Streamlined Claims Settlement

Generally, the Revenue Cycle starts with the patient making the appointments and end up with the payers making the payment, and we make it possible that the payers make the payment... and the every practice's story say the same!

Our Prowess Services:

Our Virtual Medical Assistants set in the appointments for the patients; perform preliminary examinations over the call, prescription drug management, make patient databases in the EHR/PMS so that the patient is ready to be seen by the provider at the time of the visit rather than having to waste the time at the front desk.

We do take inbound calls for the provider offices and help their patients, keeping the staff worry free of all the questions the patients might have for the check-in process, list of the accepted insurances, any billing questions they might have or appointment booking for the available time slot of the provider. We will always be ready to provide the best support and let the patient feel ease in communicating with us, just like they would talk to the front desk at the practice.

The accuracy of the Clinical Documents and specifically of the provider notes are of utmost importance in the healthcare industry as it directly impacts the revenue on the claim. Additionally, the clinical documentation team at our end are capable of understanding the day-to-day changing insurance mandates related to the documentation sufficiency.

We verify the eligibility (and benefits) of the patient before they are seen at the providers' offices, which makes the provider and the patient clear on the patient responsibilities pre-handedly in order to avoid any discrepancies regarding the insurance reimbursement later on after the care and the patient has left the providers' office.

Our team of Certified Professional Coders (CPC) decides the CPT and ICDs from the provider's notes in such a manner that the provider gets reimbursed at the best, without having to face any insurance or government litigations. Thus, we prevent the providers from reporting any fraudulent services on the claim, generally known as "Prevention of Fraud & Abuse of the Procedures."

When due diligence has been paid in the eligibility and benefits verification process, the next care is to be taken when creating the charges for the patients. Each insurance company has its own set of guidelines which the physicians have to adhere to, if they have to be paid without interruptions and we take utmost care of those guidelines and our Certified Professional Billers (CPB) are constantly getting trained and educated with the changing insurance guidelines in this ever changing era of imposed mandates by the insurances and the government.

Payment Posting is not only posting the payments from the insurance companies, but it also involves the process of monitoring the payments from the insurance companies that none of the claims are being underpaid and affecting the revenue of the hard-working physicians. In addition, we keep an eye on the certain adjustments that are being taken in routine that no adjustments are done recklessly to the claims and the provider is paid in full by this complete process. If not, then the claim is being assigned to the AR and Collection team again

AR stands for Accounts Receivable for the providers and this Receivables arethe blood of any Medical practice which keeps it going. We ensure that the AR of the provider doesn't turn out to bad debts by constantly monitoring the claims by our own set of guidelines which is well proven in the industry and not to mention, these guidelines have also been developed by our certified professional billers which doesn't miss out a single claim for payment. Our bad debts ratio is less than <1 percent and we commit to maintain this throughout the journey.

We take priority on the rejections as those are the claims that have not made their way to the insurances. Then, after that we get ourselves onto the claims that are older than 120 days old and at the same time we stabilize the current AR in such a manner that everything comes under control and we can deliver the AR days to be between 45 to 60 days within just 3 months.

Always, there are credits of the patients in their accounts in the PMS which are most of the unapplied to their outstanding balances and that's where the patients are frustrated and unhappy with the practice; we make sure that it doesn't happen and take care of the application of the unapplied balances so that the actual balances of the patients are reflected on their accounts.

The foremost part in the revenue cycle is to get the provider credentialed and contracted with the insurance companies, and we have to make sure that the insurance companies contracts with the provider at the better rates for each services rendered as the whole revenue cycle depends on the fee schedule signed at the time of initial contracting. This applies to both, the individual provider and the group or facility as well.

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