Revenue Cycle Management

At Infrahealth^® we understand that Revenue Cycle Management (RCM) is and integral part of any medical office environment. From checking insurance eligibility, applying medical codes, submitting claims and receiving payment Infrahealth^® is working to make this process work more efficiently and effectively.

Infrahealth^®‘s revenue cycle solutions maximize revenue capture and streamline the billing and collection process with electronic claim processing, automatic secondary billing, remittance posting, document image retrieval, contract and denial management, and financial analysis.

Infrahealth^®’s scalable services combine to maximize revenue while focusing on what’s really important to you – your patients. Our integrated scheduling, practice management and electronic medical records (EMR) software empowers you to manage both front and back office functions. Combined with the comprehensive service packages available, we are able to cover all aspects of the RCM from start to finish of each claim.

Our software solutions enable the facility to easily capture, organize and authenticate patient data during scheduling, saving time and resources. Coupled with our Insurance Verification & Eligibility System^™ (IVES^™) the client is able to instantly verify billing and eligibility information accessing the most payer connections in the industry.

Our disciplined compliance program is essential to mitigating the substantial business risks associated with non-compliance. We provide our medical coding staff with regular training so they remain experts on the latest coding standards. We develop compliance programs for you focusing on four major risk areas: coding/billing, reasonable and necessary service, documentation, and improper inducements. We develop a HIPAA compliance program to help you safeguard patient information. We also administer periodic chart audits and provide routine coding assistance. Our focus is maximizing revenue while maintaining the highest level of compliance.

Our experienced medical billing team administers all medical billing and collections on your behalf. We send electronic claims to all government, primary and secondary private payers. We print and mail all patient statements. We receive electronic payer responses, setup payer deposits via electronic funds transfer, and post electronic payments immediately. We are also proficient in satisfying additional documentation requirements of all payers to satisfy claims adjudication requirements.

Infrahealth^®’s key to successful account receivable management is follow-up and follow-through. We track and immediately follow-up on all insurance denials. We diligently follow up on each claim that is filed to ensure all information is received by the payer as well as the facility to complete the cycle. We answer inbound billing inquiries by patients to ensure timely collection of any unpaid balances. This ensures the timely recovery of your valuable receivables.

Achieving the highest levels of financial performance for your medical practice requires continual review of key practice metrics. That’s why we provide real-time reporting that gives you full transparency into the back-office functions we administer on your behalf. We provide customized reports that are accessible 24×7. This helps you measure the bottom-line.

Credentialing

This critical service includes credentialing as part of the hospital privileging process, as well as for the credentialing required by all insurance providers, including Medicare and Medicaid, prior to formalizing payer contracts.
Negotiating the collection and submission of all licenses, certificates, tax forms, degrees, along with a myriad of other documentation required to complete the Hawaii Credentialing Application (HCA), regularly requires the herculean efforts of our credentialing director and his staff.

Using sophisticated software designed specifically for this purpose, Catalyst currently provides credentialing verifications for the Heart Hospital of Austin, along with similar services for our startup clients, as well as on-going credentialing for numerous physicians and physician groups to keep all of their needs current. This software, for example, enables Infrahealth^® to receive automatic license renewal reminders, and even when continuing medical education (CME) credits are due.
Infrahealth^® plays an instrumental role in the timely completion of, and the submittal of all your required documents necessary for primary source credentialing.
All of these efforts translate to a greater amount of time that you can dedicate to those that need you most: Your patients.

For practice startups, Infrahealth^® works closely with attorneys and accountants highly experienced in the medical industry to establish the legal structure best suited for each doctor, and0. to secure tax IDs necessary to initially submit and complete the credentialing submittals. We are equally proud of the working relationships that we have developed over the years, and that we maintain to date with hospitals and all insurance carriers, including professional liability providers, who facilitate the credentialing process.

Contracting

Infrahealth^® provides top level contract management that optimizes practice billing and accounts receivables from all payer groups based on a best case scenario contracting strategy.

As part of this integrated service, our Director of Contract Management and his staff, first scrutinize all available billed charges, as well as review the existing contract language along with your current fee schedules. Infrahealth^® then follows up this research with the negotiation of rates for startup practices, and the negotiation/renegotiation of existing rates with all payors for established medical practices.

Infrahealth provides your practice with recommended payer allowables for each CPT (current procedure terminology) code used for billing within your specialty. Infrahealth^® coordinates this effort with your in-house billing department, or with an outsourced billing company at your request.

It should be noted that numerous insurance carriers will take considerably more time to finalize your contracts, but Infrahealth^® will provide you these payor updates as they become available.