We follow the guidelines and billing software to minimize your workload right from data entry to smoother functioning of your operations. We are here to provide a complete solution by integrating advanced technology with highly qualified and knowledgeable billing professionals. With our experienced billing professionals, the chances of errors are very low or negligible sometimes. We put effort into making the claim settlement process faster and more cost-effective.

  • Patients Registration and updating records timely.
  • Compared to your existing costs, increase savings up to 40% with us.
  • Following HIPAA Compliant process and providing remote access solution to keep control over the data.
  • Within 30 days or less, get a quick and uninterrupted transition to Clincs4Health's operations centers.

In general, we check whether the patient policy is still active or not on the given treatment date and also check whether the service provided by the doctor comes under that policy. So for the purpose of reviewing eligibility and benefits, the provider or any of his staff is supposed to verify the patient policy by calling or checking on the insurer’s website. For California Workers’ Compensation, We ensure your claim reaches the right party and gets paid timely as we verify in detail the injured worker’s claim information, accepted body parts, and payer information before sending your claims to the party.

Our work is to take care of all your insurance verification needs and can provide you with details regarding patients, also reducing the number of denials and achieving more fabulous collections at the first attempt.

In medical terms, it is essential to know in depth about the decision by your healthcare insurer or plan regarding a healthcare service, treatment plan, prescription drug, or durable medical equipment. We also call it prior authorization, prior approval, or pre-certification. To know and decide whether the medical treatment or services requested are necessary, forward a request for authorization in the prescribed form or format by your insurer, including essential information for the Utilization Review Department.

As a part of RCM Solutions Package, Clincs4Health Solutions presents this much-needed insurance authorization service.

  • Submit Authorization Requests for all Insurance Carriers
  • Assigned On-Demand Specialist
  • Get Quality Insurance Authority Service
  • Take good care of Request for authorization requests applicable to California Workers’ Compensation.

Are you worried about delayed claim processing?

Now all you need to do is connect with our highly expertized team of billing professionals and get the claims sent to payers faster, with more accuracy, and reduced costs. We have qualified and knowledgeable billing professionals who work on highly advanced technology to provide you with an impeccable solution that minimizes data-entry work using guidelines and billing software.

  • Experienced billing professionals charge for Multi-specialty entry.
  • To have fewer denials and underpayments, clean all claims before submission.
  • Necessary claim attachments or Paper Billing Submission.

Once we submit claims to insurance companies electronically or by paper mail, we continuously keep tracking to ensure provider claims reach the payer timely and they get paid. We keep a check by calling insurance companies and looking over their website activity.

Once we submit claims to insurance companies electronically or by paper mail, we continuously keep tracking to ensure provider claims reach the payer timely and they get paid. We keep a check by calling insurance companies and looking over their website activity.

Phase I – Initial evaluation of medical Account Receivable Follow-up

We begin the follow-up process after running the aging report within 15-20 days of electronic claim submission. Our focus is on ensuring that each claim has reached the correct payer. We take care that for any additional information or some other reason, no claim gets refused by the insurance company, and ordinarily, private companies process the claim within the same time frame.

If there is any denial by the insurance company due to any inaccurate reason, we need 15 days to document the same for follow-up, but we mostly try to resolve it on call.

Phase II – Analysis and prioritizing medical Account Receivable Follow-up

Our experienced medical A/R analysts begin this phase by discovering various issues for uncollectible claims (marked as bad or invalid) or claims where the contracted rate is not paid to the carrier.

Our team ensures that “clean claims” will be reimbursed according to the contracted fee schedule. We check the filing/appeal limits of the major carriers. We ensure that claims must stick to the correct processing unit by checking the claims submission address.

Phase III – Collecting the maximum of medical Account Receivable Follow-up

Once verification of all the essential billing information (Claims processing address and other medical billing rules) is found accurate, only then re-filing is possible. For this, our team will analyze claims that are supposed to be within the filing limit of the carrier.

Additionally, supporting documents are required for claims exceeding the filing limit of the carrier and claims that turn up to be underpaid by the carrier. Appeal procedures differ considerably depending on the plan, carrier, and state. Pile up these procedures and implement them on claims that are being appealed.

Wherever possible, we will pass the claims electronically to the carrier or through a clearinghouse for other carriers. We will forward the claims and follow up for confirmation.

Accomplishment to medical Account Receivable recovery

The significant achievement of the Cash Acceleration Program depends on several factors: Undoubtedly, the completeness and accuracy of the account data provided are of prime importance. In order to perform extensive collection efforts, Clincs4Health Solutions provides the protocols, expertise, and other necessary resources. We have received full support and high-level cooperation from the provider’s office for our successful programs.

We have designed a Cash Post Solution for our clients, and can you believe we generally need one business day to get all our client payments posted accurately in the billing system. It sounds excellent that our primary focus is on providing cost-effective solutions.

  • Post payments from EOBs by billing professionals, charge slips, and other documentation
  • Supporting payer billing
  • Easy management and posting of denials
  • Timely processing write-offs and other adjustments
  • Detailed verification of all payments posted
  • Reduced chances of errors and eased the reconciliation process
  • In comparison to your existing costs, save up to 40% with us
  • Consistent processing

Our Revenue Cycle Management Services

Revenue cycle management has a significant impact on the way your hospital or medical practice functions. The rising cost of healthcare combined with strict regulations which keep changing regularly has made daily operations a chore for healthcare operators. A modern healthcare provider needs policies and practices in place to remain financially secure. With our customized revenue cycle solutions, you can see a visible impact on your day-to-day operations while benefiting from enhanced customer satisfaction and improved claims submission and returns.

Whether you are a healthcare provider or an individual physician, we can provide services that will meet your exact needs. Our wide range of healthcare revenue cycle management services include –

Payment Posting Services

We can ensure quick and accurate posting of all payments into your billing system. We also do regular auditing of all posted payments, which helps to reduce errors. Read our article which highlights the 5 key advantages of payment posting in medical billing.

Denial Management Services

Insurance claim denials are a major pain point for healthcare businesses around the world. We can help you analyze, correct, and re-submit denied claims. This process includes identifying denials by revenue coding and CPT/HCPCS codes. Once this is done, the reason for the denials is analyzed and a detailed denial management report is prepared. In this way, you can effectively manage claim denials. Read our article which provides 7 tips to improve denial management of healthcare claims.

Accounts Receivable Follow-up

We take care of all discrepancies that result in delayed or denied receivables. Our AR professionals will identify discrepancies and follow-up with the shortcomings to ensure that healthcare providers are paid on time. Our team will follow-up on pending claims, initiate collections and track down overdue payments to maximize the cash flow.

AR Calling Services

We will identify the unpaid dues that are causing a bottleneck in your revenue cycle management system and follow-up with delinquent patient accounts. We will courteously engage patients and urge them to make timely payment of pending dues. We will also call the insurance companies to send details about rejected claims.

Insurance Eligibility Verification

Checking eligibility of the patients can be time-consuming because it is a resource-intensive task. This is completely taken care of by our trained professionals who will check all medical documents, verify the patient coverage, follow-up with patients if there is a shortfall in the supporting documents. The final report will be filed for faster processing.

Medical Claims Processing Services

We can manage both electronic claims submissions as well as submission of paper claims. Our experienced team prepares the Explanation of Benefits (EOBs) and submits the claims to the insurance company.

Accounts Receivables Services

We can help you identify patient accounts that require follow-ups and take the requisite action to collect unpaid/underpaid claims. Our services include –

  • Accounts receivable analysis
  • Identification of the grounds for claims denials
  • Follow-ups on pending claims We can also prepare monthly reports that can help you manage your cash flow and increase profitability. These include reports related to –
  • Aging A/R
  • Charges, payments, and adjustments
  • Payment punctuality for different Payers
  • Payer mix In this way, we provide a range of hospital revenue cycle management services that can help you work better.

Medicare Reimbursement Services

We help you successfully optimize compliant Medicare reports, which is challenging, especially when the federal and state regulations are continually changing. We have expertise in comprehending multi-layered legislation and applying it to ensure the most optimum Medicare reimbursement on an ongoing basis.

Medical Claims and Encounter Processing Services

We assist clients in submitting encounter data to the respective agencies. Our encounter processing services are HIPAA compliant and manage end-to-end testing and certification logistics. We receive, transform, and transmit full and compliant encounters.

Revenue Improvement Services

If you think your revenue stream is affected by manual or traditional management of back-end functions, we’ll take away your concerns by offering high-quality revenue improvement services.

Patient Registration

We can help you process your patients’ personal, demographic, and all insurance-related information. At each step of the process, we ensure that we verify and validate patient information. During this step, easy identification of insurance mismatch, wrong provider details, etc. can help you avoid losses down the line.

Medical Coding

Strict regulations and increasing instances of self-pay have led to increased risk in medical coding. Our accurate medical coding services can help you create and streamline patient records within a short period of time, while accelerating physician payments. Our team is comprised of Certified Professional Coders (CPCs) accredited by the American Academy of Professional Coders (AAPC). They work in accordance with the updated standards and methodologies laid down by CMS, Medicare contractors, AMA, medical societies, and federal organizations.

Charge Capture

Charge capture is extremely important since it helps doctors accurately record the entire information of services provided. This information is then sent to different payers and insurance companies for quick and timely reimbursement. We can process charges for multiple specialties within a short turnaround time. We have extensive experience in handling –

  • Medicare
  • Third Party Liability
  • Medicaid
  • Managed Care
  • Preferred Provider Organizations
  • Indemnity Insurers
  • Workers Compensation

Custom Reporting

Our services are ideal for healthcare providers who want a 3600 outlook of their RCM system, and how it’s affecting their bottom line. We create custom reports through powerful dashboards which you can access from any location and device. Our services consist of –

  • Charge and Payment reports
  • Procedure frequency and diagnosis reports
  • Payment reimbursement reports
  • Lockbox reconciliation reports
  • Payor analysis reports