ABA Therapy Billing

Our after hours answering service is the affordable, cost-effective solution for your practices looking to provide continuous care for your patients.  Our highly trained healthcare professional team is a group of night owls with a passion for service that never sleeps. If your in-house team is like all others and leaves for the day, then you could benefit from an after hours professional team.

We create a customized after hours answering service solution for you. Our live telephone answering services for evenings, nights, weekends and on-call situations can be tailored to meet your requirements.

HERE’S WHAT YOU CAN EXPECT FROM AFTER HOURS ANSWERING SERVICE:

• Highly-trained, professional agents who know your practice inside and out.
• Greatly increased availability for staff to help your patients.
• Out of hours call answering so phone calls are never mishandled or unanswered.
• A dedicated professional team who has a passion for customer service.
• Reliable call answering service coverage during evenings, overnight, on weekends, and whenever you step away from the office.
• Full access to our call management systems and tracking tools to measure our effectiveness and customer satisfaction.

The accounts receivable follow-up team in a healthcare organization is responsible for looking after denied claims and reopening them.

Collection of Accounts Receivable is essential to any medical practice but it is not an easy task. Rebekah Medical Consultants team of professionals follows efficient methods to recover the receivables, analyse the outstanding receivables and effective follow-up with insurance companies.

Clinical documentation is at the core of every patient encounter, and supports the reporting needed to measure clinical quality and secure accurate and appropriate reimbursement.  A robust Clinical Documentation Improvement (CDI) program may be essential to your preparedness for the ICD-10 transition. Our Clinical Documentation Improvement for Hospitals and Health Systems helps to ensure that clinical documentation is accurate, timely, and clearly reflects the scope of services provided.

Our professionals provide ongoing education and improvement initiatives to help your CDI programs support complete and accurate reporting to your stakeholders.

After the ICD-10 transition, continuous education and monitoring will remain critical as the industry and payers continue to adjust and develop new methods to incentivize higher quality patient care.

Clinical Documentation Improvement (CDI) is growing in every leading U.S. hospital system.

These programs directly impact quality measures, admission standards, acuity and severity levels, clinical indicators, resource utilization, pay-for-performance, value-based purchasing, population management and advanced model initiatives that require exceptional specificity of clinical documentation and accuracy of reporting.

Ways to Ensure Clinical Documentation Improvement (CDI) Success

• Standardizing care across teams.
• Reducing claim denials and increasing reimbursements.
• Managing procedure quality and bench-marking.
• Improving patient throughput and satisfaction.
• Developing more thorough, accurate procedure notes.

Here are three reasons why implementing a CDI program can prove beneficial to your healthcare organization:

• Quality reporting leading to accurate documentation.
• Achieving positive brand awareness.
• Minimizing room for medical error through improved communication.

The importance of clinical documentation

It captures patient care from admission to discharge, including diagnoses, treatment and resources used during their care. When the documentation is complete, detailed, and accurate, it prevents ambiguity, and improves communication between healthcare providers.

Key Benefits

• Enhance clinical documentation specificity to support accurate code assignment
• Identify potential compliance issues and areas for improvement
• Provide tailored CDI training to your physicians
• Educate your physicians on heightened documentation expectations due to regulatory mandates

What is advanced CDI?

An advanced approach to clinical documentation improvement addresses all payers and all care settings, a program driven by physicians. While still optimizing providers’ work in the current fee-for-service reimbursement model, advanced CDI must help prepare health systems for the future of value-based care and focus on quality scorecards.

WE,

Partnering with hospitals, creating a documentation culture that reflects the clinical truth ensuring hospital funding reflects patient complexity.

Clerical tasks and poorly-designed EHRs have physicians suffering from a growing sense that they are neglecting their patients as they try to keep up with an overload of type-and-click tasks.

Denial management is a critical element to a healthy cash flow, and successful revenue cycle management.

Our experienced and proactive denial management team carefully analyze your remittance advice to identify the root causes of denials, zero pays, claim reversals and meticulously work on them until the claim is closed out.

The health insurance verification process is a series of steps that checks whether or not the patient admitted has the ability to make a reimbursable claim to their health insurance provider.

In the era of high patient deductibles, we help take on the heavy lifting of gathering both eligibility and benefits before the patient visit. This is an essential service for your clients as they struggle with increasing patient payment responsibilities.

Leading Medical Billing Services provider with 12+ years of experience in Multi-Specialty Medical Billing with a wide presence across the Nation.

Our team of highly experienced billing professionals perform the charge entry functions. Our highly trained Data Entry Team and Quality Control Team makes sure that all data is entered exactly as provided. We understand the importance of making sure that insurance ID numbers, claims address and all demographic and insurance information is entered correctly and directly impacts claim payment.

100% CPC Certified Coders. Strict Quality Assurance Standards. Get peace of mind that your coding achieves the highest level of specificity your documentation allows. Leveraging our optional Medical Coding Services ensures that your organization collects the most possible revenue from each and every encounter.

Our certified coders maintain an AAPC, AHIMA, or multiple certifications to provide the highest level of service to organizations who choose to add Coding to their revenue cycle offering from Rebekah Medical Consultants.

To review and analyze the records which are coming to the software and index with respective label and attach it to patient’s medical chart. This includes all types of records such as hospital & emergency discharge note, admission notification, Transition care summary, Lab results, Hi-tech radiology results, consultation notes, Insurance procedure authorization request, Medication prior authorization, Medical records from outside doctor, Referral request from the patient to see a specialist.

We’ve a team specialized and experienced in analyzing the records and will be completing promptly.

This is one of the critical role and we’ve experienced staff on this process who will coordinate with multiple departments and ensure the Quality of care to the patients.

• Patient Scheduling – We call the patients and remind their upcoming appointments and confirm their arrival on the scheduled date. If the patient request to cancel and reschedule to some other day, we offer them based on the availability of the schedules.
• Processing Referrals – We process both Global referrals and Procedure referrals by submitting the request through insurance portal or calling the insurance to process the request. Upon approval, we’ll notify the specialist office through fax or call.

We also submit the medical records or lab results if it is required from the insurance to approve the authorization number.

• Gaps and care – Identify the gaps and Quality measures in the patient chart, track them and schedule the patient to fill up the gaps and to improve the Quality of care. Educate the patients on their yearly dues on their lab tests or radiology tests and tests ordered by the physician and schedule the appointment.

We also follow-up on the hospital discharge patients within the stipulated time to f/up with the primary care doctors.

• Medication refill request, DME request , Patient billing clarification and follow-up with the patient for unpaid balances.

 To review the prescription drug request coming through online portal, through incoming faxes, from patient or from the pharmacy on behalf of patient. Our skilled team who has clinical background with Nurse degree will review request and determine the necessity of drugs for the patient and sent the request to doctor approve it.

We do call the pharmacy for any clarification and communicate to patient for further action on dosage or directions.

Payment posting refers to the viewing of the payments and the financial picture of medical practice.

We have experienced and well trained billing professionals knowledgeable of different kind of EOB’s (Explanation Of Benefits) across ALL PAYERS posting MANUAL and ELECTRONIC PAYMENTS. Payments received from Patient’s and Insurance Companies are posted to the patient accounts in the client’s medical billing system. The posted payments are balanced against the bank deposit slips to ensure payments received are reconciled on a day to day basis.

Our intent to help the busy physicians juggling between patients throughout the day, we’ve doctors who are credentialed will take over the electronic medical chart in EHR to analyze the reason for the patient visit, checking the history of the patient, current medications and old medications in the chart, prioritize the diagnosis conditions and order the lab test if it is required or if the patient is due. Additionally, our doctors will focus on the medications list to ensure the dosage and directions and record all the information in the medical chart.

Physicians at the head office will assess the pre-charted notes at the time of patient arrival and modify the assessment section based on the discussion at the time of encounter and sign the record in the EHR

Our doctors also take care of No-show patients, very next day of the appointment and cancel those documented notes in EHR.

Realize financial success in value-based care with Rebekah Medical Consultants’ suite of risk adjustment and consulting solutions. As a leading provider of end-to-end Risk Adjustment solutions, all partnerships include:

• Real-time Risk DNA insights
• Access to our team of risk adjustment physicians
• Dedicated and experienced Risk Adjustment Account Managers
• Prospective, Concurrent, and Retrospective HCC clinical-coding experts
• Complete risk and quality performance reporting insights

MRA

The purpose of risk adjustment chart review is to adequately capture all the missed and hidden HCC diagnosis from the medical records.

How Does it works?

The risk adjustment chart review is a type of comprehensive review and reading all the medical records and understand the complete medical history and come up with the new HCC diagnosis from the possible opportunities which eventually improves the risk score.This risk adjusted base payment amount is then added to the rebate for plans bidding below the benchmark to determine total reimbursement.

What is a good Medicare risk score?

Risk scores generally range between 0.9 and 1.7, and beneficiaries with risk scores less than 1.0 are considered relatively healthy.

What is HCC Coding?

Understanding Today’s Risk Adjustment Model:
CMS uses HCCs to reimburse Medicare Advantage plans based on the health of their members. It pays accurately for the predicted cost expenditures of patients by adjusting those payments based on demographic information and patient health status. The risk assessment data used is based on the diagnosis information pulled from claims and medical records which are collected by physician offices, hospital inpatient visits, and in outpatient settings.

How HCCs work?

Diseases and conditions are organized into body systems or similar disease processes. The top HCC categories include:

• Major depressive and bipolar disorders
• Asthma and pulmonary disease
• Diabetes
• Specified heart arrhythmias
• Congestive Heart Failure
• Breast and prostate cancer
• Rheumatoid arthritis
• Colorectal, breast, kidney
  For HCC to be successful, the provider must report all diagnoses that impact the patient’s evaluation, care, and treatment including co-existing conditions, chronic conditions, and treatments rendered.

What Rebekah medical consultants do?

• We as a team do a chart review based on your requirements.
• We read all the medical records and pick up the missed HCC diagnosis and possible opportunities.
• Then we deliver the reports.

Our chart review frequency models

1. Yearly review (One time review)
2. Half-yearly review (Twice a year)
3. Quarterly review
4. Daily basis (Based on patient schedule)

Prospective Review

Prospective clinical reviews occur prior to the point of care. Highly effective clinical review teams utilize clinicians and clinical coders to assess diagnostics, health history, medication lists, treatment plans, imaging reports, and additional clinical documentation to capture diagnoses that aren’t inherently visible to the treating physician. Our approach provides intelligent insights into the patient-provider interaction by delivering qualified conditions with supporting logic to the physicians ahead of the date of service and we push prospective diagnosis into EMR.

Retrospective Review

Dig deep into your healthcare beneficiary risk stratification, with risk adjustment insights. Rebekah Medical Consultants’ retrospective chart reviews analyse date of service to abstract HCC codes to the highest specificity possible. Our team of HCC professional identifies care-gaps and missed HCC opportunities during the retrospective review process to optimize your operational efficiencies.

Concurrent Risk Review

Concurrent reviews occur in the EHR system and capture risk adjusting ICD [HCC] codes in real-time. Not all EHR systems are designed to support the HCC model, however. High-performing medical groups and numerous payer organizations utilize Rebekah Medical Consultants’ claims review and HCC coders to optimize claims before they are submitted.

MRA Validation

We audit the current HCC from the problem list and make sure all the HCC have the proper clinical evidence.  We also suggest the physician to address the condition (HCC) when there is lack of clinical evidence in the Medical records.