Four services,
or all of it.
Practices come to us for one of these or for the whole revenue cycle. Either works. What does not work is taking on the back end and never touching the front end, because most of what denies at the back was decided at the front.
Most denials are decided before the patient arrives
Eligibility is not a checkbox at the front desk. It is coverage active on the date of service, the right plan out of the several a patient may hold, benefits that apply to the specific thing you are about to do, and the patient responsibility that follows from all of it. Run the day before rather than the week before, because plans terminate and nobody sends you a note when they do.
- Real-time benefit checks against the plan active on the date of service
- Coverage confirmed for the specific service, not just for the patient
- Patient responsibility estimated before the visit rather than billed after it
- Secondary and tertiary coverage identified up front, not at the second denial
Posting is where underpayment becomes visible, or invisible forever
ERA posts automatically, the remainder posts by hand, and both get reconciled against the bank rather than against the claim. The reason to do this properly is not tidiness. A payment posted without comparing it to the expected contract rate turns an underpayment into a closed account, and a closed account is one nobody looks at again.
- ERA and EFT reconciled against the bank, not just against the claim
- Manual posting for everything the remittance does not cover
- Payments compared to expected contract rate so underpayment surfaces
- Adjustments and write-offs coded by reason rather than lumped together
Forty denials with one cause is one problem, not forty
Denials get sorted by CARC and RARC code rather than by dollar value, because the same reason repeating is a workflow defect and working them one at a time never fixes the thing producing them. Appeals go out on a schedule, with the documentation the payer actually asked for rather than a covering letter. What cannot be recovered gets said out loud instead of quietly written off.
- Denials grouped by reason code so the pattern is visible
- Appeals worked to a fixed schedule rather than whenever somebody reaches them
- Root causes routed back to the front end, where they were created
- Unrecoverable claims named, with what it would have taken to save them
Aged A/R is a project, not a queue
Receivables left by a previous biller, a closing practice or a system migration do not behave like current claims. Timely filing windows are often already spent, the documentation may sit in a system you no longer have a login for, and the economics of chasing a balance change with its age. Worked as a project with a defined scope and an honest view of what is realistically still collectable.
- Aged A/R broken out by bucket and payer before anything gets worked
- Timely filing exposure assessed so effort goes where it can still be paid
- Findings given in writing, including what is not worth chasing
- Practices in transition supported through to close, not abandoned mid-wind-down
These are what we do. Which specialty you are in changes how they are done.
Denial management in an infusion practice is mostly unit math and prior authorization. In an orthopedic practice it is mostly modifiers and global periods. The service is the same word and a different job, which is why the specialty pages exist.