RCM:

The lifeline to any healthcare enterprise is being able to timely and fully collect revenues that are due them without breaking the bank! One may be content with their RCM services because they have not experienced anything better but just imagine being able to significantly reduce your AR days (accounts receivable days), increase the collection rate and reduce the billing costs! That becomes reality with K-RCM’s proven methodology. What is more, the innovative and proactive K-Pre Collect system not only ensures timely payments but virtually nips denials in the bud boosting collection rates to near 100%!

AR:

High volume providers usually have limited time to chase after and collect on denied or suspended accounts and these can keep accumulating and eventually have to be written off because they become too old to collect. Our AR system is designed for just such a situation. We can assist you in recovering the revenues from claims that need that extra bit of work to get paid. We can do that in tandem with your team or independent of your team freeing them up for more urgent tasks.

AR ANALYZE:

If you keep doing what you are doing, you will keep getting what you have been getting. This adage is true in the Billing & Collection world. In order to avoid repetitious errors and to focus efforts for maximum impact, it is important to analyze the process, outcomes, and efforts of various segments to base important strategic decisions on and that is exactly what AR ANALYZE does for you.

STATEMENTS:

Timely delivery of easy-to-understand and customized patient statements is key to obtaining timely payments from patients. Our system not only makes it easy for your team to upload the information into our system to generate and mail the statements but also makes it easy for your patients to remit their payments in any way they prefer using our user-friendly systems.

COLLECT:

To help you in reminding and convincing your patients who are reluctant to pay their share of the financial obligations, we can take over the collections functions for you so that your staff can utilize their time on other important functions.

ELIGIBILITY AND BENEFITS VERIFICATION:

An accurate eligibility verification process serves two important purposes for healthcare professionals, physicians, and hospitals. The first one is to avoid claim resubmission, claim rejections, and denials. The second one is to increase upfront collection through clean claims. With Keizer, you can leverage the expertise of our medical insurance experts to revive and revamp your insurance eligibility verification process. It is a commitment to our clients that our skills and technological expertise will bring down your practice costs with quality deliverables.

When Should Eligibility be Checked?

Practices should proactively check eligibility. The most effective time is before the patient is seen by the physician, ideally 48 hours before the visit. In the alternative, this process can take place anytime up until, or at, check-in. Front-office staff should always ask patients if their insurance has changed since their last visit.

Benefits of Eligibility & Benefits Verification Services from Keizer:

• Optimized cash flow.
• Reduced patient-related denials.
• Accurate verification of primary and secondary coverage details, including member ID, group ID, coverage period, co-pay, deductible, and co-insurance and benefits information & other code level benefits information including max limits allowed.
• Avoided rejection of claims by payers due to inaccurate or incomplete information.
• Identification of the patient’s responsibility upfront.
• Improved patient satisfaction.
• Prompt identification and resolution of missing or invalid data.
• In case of issues regarding a patient’s eligibility, we inform the client immediately.

Insurance Eligibility & Benefits Verification process at Keizer:

• We receive the patient schedule via email or on our secured HIPAA Compliant Sharefile or we pull the patient’s schedule from the EMR system.
• We call the payers directly/IVR or verify the eligibility & benefits through authorized online insurance portals and obtain the patient’s eligibility information like
  • Member ID number & Group ID number
  • Coverage effective/Termination dates
  • Primary & Secondary coverage details
  • Co-pay information
  • If a policy is terminated, other insurance coverage details and a detailed list of benefits depend on the patient’s plan.
• The eligibility & benefits information is directly uploaded to the respective patient account in the billing system. A copy of the report will be e-mailed to the client before the patient visits the doctor’s office.
• Our insurance verification team follows a standard questionnaire while verifying the patient’s eligibility & benefits. This questionnaire has been built in a way to zero out any rejections from the payers and ensure all the claims sent outreaches the payer as a Clean Claims resulting in maximizing the cash flow of the practice.

Pre-Authorization

The Keizer team helps providers to obtain Pre authorization. In the medical billing world, pre-authorization, prior authorization, pre-certification, and notification are terms that may be used interchangeably to mean that for certain situations and procedures, providers have to contact insurers in advance and obtain a certification number in order to be reimbursed properly (or at all) for services.  In fact, most claim denials happen when a patient is ineligible for services billed by the provider. Depending on what the patient’s coverage documents and the provider’s contract with the insurer say, neglecting to obtain pre-authorization can result in reduced reimbursements or lower benefits for the patient. Services that don’t require pre-authorization can be subject to review in some cases. Knowing which insurers require which pre-authorizations can be complex, but our medical billing software and/or pre-certification tools provided by insurers can help medical billing specialists navigate the pre-authorization maze.

How We Submit Pre-Authorization Request 

We at Keizer, submit our pre-authorization request over the call, fax and on insurance portals. Many insurance companies provide Prior Authorization Request Form (both offline and online) to submit written pre-authorization. Every insurance company has its own requirements for pre-authorization requests.

Benefits of Keizer Pre-Authorization Services

• Cost effective and hassle free
• Covering all specialties including DMEs, injections and PT
• Dedicated team for faster response time
• Timely and regular follow ups with insurances
• Arranging Peer-to-Peer
• Sending first level and second level appeals in case of denials
• Retro-Authorization
• Approval ratio >90%

Provider Credentialing and Enrollment Services

Provider credentialing and enrollment services is a process of enrollment and attestation that a physician is part of a Payer’s network and authorized to provide services to patients who are members in the Payer’s plans. The credentialing process validates that a physician meets standards for delivering clinical care, wherein the Payer verifies the physician’s education, license, experience, certifications, affiliations, malpractice, any adverse clinical occurrences, and training.

Payers may delay or refuse payments to physicians who are not credentialed and enrolled with them. These impact the financials of the practice negatively.

Keizer’s Payer Credentialing and Enrollment Services:

1. Starting a new practice.
2. Switching from one physician practice group to another.
3. Join or become affiliated with new groups or practices.
4. Enroll with new players (including DME credentialing).
5. Workers Compensation Credentialing.
6. Monitoring & maintaining the provider credentialing services.
7. Updating practice’s Pay-to address.
8. Enrolling in electronic transactions.

• Electronic Data Interchange (EDI
• Electronic Remittance Advice (ERA)
• Electronic Fund Transfer (EFT) and
• CSI

1. CAQH application completion and attestation.
2. NPI Registration (Type I and type II).
3. Group & Individual Medicare Revalidation.
4. PECOS/ I&A updates.

Benefits of Keizer’s Credentialing Services:

• Eliminate the immense amount of your time spent making phone calls, submitting applications, and handling emails and incoming faxes.
• Reduce the cost by up to 30-40%.
• Keep the organization acquiescent with insurance payers Improves turnaround time, usually within 30-60 days.
• Weekly Status report for each provider and insurance.
• Accelerate revenue by permitting physicians to examine patients with certain payers more quickly.
• Dedicated team for faster responses to queries or issues.
• Eliminate accounting errors that delay the enrollment process