Caliber Point :: Services :: Healthcare Outsourcing

At Caliber Point, we look at optimizing the solutions and services we offer through process innovation and complying with best-of-breed quality standards. Besides having gained significant expertise and experience in the Payer segment, we have also excelled in providing quality services to the Provider segment with the endeavor to help our clients maximize returns, reduce expenses and gain a competitive edge. We are specialized in providing end-to-end Revenue Cycle Management and provide an array of outsourcing solutions to Medical Providers, Billing Companies and Hospitals

Our Provider Services include:

Revenue Cycle Management
Electronic Medical Records (EMR)
Practice Management Consulting

Patient Scheduling and Eligibility Verification

Process of providing client satisfaction even before registration.

Stages in Brief:

Receive calls from patients to schedule an appointment
Collect basic patient details on the call like Patient Name, SSN number, visit reason etc.
We receive Schedules from the Hospital via EDI or email
Check for availability and schedule the patient accordingly
Verify the patient details provided during the call
Verify coverage on all Primary and Secondary (if applicable) Payers through Payer Web Sites, WebMD and through phone calls
Contact patient for information if necessary
Provide the results which include eligibility and benefits information such as member ID, group ID, coverage end and start dates, co-pay information and much more

Benefits:

Correct information at the time of registration allows accurate bills to be submitted to payers, reducing administrative delays and potentially denied claims
Accurate patient contact information facilitates communication with the patient after their date of service, allowing Business Office staff to more effectively contact patients for additional information needs as well as to follow-up on patient liabilities
By communicating with the patient prior to their date of service, our clients are able to dramatically increase their upfront collections, ultimately easing the backend, low dollar, self-pay follow-up burden
Reduction in Denials
Improved Patient Satisfaction

Highlights:

Gather important and accurate information
Real time on-line eligibility verification
Experienced staff providing best professional support
24x7 Voice support

Medical Coding

Coding is the focal point of claim charges being generated and reimbursed accurately.

Stages in Brief:

Scan and upload patient records
Receive doctors diagnostics as digital images or voice recorded
Understand the patient's symptoms and the diagnostics provided by the doctor
Input the corresponding medical codes (ICD and CPT) for the diagnostics provided by the doctor
Validate the input data
Quality check through HIPAA compliance
Encrypt and upload data back in the clients system

Benefits:

Free form the hassle of recruiting and training coding staff
Correct Diagnosis (ICD-9/ ICD-10) and Procedure codes (CPT-4) reduces denials
Effective auditing, monitoring and feedback mechanism

Highlights:

Team of coders who are certified by the American Association of Certified Coders (AAPC)
Skilled in ICD 9, ICD 10 and CPT 4 codes
Compliance as per government regulations
Coding specialties include: Radiology, Pathology, Cardiology, Gynecology, Anesthesiology, Emergency Room and Surgery
Skilled and cost effective labor in this sector

Coding Audits

Caliber Point has created the CPT-4 & ICD-9-CM Coding Audit plan to evaluate coding accuracy and the appropriateness of provider medical records.

Stages in Brief:

Review of a targeted sample of records
Calculation of the average increase/decrease per case (undercoding/overcoding)
Bundling/Unbundling
Projection of annual impact
Identification of cases for adjustments
Training on cases reviewed

Benefits:

Reduce coding errors
Analyzes various categories for risk of up-coding and under-coding
Increases level of Accuracy
Update knowledge base

Highlights:

Performed by consultants who have more than 8 years of experience in coding
Coding as per State and Federal guidelines
Analyze frequently to reduce errors

Charge and Demographic Entry

At Caliber Point Demographics and Charge Entry are done by a competent and experienced data entry team.After entering the procedure and diagnosis codes from the medical records or superbills, our operators also check for the compatibility of the diagnosis and procedures codes ( LMRP match), thus ensuring submission of a clean claim to insurance carriers. Charge Entry is completed within the agreed turnaround time, which is usually within 24 to 48 hours from the date of receipt of the same.

Payment Posting and Denial Analysis

The Payment posting team at Caliber Point applies the payments, by reviewing the EOBs (Full Form) in detail against the appropriate patient account. During cash application, underpayments/overpayments are immediately identified and necessary refund requests or credit reports are generated and sent to client for further action. Additionally, underpayments/denials are conveyed to the analysts. Services to our clients also include denial posting, reconciliation, returned mail, PPO and federal carriers based adjustments and write offs.

Very often in many clinics or practices, denials are not managed properly or worse yet, simply ignored. We at Caliber Point have a Denial and Appeal Management process handled by a team of experienced analysts, who not only address denials but also study the denial patterns and educate the client in countering the denials and work with the payers aggressively to resolve the same. Denials are identified based on the payer, type of denial, reason for denial, the resolution and how to prevent the denial in future. Also tracking of denials that require appeals are done by the team and this helps our clients to avoid missing timelines for submitting medical necessity appeals within the regulatory timeframe.

Payer A/R follow up and Recovery

Accounts receivables follow-up and analysis are extremely important to any client from a cash flow perspective.

Stages in Brief:

Receive A/R Database from client
Managers and Analysts
- Sort by Payer, DOS, Money Value etc.
- Analyze and Prioritize
- Work order Issued and Allocated
A/R Callers
- Patient follow-up
  - Identify Credit Status
  - Document Status/ Action in the system
  - Take action and update in the system
- Insurance follow-up
  - Identify Claim status
  - Document Status/ Action in the system
  - Take action and update in the system
Performance check and Quality Control
Generate productivity/ Review Report
Update Client

Benefits:

Correct information at the time of registration allows accurate bills to be submitted to payers, reducing administrative delays and potentially denied claims
Accurate patient contact information facilitates communication with the patient after their date of service, allowing Business Office staff to more effectively contact patients for additional information needs as well as to follow-up on patient liabilities
By communicating with the patient prior to their date of service, our clients are able to dramatically increase their upfront collections, ultimately easing the backend, low dollar, self-pay follow-up burden
Reduction in Denials
Improved Patient Satisfaction

Highlights:

Gather important and accurate information
Real time on-line eligibility verification
Experienced staff providing best professional support
24x7 Voice support

Practice Management Consulting

In providing Consulting our area of focus is to ensure that we identify the "problem areas" within your practice and providing a comprehensive plan to resolve the same. The consulting assignment can be taken up as a comprehensive package that includes the entire gamut of services or could be done on a piece meal basis addressing only the areas identified by the practice. Our expertise can be summoned up as follows:

Billing and Coding services
Fee Schedule Analysis
Underpayment Analysis
Implementation of best practices