Description of Services

Coding and Coding Auditing

• Review and assign appropriate ICD-9-CM and CPT/HCPCS codes within client systems
  • Ensure multiple CPT codes not components of a larger, more comprehensive procedure.
  • Assign modifiers as appropriate within client specific coding guidelines.
• Audit clinical encounter documentation prior to billing.
• Provide audit outcomes to appropriate personnel for required actions.

Patient Appointing and Referral Management

• Schedule appointments.
• Gather and update patient medical, demographic and insurance information into the client system.
• Coordinate appointments with other direct-care providers.
• Match patient and provider based on the appropriate Access to Care (ATC) category and detail codes.

Other Health Insurance (OHI) Discovery

• Identify and capture other health insurance through:
  • Insurance Network Databases
  • Personal Interviews with Beneficiaries
  • DD Form 2569 Letter Campaigns
• Promote and educate beneficiaries on the impact and importance of OHI discovery through:
  • Educational events for beneficiaries
  • Established national toll-free OHI Hotline for beneficiary program education
  • Mail campaigns
  • Websites
  • Kiosks

Insurance Verification, Authorization and Pre-certification

• Utilize Signature's Electronic OHI Network to obtain other health insurance plan coverage information.
• Information is updated to ensure the health care facility has highly accurate and complete patient insurance.
• Improves patient and payer relations and velocity of collections while reducing rejected claim volume.
• Patient other health insurance information is validated through:
  • Insurance ID cards
  • Telephone inquiries
  • Electronic inquiries
• Support functions associated with Private Health/OHI Discovery including:
  • Records management support
  • Database/data entry support
  • Report creation and distribution
  • Imaging and filing
• Contact other health insurance provider to obtain pre-certification and/or authorization for treatment.
• Monitor authorization status and notify health care facility once treatment has been approved or denied.

Transcription Services

• Transcribe highly specialized and accredited medical dictation, meeting medical, legal, and organizational requirements.

Records Documentation and Management

• Manage, maintain and support active, inactive, and legacy patient records.

Claims Processing and Auditing

• Generate (electronically and manually) Inpatient, Clinical, Laboratory, Radiology, Pharmacy, Ambulance and other ancillary service claims for submission to patients' insurance benefit plans.
• Review Explanation of Benefit (EOB) from other health insurance payers to ensure proper reimbursement based on the beneficiary's insurance benefit plan and the 32 CFR.
• Manage outcomes of EOB audits through our Accounts Receivable team to determine appropriate follow up activities.

Payment Posting

• Post and reconcile payments from remittance transactions and/or Explanation of Benefit (EOB) received from insurance benefit plans.
• Post approved write offs (i.e. deductibles, co-pays) to the patient account.
• Transactions are performed in the appropriate client systems.

Claims Follow-up, Denial Management and Payer Relations

• Negotiate with the insurance payer on unpaid and/or incorrectly paid claims.
• Facilitate process through Signature's Technology Accounts Receivable System (STARS), a cutting-edge, custom-designed program that ensure follow up, denial management and payer reimbursements are timely and accurate.
• Establish client-customized claims denial and appeal policies, based on insurance benefit plans and regulatory requirements to reduce future denied claims and optimize recoveries.
• Establish key insurance payer relationships to improve cash collections performance, shorten revenue cycle time, improve claims processing, administration, and reimbursements.