Why Choose Rely on Us?
15 days free trial
Compliant coding with minimization of claim denials.
100% HIPAA compliant operations and processes.
Daily reporting of documentation deficiency reports.
Guaranteed revenue increase by 5-15% of your collections.
Reduced over-head and increased profitability.
97% of claims get paid within 35 days.
Monthly reports of detailed analysis and much more.
Proactive Prior authorization: Our team can help provider get prior authorizations approved by the payers by proactively advising our clients on medical necessity, frequency limitations, medically unlikely edits, bundled procedures, etc which strengthens the documentation thereby minimizing time in receiving prior authorization.
Stalwart Leadership: Pain management is a specialty with intricate guidelines requiring a team of robust experience and knowledge to handle the process. The success of any process depends upon the team we create and Rely on us has such a promising team who would inevitably bring a phenomenal change in your business revenue in-flow and we have proven records that set standards for our credibility.
Transition Strategy: We have live examples with our existing clients where we had come up with exclusive strategies for a smooth transition from onshore.
Consistency: With the dynamism pain management practice runs with, we are capable with a stable team with low or no attrition ensuring we maintain the consistency in our deliverable's.
Sustainability: Sustainability is not part of our work- It’s a guidance influence for all our work. Rely on us has a dedicated team who are trustworthy and experienced to handle huge volumes of your practice with quality outputs.
Rheumatology Billing Services
Rheumatology is one of the practices that were affected by the implementation of MACRA. With ever changing rules and regulations, specialty of rheumatology is always complex as we have to deal with numerous services ranging from evaluation and management to infusions and injections. Eliminating the inefficiencies in billing and collections can significantly increase the savings and improve the practice health which can be better used to enhance the patient care. Rely On Us Healthcare services efficient and empowered revenue cycle management system can help in accomplish this goal.
Eligibility & Benefit Verification: Most employer insurance plans change Jan 1, it is always a best practice to ask if there is any change to the patient’s medical coverage. Even if the patient indicates that there are no changes, staff should verify the insurance card. At Rely On Us, we ensure that the insurance eligibility is verified prior to the delivery of the treatment. Checking the benefits verification and eligibility can greatly minimize the denials.
Prior Authorizations: Unfortunately, the process of getting prior authorizations continues to be a burden for all practices including rheumatology. Effective Jan 1 2019, UHC will retire fax numbers used for the prior authorizations. UHC will require all the PA requests to be submitted via their Prior Authorization and Notification tool. Certain states allow the faxed medical requests. A fax number will still be available for the majority of the community plans for states like Arizona, California, Louisiana, Massachusetts, Michigan, Mississipi, Nevada, New York, Pennsylvania, and Texas. Knowing the payor related specifics can especially avoid delay in the process of getting prior authorizations.
Billing of an Evaluation and Management Service: There are many circumstances in rheumatology which questions the coders ability to analyze whether to bill or not to bill for the evaluation and management service in rheumatology. Generally, we code and bill for an evaluation and management service if a new problem is assessed and a treatment plan is established during the visit. By and large, patients who are seen in the office for a follow up injection are not billed with an evaluation and management service unless there was a separate examination was performed for the condition or a change is made to the patient’s treatment plan. The billing of evaluation and management always must be supported by the medical necessity. Clear and concise documentation supports the medical necessity for all the services performed.
Coding for Injections: Proper coding of injection procedures is very essential for prompt reimbursement of services. One of the common errors that every practice face is on the coding for knee injections (Supartz). The first visit is usually initiated by the physician and the nurse administers the injection in the subsequent visits. Practices usually report this with 99211 – 25 modifier and then the codes for the injection and the drug administration respectively. Nursing visit is not allowed to be billed with the injection code as the work is built in the relative value units of the injection code. The inappropriate use of the 99211 code and the 25 modifiers often raises the red flags and these can be prevented if the coders possess the correct knowledge and understanding of the billing essentials. Rely On Us Healthcare services expert coders refer to the documentation and query the physicians if required for accurate reporting of the services rendered.
Knowledge of Medications: Patients suffering from rheumatic ailments are treated with variety of medications including administration of biologic, antiresorptive and other medications. In depth knowledge of dosing calculations, manufacturer’s full prescribing information and billing specifics are very essential. Payor rules also differ with billing of such drugs. Proper billing of the drugs ensures prompt reimbursement from the insurances. The ability of the coders to query for lack of information if any prior to billing also helps in avoiding denials.
Denial Management: The process of managing denials and the appeals are two most underestimated processes in the rheumatology offices. Most of the practices face an inflated AR simply because of not following up on the denied claims with appropriate actions or writing off the denied claims. Rely On Us Healthcare services support the rheumatology practices by promptly following up on the denied claims with appropriate resolution strategies and payor guidelines and making sure the claims are refilled in a timely manner. While appealing a claim, a practice should always keep an eye on the time limit with different payors as the deadline for appealing the claim may range from 30 days to one year.
These are just a few challenges that every other Rheumatology practice may face. Rely On Us Healthcare services expert professionals help you handle the challenges and ensure prompt reimbursement with compliant solutions.