Our Comprehensive Revenue Cycle Management Approach

We manage the entire billing lifecycle, from initial data capture through final payment resolution, ensuring accuracy and efficiency at every stage.

Front-End RCM Services: Setting the Stage for Success

• Patient Information Management: While intake often occurs in your EMR, we emphasize the importance of accurate demographic and insurance data capture, which is foundational for clean claims.
• Eligibility Verification & Authorization: We help verify patient insurance coverage and eligibility details upfront to minimize surprises and reduce downstream denials. Obtaining pre-authorizations where required is key.

Mid-Cycle RCM Services: Accurate Claims Processing

• Charge Capture & Visit Verification: We work with your documentation to ensure all billable services and visits are accurately captured. For agencies requiring Electronic Visit Verification (EVV), we integrate with systems like HHAeXchange and Sandata to ensure compliance and accurate billing tied to verified visits.
• Medical Coding Assurance: We stress the importance of correct CPT, HCPCS, ICD-10, and Revenue Code usage based on clinical documentation to ensure compliance and proper payment.
• Timely & Clean Claim Submission: We prepare and submit claims electronically to Medicare, Medicaid (Direct and MCOs), Private Insurance, and other payers. Our focus is on submitting "clean claims" right the first time to expedite payment.
• Specialized Submissions: Expertise in Home Health PPS claims (NOAs, End of Episode), Hospice billing, and CAP/PCS requirements.

Back-End RCM Services: Securing Your Revenue

• Payment Posting (ERA & Manual): We efficiently post payments from Electronic Remittance Advice (ERA) and handle manual posting for paper checks or patient payments, ensuring accurate A/R balances.
• Denial Management & Resolution: We don't just report denials; we actively manage them. We analyze denial reasons, coordinate with your staff for corrections if needed (e.g., clinical/coding errors), contact payers to resolve issues, and resubmit claims promptly.
• Accounts Receivable (A/R) Follow-up: Proactive monitoring of outstanding claims ensures issues are identified and addressed quickly. We follow up on aged claims to maximize collections.
• Patient Billing & Support: Assisting with patient statements and inquiries regarding their portion of the bill (if applicable as part of your service agreement).

Overall RCM Support

• Reporting & Analytics: We provide tracking reports (weekly, biweekly, or monthly) on key metrics like unbilled claims, A/R aging, and payment posting, giving you visibility into your financial performance.
• Compliance: Staying up-to-date with HIPAA regulations, payer rules, and requirements like EVV is integral to our service.
• Dedicated Support: Our experienced billing staff are dedicated to improving and maintaining your agency's cash flow.

CAP/PCS Billing Services

• Medicaid Direct Billing tied to EVV
• Medicaid MCO Billing through HHAeXchange
• EVV Upload to HHAeXchange
• EVV Upload to Sandata

Contact Us

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Home Health Billing Services

• We create and send End of Episode claims to your PPS and nonPPS payers. We start monitoring those claims at least 3 weeks after transmission, until those claims are paid.
• Resolve rejected claims: We work to resolve any rejected claims ASAP to get those claims back out the door for payment.
• Monitor unbilled claims: We run biweekly reports to make sure no claims are just sitting there collecting dust. If there are any issues holding the claim from generating, we provide report to staff.
• Payment Posting: We retrieve and post your electronic remittances. We also process paper check payments from insurance companies, and patient-pay cash/check payments.
• Tracking Reports: We monitor unbilled claims and provide tracking reports: weekly, biweekly or monthly.

We have trained staff with years of billing experience and are dedicated to establishing, maintaining or improving your agency cash flow.