Description of Services

Patient Access

• Scheduling Appointments.
• Gather and update patient medical, demographic and insurance information into the client system.

Other Health Insurance (OHI) Discovery

• Identify and capture other health insurance through:
  • Signature Insurance Network Databases
  • Personal Interviews with Beneficiaries
  • Collection of Beneficiaries Insurance Card(s)
  • 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 and Authorization

• 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

Insurance Administration and Support

• Support functions associated with Private Health/OHI Discovery including:
• Records management support
• Database/data entry support
• Report creation and distribution
• Imaging and filing

Pre-certification and Authorization

• 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.

Referral Management

• Coordinate appointments with other direct-care providers.
• Match patient and provider based on the appropriate Access to Care (ATC) category and detail codes.

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.

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.

Claims Processing

• Generate (electronically and manually) Inpatient, Clinical, Laboratory, Radiology, Pharmacy, Ambulance and other ancillary service claims for submission to patients' insurance benefit plans.

Claims Auditing

• 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.

Claims Follow Up

• 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.

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.

Denial Management and Appeals

• Establish client-customized claims denial and appeal policies, based on insurance benefit plans and regulatory requirements to reduce future denied claims and optimize recoveries.

Payer Relations

• Establish key insurance payer relationships to improve cash collections performance, shorten revenue cycle time, improve claims processing, administration, and reimbursements.

Contract and Program Management

Assure clients receive maximum value from vital contractors and vendor relationships by offering the following Contract and Program Management Services:

• Contractor selection
• Scope of work
• Goal-setting
• Performance measurements
• Performance incentives
• Contractor compensation
• Contractor relationship management and communication
• Contractor performance, compliance and audit management

Revenue Cycle Training Consultative Services

Highly-trained consultants help facilities develop A/R strategy and execution plans needed to align the Revenue Cycle program with the organization's overall mission and goals.

Services include:

• Operational review of Revenue Cycle (full or partial review)
• Revenue Cycle strategies
• Revenue Cycle business processes
• Successful execution and fulfillment practices for in-house Revenue Cycle servicing
• Staff production and performance
• Staff goal setting and measurement
• Staff training (all Revenue Cycle functional areas)
• Employee engagement
• Staff performance scorecards
• Portfolio segmentation treatment modeling

Health Care Revenue Cycle Program Education and UBO Program Representation

Provide subject matter expertise in support of and/or by attending Army/UBO/DoD Program Management meetings which align with Health Care Revenue Cycle program strategies, goals and objectives.

As subject matter experts, provide training or support of personnel to help realize the full potential of the revenue cycle program.

Identify specific training needs with a training resolution plan, as well as support recommendations (as needed) to designated leadership for each specific health care facility.