Comprehensive Revenue Cycle Assessment

We start by conducting an in-depth analysis of your entire revenue cycle to identify inefficiencies and areas for improvement. This includes evaluating processes such as patient intake, coding accuracy, claim submission, and collections. Our thorough review provides a clear understanding of your current revenue flow and highlights critical areas that need enhancement.

Tailored Optimization Strategy

Based on our analysis, we develop a customized optimization strategy designed to meet the specific needs of your practice. This strategy aims to enhance every stage of your revenue cycle, from reducing claim denials to improving patient collections, with the ultimate goal of increasing efficiency and boosting your revenue.

Advanced Coding and Documentation Review

Accurate coding and detailed documentation are vital for maximizing reimbursement. Our program includes a comprehensive review of your coding practices and documentation procedures to ensure compliance with current standards and payer requirements. We implement best practices to minimize errors and improve reimbursement accuracy.

Streamlined Claims Management

We optimize your claim submission process to reduce rejections and delays. Our program introduces efficient workflows for preparing, submitting, and following up on claims. We also use advanced tools to track and manage claims, ensuring timely payments and minimizing the risk of revenue loss.

Proactive Denial Management

Denial management is a key focus of our program. We analyze denied claims to identify recurring issues and develop effective appeal strategies. Our proactive approach helps recover denied payments and addresses underlying causes to reduce future denials.

Improved Patient Collections

Enhancing patient collections is crucial for maximizing revenue. Our program includes strategies to streamline patient billing processes and improve collection efforts. We also offer patient financial counseling to help patients understand their financial obligations, leading to better collection rates.

Key Components of an Optimized Revenue System

Claim Evaluation Before Submission

Caddison’s billing department adheres to standard operating procedures (SOPs) to identify and correct errors before a claim is submitted. Our skilled team meticulously verifies demographic entry, pre-authorization, eligibility, benefits, and coding edits to ensure accuracy.

Error-Free Claims Submission

Our team accurately selects the appropriate billing form (CMS-1500/UB 04) based on the services provided. Claims are primarily submitted electronically following EDI protocols, although some are submitted on paper due to certain payers not accepting electronic claims.

Claims Follow-Up

After successful claim submission, our billing staff consistently undertakes the following tasks:

• Monitoring claim status
• Tracking payment delays
• Handling reconsiderations and appeals
• Communicating with payers
• Preventing future issues

Denial Management and Outstanding Balances

Payments are promptly posted to the respective patient’s account. Denied and underpaid claims are assigned to our specialized denial management team, who resolve the issues and resubmit the claims to the appropriate payer. The Accounts Receivable department advocates with insurance companies for additional payments on low-paid claims by submitting reconsiderations and appeals.

Audit Execution

Conducting audits is essential for optimizing revenue flow. VitGenix’s dedicated audit team identifies process weaknesses in various aspects of the revenue cycle. This analysis reveals which parts of the cycle need improvement. Analysts monitor each stage of the cycle and provide detailed reports on the organization’s progress.

Compliance Management

The compliance department oversees ongoing processes and ensures that team members adhere to their job descriptions. They also educate teams on legal and regulatory matters and share the latest industry standards to keep everyone informed of upcoming changes.

Partner with Us!

At Caddison, our Revenue Optimization Program is crafted to enhance financial excellence and operational efficiency within your practice. Let us assist you in discovering new avenues for revenue growth and achieving long-term success.

Reach out to us today to find out how our program can elevate your practice’s financial performance.