Our Solutions: Complete Patient Financial Services

 

Patient Financial Services Program:

Includes bill production, mass batch processing, claims submission, claims follow-up, collection practices, reduction of write-offs and contractual allowances, bad debt assignments, payment remittance/vouchers, denial trending, collector productivity standards, net account receivable reporting vs. gross receivable (customized with daily dashboard management), payment posting, denial management, monthly performance assessments, ongoing financial improvement initiatives and open book management. ESI billers are trained to create clean claims validated through standard and custom edits prior to electronic claims submission to payors. ESI staff includes billing specialists for each payor type. Cross training is also performed for staffing maximization. Processes included in outsourcing services:

• Utilizing robust claims editing software with both standard and custom edits, bills are submitted electronically and accurately to various payors. Paper claims are only created when required.
• Policies and procedures are followed based on HIPAA, OIG, CMS, and DOJ initiatives. Risk is reduced and managed.
• The complete itemized bill is audited for accuracy including over/under charging behaviors, the medical record is verified, and all necessary adjustments are made to patient accounts.
• Backlog elimination projects or specialty billing are available to be performed by third party payor type and/or provider type.

Accelerated Secondary Billing:

ESI uses a financial information query system for inefficiencies associated within the 14-day Medicare payment hold. ESI’s accelerated secondary billing program automatically queries the Medicare Intermediary database to obtain claim status and intended payment amounts as soon as three days after claims transmission. This program generates a secondary claim up to 12 days sooner, enabling providers to recoup cash faster and with minimal manual effort. With ESI you can:

• Accelerate payment processing by automatically generating secondary bills as soon as 12-days prior to the Medicare’s Remittance Advice.
• Reduce the intensive manual effort required to identify and process supplemental claims
• Eliminate the need to buy and store claim forms because secondary claims are printed on laser copy paper in the correct claim format.
• Reduce outstanding AR days because secondary payors are billed before the remittance advice is received from the primary payor.

Cash Posting:

By outsourcing the cash posting process as part of the revenue cycle, accuracy of payment posting and reimbursement is improved dramatically. The following are some of the services offered:

• Thorough scanning and interface technology, EOB’s and checks are scanned and indexed at the patient account level, eliminating paper from the revenue cycle and creating access to all documentation electrically.
• Payments are analyzed at point of posting for accuracy and underpayments are identified and appealed to the payors immediately.
• Managed care and other contracts are continuously analyzed for compliance and contractuals are posted at the time of billing.

PFS Business Processes:

Software and best practice principals streamline business office processes to help organizations manage patient accounting documentation, collections, accelerated payments, and long term patient tracking databases.

Back-End Revenue Cycle Consulting Services:

Ensures revenue cycle success by focusing on processes and technology to improve cash flow, produce fewer claims denials, reduce payment delays and increase cash collections.

TPA and Claims Administration Services:

A highly customizable, HIPAA-compliant solution for the effective administration and adjudication of healthcare claims. These services are offered and are used by both our healthcare payor and provider partners in a variety of ways: handling industrial accounts; self-funded HSAs; medical school grant affiliations for indigent patient populations; professional and facility billing; relationships with correctional/prison facilities; and tax subsidized organizations and state programs.

TPA services include the pre-implementation business-requirement gathering and documentation, development of rules-based edits, and custom configurations.

Transaction Solutions Hub for Healthcare Providers:

ESI clearinghouse services with web-based interface and a suite of integrated solutions for collaboration amount providers and payors.