise in Healthcare Revenue Cycle Management: Our team has deep knowledge and experience in all aspects of the revenue cycle, from patient access to collections.
• Enhanced Revenue Recovery: We employ advanced analytics to identify underpayments and areas of lost revenue, ensuring you get paid for all services provided.
• Compliance and Integrity: We prioritize compliance with healthcare regulations, reducing the risk of audits and fines maintaining the integrity of your financial operations.
• Customized Solutions: Understanding that each healthcare entity is unique, we tailor our solutions to fit your specific needs and challenges.
• Increased Efficiency: By automating and improving processes, we help you reduce administrative burdens, allowing you to focus on patient care.
• Training and Support: Our services include ongoing training and support for staff, ensuring that improvements are sustainable.
• Cost Savings: With our focus on efficiency and revenue recovery, we aim to provide a return on investment that exceeds the cost of our services.

By managing these aspects effectively, HCIRS helps healthcare providers reduce administrative burdens, minimize errors, ensure compliance with insurance requirements, and enhance patient satisfaction by offering a smoother, more predictable healthcare experience.

Scheduling:

• Patient Appointment Management: This service includes setting up appointments for patients based on provider availability, patient preferences, and urgency of care. It involves managing schedules to optimize provider time and ensuring patients are seen in a timely manner.
• Reminders and Follow-Ups: Automated systems may be employed to remind patients of their appointments and follow up on no-shows or reschedule as necessary.

Preservice:

• Patient Registration: Collecting patient demographic and insurance information prior to the visit to expedite the check-in process.
• Financial Counseling: Provide information about their estimated costs, payment options, and financial responsibilities before receiving services.

Insurance Verification:

• Benefit Confirmation: Check patients' insurance coverage details to verify benefits and ensure services are covered.
• Eligibility Checks: Verifying patient eligibility for services on the date of service to prevent denials and delays in payment.
• Coverage Details: Detailed information such as copays, deductibles, and co-insurance amounts are confirmed to inform the provider and patient of potential out-of-pocket costs.

Authorization for Procedures:

• Prior Authorization Management: Manage the process of obtaining prior authorization for services, procedures and/or medications as required by insurance companies to ensure coverage.
• Documentation Submission: Submitting all necessary clinical information and documentation to insurance companies to justify the need for a procedure or service.
• Follow-Up: Tracking authorization status and following up with insurance companies as needed to avoid delays in care. 

Expertise Meets Innovation for Optimal Financial Outcomes

Our Revenue Integrity solution embodies a holistic approach that integrates cutting-edge technology with the expertise of seasoned Revenue Integrity specialists. These professionals are the cornerstone of our service, bringing in-depth knowledge and hands-on experience to the complex challenges of revenue cycle management.

Key Features:

• Charge Capture Verification: Checks and balances to ensure that all provided services are accurately captured and documented.
• Coding Accuracy: Expert oversight to maintain coding compliance, reducing the risk of denials and underbilling.
• Claim Integrity: Detailed scrutiny of claims before submission to ensure they are complete, compliant, and correct, minimizing the risk of rejection or audit.
• Revenue Recovery: Proactive identification of underpayments and denials to recover lost revenue and improve the bottom line.
• Analytics and Reporting: Real-time analytics provide insights into operational efficiency, financial performance, and areas for improvement.
• Compliance Management: Staying ahead of regulatory changes to mitigate risks and ensure adherence to all guidelines.

Benefits:

• Enhanced Revenue Capture: By leaving no service unbilled and ensuring proper coding, our solution boosts revenue without increasing patient volume.
• Reduced Financial Leakage: Minimize the occurrence of missed charges, under coding, or non-compliant billing practices that lead to lost revenue.
• Improved Efficiency: Streamlining the billing process reduces administrative burdens.
• Compliance Assurance: With continuous updates reflecting current regulations, your organization remains compliant, avoiding costly penalties and audits.

Designed to streamline the revenue cycle management of healthcare providers, reduce the administrative burden on medical staff, and increase the collection rates through rapid claim reimbursement, efficient billing practices and effective denial resolution. By outsourcing these complex tasks to HCIRS, healthcare providers can focus more on patient care while improving their bottom line.

Billing Services:

• Claims Submission: Submission of claims to insurance payers, responsible for making sure that the claims are processed in a timely manner.
• Payment Posting: Payments from payers and patients are posted to respective EMR systems. 

Follow-up Services:

• Insurance Follow-up: Track unpaid claims with insurance companies to ensure payment is received.
• Patient Follow-up: Manage patient statements and handle inquiries from patients regarding their bills.
• Account Receivable Management: Monitoring the age of accounts receivable and prioritize follow-up activities to reduce the number of days charges are outstanding.

Denial Management:

• Denial Analysis: Examine denied claims to understand the root cause of the denial.
• Correction and Resubmission:   Claim Corrections to fix any errors on denied claims and resubmit them for processing.
• Appeals: Handle the appeals process for denials that require additional negotiation or justification. 
• Denial Prevention: By analyzing denial trends, implement measures to prevent future denials through improved processes or staff training.