REVENUE CYCLE MANAGEMENT

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Reduce the burden on your billing staff and minimize administrative costs.

Grandeur Healthcare can handle virtually all aspects of the revenue cycle process. We can do your work either by function, or you can trust us to effectively handle the end-to-end revenue cycle management of your billing company, on your software platform.

Patient Registration, Charge Posting and Demographic Entry:

The first step in a clean claim is to make certain that the demographic information has been entered into the system correctly. This process involves collecting patient demographics from clinics and hospitals. Our team is trained to process, verify, and validate demographic information into the billing system. We also enter entire patient demographics in TMNDX and interact with the client to obtain missing information. Our expert billing team at Grandeur Healthcare shall also take care of your complete charge posting form the super bill.

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Payment Posting/Adjudication, Reconciliation, Adjustments and Denial Processing: (I feel too much content, you are the expert to do editing) 

Grandeur Healthcare saves you from the trouble of denials, adjustments and delays by resolving them quickly to ensure that patients fulfill their responsibilities.
Grandeur Healthcare makes it a smooth-sailing ride for patients by dramatically reducing their labor to, as our team bridges well framed documents after proper scrutiny before they are submitted and received.
Insurance payments are posted to patient accounts from EOB’s into the client’s software systems, with a turn-around-time between 24 to 48 hours. Whether you have electronic lock-boxes or receive hundreds (or thousands) of EOB’s mailed weekly to your office, this information must all be posted to a patient’s account in a timely manner. Adjustments or denials must be adjudicated promptly to insure that patients understand their payment responsibilities. Of equal importance is to have the practice’s accounts receivable reflecting the most current payment receipts.

Using Grandeur Healthcare’s Payment Posting service, your staff is freed from this labor intensive function. You will have the comfort of knowing that all payments will be posted and reconciled on the day we receive the EOB’s. At the end of the month, your monthly payment will be posted and reconciled. In addition, you can also have Grandeur Healthcare handle the adjudication of a claim (see below) based upon your specific instructions. We also generate secondary claims and mail them to the correct insurance companies.

Getting this information to Grandeur Healthcare is easy. If you are receiving paper EOB’s you need only scan them to a secure FTP site for us to work with. If you have electronic lock-boxes, we can interface with them to get the information we need. Being tied in to your practice management software allows us to make all information available to you on a real time basis. As an added benefit of our Payment Posting service, we will index the EOB’s to the appropriate patient record (subject to your practice management software) allowing you to find specific EOB’s by simply going to a patient record. This alone can save you many hours in searching for a particular EOB to answer a specific question.

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There are many times when an insurance carrier does not pay the entire claim. Grandeur Healthcare will handle the final adjudication of a claim based upon parameters provided by its clients. Our staff will contact the insurance carrier to determine reason for non-payment and, based upon your wishes, take the appropriate action. At times this may simply mean going into your practice management system to resolve the issue; at other times Grandeur Healthcare may contact the appropriate office for further information. If the claim is to be resubmitted, Grandeur Healthcare will do so. In any event, this service will take away the labor, time and cost associated with your staff handling this function.

Most insurance carriers are required to pay the claim or provide a denial in writing within 30 days of receipt. Using our proactive approach to handling denials, we can improve your “days in AR” substantially. All the denials are segregated and forwarded to our denial management team for prompt resolution. The team then measures, monitors, analyzes, and resolves all the denials received from each payer.

A/R Follow Up & Claims Statusing – Insurance & Patient Collections:

Next to growing your practice by providing the best in patient care and the most efficient and patient-centric environment, maintaining your accounts receivable at an acceptable level is vital for your continued success, whether you are a single practice or large HEALTHCARE group. Once claims begin to exceed 30-45 days of non-payment, you run the risk of reducing cash flow as well as being denied payments for a variety of reasons.
Grandeur Healthcare’s experienced staff of A/R specialists works with thousands of claims daily, resolving issues with insurance carriers so that you can get paid in a timely manner and at the highest level of reimbursement. Based upon parameters provided by our clients, and because we are tied into their practice management software, we can run necessary reports of those claims that require action be taken.

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Through our Claims Statusing service, we will determine the reason for non-payment of a claim and provide our clients with details as to what is required to “fix” and resubmit the claim. As an alternative, we will determine the reason for the claim not being paid and handle the adjudication and resubmission of the claim saving your office the time and labor to accomplish this function. In either case, your claims will be handled in a timely and efficient manner reducing your outstanding A/R.

In addition to our working with claims once they reach a certain aging, many of our clients provide us with the backlog of A/R claims (some dating to one year or more) as an initial phase of our work with them.

With regard to patient collections, Grandeur Healthcare has a set of specialists (fluent in English and Spanish) who work with its clients to collect outstanding patient balances. Prior to beginning such collection efforts, clients have the opportunity of “interviewing” our agents to hear, first-hand, their skills in dealing with patients. Grandeur Healthcare, of course, complies with the Fair Debt Collection Practices Act in all of its patient collection activities.

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Fee Schedule Maintenance:

In addition to the beginning of a calendar year, fees may be changed at any time for hundreds of plans. Many times, this information is received by the practice but just sits in a desk drawer due to the lack of time to update current fee schedules. Incorrect fees affect many areas of a practice including, treatment plans, patient expectations, claims processing and A/R follow up. The wrong fee causes delays in payment and may have a negative effect on patients who must be told that their responsibility is different from what originally was explained to them.

Grandeur Healthcare’s staff will enter all fee schedules in your practice management software and maintain them on an on-going basis. This coupled with Grandeur Healthcare’s Eligibility/Benefits Verification and re-verification services insure that treatment plans are correct and that claims are processed accurately leading to increased cash collections, fewer denials and increased revenues.

Credentialing, Enrolment & Re-Credentialing:

Grandeur Healthcare provides physicians with efficient and fast, enrolment and credentialing services, and enables them to focus on their core business of providing quality healthcare to patients.

For larger HEALTHCARE groups and practices that are adding practitioners or opening new offices, the need to insure timely credentialing and enrollment of providers is vital to the success of the operation. Until practitioners are properly credentialed with appropriate insurance carriers and for specific HEALTHCARE locations, claims cannot be submitted and cash flow is severely impacted.

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Grandeur Healthcare’s experienced credentialing specialists will insure that all the information required for credentialing is obtained from the practitioner (generally through a contact at the HEALTHCARE office), format the information to meet the specific needs of each insurance carrier, submit such information to the insurance carriers and follow-up the enrollment process. We are involved in credentialing and re-credentialing all licensed individual medical practitioners including physicians, facilities and non-physicians with whom it contracts and who fall within its scope of authority and action to ensure that network and federal program enrollment is complete and up-to-date. Grandeur Healthcare will also maintain a data base of all such information and monitor it on a regular basis to meet re-credentialing requirements.

We are able to complete enrolments in 45-60 days using authenticated sources like NCQA and URAC guidelines for primary source verification.

Credentialing:

We provide the following services:

  • All Credentialing for Medicare and Commercial carriers (including DME credentialing);
  • Coordination with client to collect all appropriate documents;
  • Preparation of data base of providers showing status of all documents;
  • Completion of enrollment forms for insurance carriers;
  • Follow up with Insurance Carriers until applications are approved;
  • Tracking of providers for re-credentialing purposes;
  • Handling of the re-credentialing process as above.

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