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
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.
- 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.
- 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.