PROVIDER SOLUTIONS

Healthcare is undergoing a profound transformation. The biggest challenge faced by providers in this sector today is how to improve the quality of care provided without increasing the cost. A typical difficulty in this scenario involves getting paid for services rendered. In other words, it concerns healthcare providers working hard to improve the quality of services to patients and yet, not getting paid for it at the end of the day due to an outdated, or simply inefficient, revenue cycle management process. They are falling victim to missed, inaccurate or delayed payments, which in turn are hurting their businesses.

This is where we can make a big difference. Our proactive and streamlined revenue cycle management process gives you complete visibility and assurance of your payments – starting from charge entry to claims submission through payment follow-up.

We have been successfully serving healthcare providers in every domain – physicians, hospitals, urgent cares and durable medical equipment. Our billers and coders are proficient in working in several industry-standard practice management and billing systems, and have an excellent track record in delighting each customer through their expertise, dedication and steady focus on making you realize your payments on time.

Our range of services for healthcare providers produces significant cost advantages for our clients, such as a dramatic reduction in the cost of billing operations, higher revenue & cash flow resulting from a lower denial rate, and in many cases, increasing payments from payers.

We welcome you to explore our widely acclaimed range of solutions geared for healthcare service providers just like you. We will be glad to offer you our powerful yet cost-effective services to help you take your business to the next level of success.

Providing billing services for Durable Medical Equipment (DME), or Home Medical Equipment (HME) as they are sometimes called, can be a time-consuming and tedious affair. Among other things, it requires in-depth knowledge of reimbursement guidelines for Medicare, Medicaid and Commercial Plans. It also requires a constant adherence to quality and staying abreast of all the changes happening in reimbursement regulations, coding and documentation requirements.

We have a highly capable team of DME billing experts who can make life easier for you from the very first day. With us by your side, you can leave all your DME billing worries to expert care. Outsourcing your DME billing requirements to us will allow you and your staff to concentrate on marketing, growing and running business operations, rather than managing a billing and collections department.

Our experience shows that the process for DMEPOS billing can be cumbersome due to its inherent nature, viz. the order getting generated from a physician’s office. This increases complications and the turn-around time as dependencies increase. DME, Prosthetics & Orthotics companies need to devote much time coordinating and communicating with the ordering physician’s office for a valid Rx, medical/therapy notes, etc. Equipment that requires prior authorization also involves innumerable follow-up calls. This is managed effectively by us through a methodical and streamlined process that tracks each request in detail ensuring timely follow-up. Payer guidelines are specific to diagnosis, and a thorough knowledge of this results in drastically reducing denials. Our diligent physician and payer follow-up activities also help reduce turn-around time and improve cash flow. The process starts with entry of orders and ends when the account has zero balance. This includes conducting eligibility checks, obtaining authorization, creating sales orders, scheduling delivery, submitting claims, managing rejections and denials, and proactively following-up AR.

Highlights
  • Follow-up on incomplete prescription with physician’s office
  • Follow-up for document collection (diabetic verification forms, LMN, CMN etc.)
  • Error free patient entry
  • Error free sales order creation
  • HIPAA compliant
  • Real time transaction audits
  • Primary and secondary insurance verification
  • Insurance verification for rental items
  • Obtaining authorizations & extending authorization
  • Open order audit and clean-up
  • CPAP user compliance tracking and counseling calls to non-compliant patients
  • Claims submission within 48 hours of receiving proof of delivery
  • Rejection follow-up within 24 hours
  • Tracking and follow-up of partial or incorrect payments
  • Denial management based on detailed analysis
  • Methodical and proactive AR follow-up
  • Timely payment posting to reflect accurate AR
  • Customized reporting
    • Claims submission
    • Collections
    • Denials
    • Accounts receivables

Our medical coding and billing services are designed to address a wide range of issues and challenges faced by hospitals and physicians while realizing payments. By leveraging efficient processes and billing workflows, we help to improve productivity and quality, which in turn reduces operational cost and boosts revenue generation. Our billing process experts can provide customized solutions to help you achieve your business objectives. These solutions not only dramatically improve efficiency in a manner which is surprisingly cost-effective, but also allow you to focus on the more important aspects of your business.

Medical billing involves accurate interpretation of SOAP notes for correct coding combinations based on payer specific guidelines. A thorough understanding of the nuances associated with various physician specialties is required. This drastically reduces denials, which in turn leads to a significant reduction in days in AR. Denials due to incorrect entry of demographics are minimized through our transaction based internal audit mechanism. Rejections are worked as a priority to reduce turn-around time and detailed analysis of denials helps identify changes in payers’ reimbursement guidelines. Systematic follow-up is also conducted that minimize the possibility of untimely denials while ensuring their early identification, requests for medical notes, etc. All claims that have not been closed out in the system are categorized by age and insurance for effective management of the follow-up process. Billings of secondary claims are also followed up to reduce the patient’s financial responsibility while ensuring better collections.

Highlights
  • Accurate coding combination, i.e. service code, diagnosis code, modifiers and place of service code
  • Error free patient entry
  • Real time transaction audits for patient and charge entry
  • Claims submission within 48 hours of receiving patient (demographic & insurance) and service information
  • Rejection follow-up within 24 hours
  • Tracking and follow-up of partial or incorrect payments
  • Denial management based on detailed analysis
  • Methodical and proactive AR follow-up
  • Timely payment posting to reflect accurate AR
  • HIPAA compliant
  • Customized reporting
    • Claims submission
    • Collections
    • Denials
    • Accounts receivables

Our AR follow-up process monitors and proactively pursues collection of payments. All claims that have not been closed out in the system are categorized by age and insurance for effective management of the follow-up process. Calls are initiated for claims that are 31 days old or more. We attempt to identify the source of the problem through proactive calling so that the turn-around time on collections can be reduced.

Diligent follow-up for paper submissions ensures that “claims not on file” are resubmitted within filing limits. Weekly AR Reports are analyzed and reviewed to prioritize work for the week. All interactions with payers are documented in detail, making repeat follow-ups streamlined and more effective. Our experienced team is adept at gathering information through appropriate probing questions. Findings are communicated with clients through a detailed report on a daily basis. The report also includes suggestions for actions to be taken from the client’s end e.g. resubmitting with medical notes, or with modifier/coding changes, and so on.

Every cash amount receives the same degree of attention as the other, irrespective of its size or source. Combine that with our high accuracy standards and you can rest assured that every penny you are entitled to will be claimed and recovered by us in the shortest possible time! Moreover, our knowledge of pertinent federal laws and acts such as EMTALA (Emergency Medical Treatment and Labor Act), ERISA (Employee Retirement Income Security Act), the Prompt Pay Law and others, help in resolving issues and settling accounts much faster than other AR Managing companies.

Highlights
  • Streamlined and improved workflow using effective tracking tools
  • Multiple follow-up calls for same claim
  • Follow-up on all paper submissions
  • Payer specific analysis
  • Detailed reporting with suggestions for actions to be taken
  • Improved cash flow
  • Reduction in turn-around time
  • 100% HIPAA compliant

Payer Solutions

If you are in the healthcare business and are involved in paying for medical services rendered to different parties under some form of insurance cover, you are probably no stranger to the usual concern over accurately justifying the payment, eliminating fraud and making sure that you are not exploited.

In fact, this is one of the biggest worries of any payer. Is your money going towards a just claim? Are you paying for a genuine cause? Are you sure that you are not being asked to pay for a service that you do not cover?

With our wide range of specialized services tailored for payers like you, Billing and Telemed is uniquely equipped to take care of all such worries quickly, professionally and in a highly cost-effective way.

Take a look at our various solutions and get in touch with us today.

We are a pioneer in the claims process outsourcing arena, with proven demonstrable experience in insurance claims adjudication. We implement procedures and systems that are HIPAA complaint to process and adjudicate medical claims. Our customers are attracted to our relentless pursuit of quality (we offer 99%+ accuracy at claims level). Our processing timelines comply with CMS guidelines. Our claims adjudicators are trained in several industry-standard claims adjudication software programs, and can adapt to any claims adjudication system within a short period.

Highlights
  • Verification of all keyed fields in case of claims that are not submitted electronically
  • Determination of member eligibility and coverage
  • Primary insurance verification
  • Determination of timely filing limit of claims
  • Confirmation of provider status (participating / non-participating).
  • Checking authorization notes for instructions and applying authorization status to claims
  • Identification of duplicate / corrected / interim / final submissions
  • Determination of DRG
  • Apply case-rate / per diem to services within the purview of the case-rate / per diem contract
  • Determination of correct allowable
  • Ensuring that co-pay, coinsurance, deductible and OOP are accurately calculated and applied as per the benefit plan
  • Use of appropriate remark/adjustment codes
  • Real time audits
  • Customized reporting
    • Inventory Report
    • Quality report
    • Production report
    • Pend report
    • Skip Report

Credentialing is the process of obtaining, verifying, and evaluating qualification of a provider and determines whether an applicant is qualified to be a participating provider with the organization.

We are happy to aid provider groups as well as clients with a complete range of credentialing services through a time-tested technique that ensures organizational providers are compliant with state and regulatory bodies before directing membership to these facilities.

Proper credentialing requires a watchful eye for total and stringent compliance with applicable standards. It also requires that applicants are evaluated in the right manner and their competencies are measured accurately. For this, a number of resources are consulted such as the social, academic and professional history of the applicant, peer and expert reviews, end-user reviews on the quality of the applicant’s services, and more.

We are fully equipped to take care of all these requirements quickly and efficiently. We approach the subject in an organized and systematic manner. The key components of our credentialing process are highlighted below.:

Highlights
  • Full range of credentialing services
  • Re-credentialing after every 3 years
  • Regular update of provider data in credentialing and claims systems
  • Generation of all pertinent reports:
    • HSD Report
    • Physician and Facility Reports
    • Weekly ADD/TERM report
    • Delegated credentialing report
    • Group/taxonomy etc. specific ad-hoc reports

We work with a full team of credentialing veterans who strictly abide by the standards and guidelines set within Medicare Managed Care Manual and National Committee for Quality Assurance (NCQA). So, why look anywhere else?

The Billing and Collection team provides customized and decisive solutions to Medicare and Medicaid HMOs, Commercial Insurance plans as well as PBMs, enabling them to achieve sustainable results. Our certified public accountants and financial analysts manage each process, using our robust data warehouse and state-of-art technology.

We are fully equipped and well-positioned to cater successfully to all the needs of our clients, providing them with sound, full-cycle billing and collection solutions. And all of this in a surprisingly cost-effective manner.

Highlights

Our Billing and Collection services include:

  • Data Preparation and Entry
  • Accounts Payable and Receivable
  • Premium Billing
  • Payment Tracking/Logging and Member Premium Reconciliation
  • Plan to Plan Reconciliation
  • Risk Management
  • Report Generation, including DOI (Department of Insurance) Reporting, Cash Flow Statement, Segmental Report etc.
  • Risk Sharing and Yearly CMS Payment Reconciliation

Utilization Management is the evaluation of the appropriateness and medical need of health care services, procedures and facilities, according to preset criteria or guidelines, and also under the provisions of an applicable health benefits plan. It is a critical and core component of the healthcare system in the US and requires professional expertise to a very high extent.

We specialize in providing our clients with a full range of Utilization Management services for Part A, B & D. Trust our accurate and timely reports, strict adherence to UM codes, efficient evaluation by qualified medical professionals and proven expertise to bring you robust and reliable Utilization Management solutions.

If cost-effective Utilization Management services are on your mind, look no further. Contact us today!

Highlights
  • Dedicated team comprising physicians and pharmacists
  • Medical transcription of clinical notes to aid in decision making in client specific systems
  • Collection of additional clinical information from physician’s office
  • Final decision made by qualified physicians and nurses in the US
  • Reducing the standard procedure turnover time from CMS mandated 30 days to 7 days for Part A & B Utilization Management and from 72 hours to 48 hours for Part D Utilization Management
  • Expedited procedure to determine authorization within 24-36 hours
  • Standardized process and effective application of appropriate tools before rendering any decision
  • Specialized clinical customer support 24x7 Help Desk

Technology Solutions

Harness the power of technology to take your business to the next level of efficiency and profitability. With our wide spectrum of technological services, you now have everything you need to make your business a roaring success even as the competition increases.

The Billing and Telemed teams of SunKnowledge, GoTelecare and ProblemSolvers are proud to bring you this powerful range of business solutions that could make all the difference to your business.

We boast of an experienced and highly skilled in-house team of coders, designers, database administrators, software developers and IT professionals, ready to provide you with powerful proprietary applications and fast enterprise solutions to improve your processes and cut costs like never before.

Get in touch with us today and discover how you can surge ahead of your competition.

We help clients build and maintain a flexible and secure IT infrastructure. With our experience in maintaining health care IT systems, clients can rest assured about their data security, while complying with industry standards and best practices such as HIPAA, ISO 27001:2008, etc.

We offer valuable guidance to our service-users on how to systematize, maintain and manage their software assets, consistently and flawlessly, throughout their life-cycle. Our competent IT professionals provide clients with an exhaustive range of solutions, allowing maximum cost-containment and addressing their business challenges effectively.

Our broad spectrum of software services includes:
  • Business Analysis and System Design
  • Technology Architecture Consulting
  • Application Software Development
  • Maintenance and Technical Support
  • Production Support
  • Troubleshooting and Issue Resolving
  • Managing Updates and Patches, and more!
    • We have experience and expertise in working on many platforms and systems including Java (Java SE/EE, Struts, Spring, Hibernate/JPA, Axis), Web Application Servers (Tomcat, JBoss) and Databases (Oracle).

      Combine our proactive consulting services, technological knowhow and domain expertise, and you’ve got an explosive mix to improve your process efficiency, streamline administration, multiply profits and blow the competition away!

We provide comprehensive multi-level support solutions for our clients with our skills and expertise in a wide range of IT systems. Combined with 24/7 automated system monitoring and around the clock support personnel, we assure prompt issue resolution, helping us maintain strict Service Level Agreements.

We are capable of providing solutions and support across various IT systems.

Network Infrastructure
Our specialists can provide solutions across multi-vendor network system, such as UTM firewalls, network load-balancers, routers and L2 & L3 switches from Cisco, Checkpoint, Fortinet, Sonic wall, Juniper, F5, HP and other leading brands.
Server Infrastructure
  • Microsoft Active Directory Domain service management with multi-domain infrastructure
  • Manage and optimize cross-platform in-house and external web hosting services
  • Manage and monitor email systems such as Microsoft Exchange 2013, Microsoft Office 365, Google Apps for Business, etc.
  • Design, implement and maintain business application server infrastructure
  • Design and implement scalable virtual systems
Telephony Infrastructure
  • Manage telephony systems Avaya IPO and communication manager
  • Manage, monitor and support cloud hosted telephony systems. RingCentral, 8x8, etc.
  • Design, implement and support Call center systems with IVR, ACD, skill-based routing, recording and reporting

HOME HEALTH CARE

  1. Reduce transportation costs
  2. Increase provider specialist access
  3. Minimize patient risk by eliminating transportation
  4. Maximize staff efficiency

TELEMEDICINE SOLUTIONS

A payer neutral, HIPAA secure, doctor-to-patient video teleconferencing platform with built-in Electronic Medical Record (EMR), medical billing and mHealth capabilities that requires little to no up-front expense for implementation, and no additional out-of-pocket expenses for patients.

Key Facts

  1. Comprehensive end-to-end telemedicine solution
  2. No upfront cost, software to purchase, nor implementation costs
  3. Customizable telemedicine platform to meet your program goals
  4. Only computer, laptop, or smart phone required
  5. HIPAA & PCI Payment Compliant
  6. Scheduling, medical billing, & collections included

Our Telemedicine Solutions are applicable to the following:

HOSPITALS

  1. Reduce Re-admissions
  2. Reduce Emergency Room wait times
  3. Increase Patient Satisfaction
  4. Customizable telemedicine programs

HOME HEALTH CARE

  1. Reduce transportation costs
  2. Increase provider specialist access
  3. Minimize patient risk by eliminating transportation
  4. Maximize staff efficiency

NURSING HOME

  1. Improve state survey scores
  2. Increase provider specialist access
  3. Decrease hospitalizations
  4. Generate revenue through Medicare reimbursements*

ASSISTED LIVING

  1. Offer provider visits on-site to distinguish your community
  2. Decrease ER visits with immediate access
  3. Increase patient and family satisfaction
  4. Integrate with remote patient monitoring

INSURANCE PLANS

  1. Improve state survey scores
  2. Save on transportation costs
  3. Maximize the provider network
  4. Reduce preventable Urgent Care and ER visits
  5. Avoid ER visits and inpatient hospitalizations

HEALTHCARE PROVIDERS

  1. Generate revenue on off-hour calls
  2. Work from home, office, or virtually anywhere
  3. Grow your income by connecting with new patients
  4. Expand your patient geographical reach