revenue Cycle Management

A revenue cycle assessment is a comprehensive review of an organization’s billing processes, from patient or client registration to final payment. This assessment identifies inefficiencies, gaps in documentation, and areas of improvement that may be hindering timely reimbursement and contributing to aged accounts receivable. By examining claims data, denial patterns, coding accuracy, and compliance with payer requirements, a revenue cycle assessment provides valuable insights into the financial health of an organization or practice. It is a crucial first step in building a sustainable financial strategy, as it informs a plan to optimize cash flow, reduce outstanding receivables, and improve overall revenue cycle performance.

Pivot First provides revenue cycle assessments with no contractual obligation for medical billing services. At the conclusion of the assessment, clients will be provided with a report documenting:

• Strengths: Areas where providers excel in their revenue cycle process.

• Weaknesses: Gaps or inefficiencies that need to be addressed.

• Opportunities for Improvement: Actionable steps for enhancing revenue cycle performance.

• Compliance Issues: Any areas of non-compliance with HIPAA, payer, or other regulatory requirements.

Medical billing is a critical component of healthcare that directly impacts the financial health of an organization. Accurate billing ensures that services are properly coded, and claims are submitted on time, leading to quicker reimbursements and improved cash flow. In today’s complex healthcare landscape, efficient medical billing is essential for maintaining operational stability and maximizing revenue. Community-based organizations, physicians, hospitals, and independent practitioners increasingly rely on outsourced billing services to manage this intricate process. At Pivot First, we provide tailored medical billing solutions to community clinics, public health departments, and independent practitioners. By outsourcing medical billing, organizations and providers can focus on delivering quality care while ensuring their financial sustainability.

Medical Billing Services

• Preliminary Practice Setup: Filling out billing software with all of the provider, insurance carrier, fee schedule, and ICD-10 and CPT-4 codes.

• Data entry of all charges within 48 hours.

• Filing insurance claims to carriers both electronically and on paper.

• Accurate ICD-10 and CPT code entry for the services provided.

• Persistent follow up on filed claims until they are closed and processed.

• Handling appeals and denials, observing insurance company criteria and exploring all payment options.

• Cash statements are mailed to patients, and afterward, soft collections are handled.

• Posting payments collected from patients, clients, and insurance companies.

• Answering billing calls from patients and answering any questions about their balances.

Make sure you receive information on insurance coverage promptly and accurately and ascertain whether your patient has a financial obligation to pay for their medical services. The process of medical billing begins with the eligibility and verification of insurance. Claims that are mismanaged or handled improperly may be delayed or denied.

It is essential to make sure that insurance plans are properly verified because they are subject to constant updates and modifications. Smooth billing will not occur if the eligibility for an insurance coverage is not confirmed.

When you select Pivot First as your eligibility verification and prior authorization partner, we can assist you to:

• Improve patient satisfaction

• Eliminate write-offs and improve collections

• Minimize delays and denials significantly

Our knowledgeable insurance verification professionals quickly obtain authorizations by contacting insurance providers. We complete all required documentation. After compiling all the required data for a claim, we update the online portal with the eligibility and verification information, including payment alternatives, member and group IDs, coverage periods, and other perks. Any irregularities in a claim will be promptly communicated to you.

Pivot First offers an all-inclusive package that includes full charge entry, payment posting, insurance follow-up and patient billing. Our charges start from as low as 10% of the collected amount. Charges are determined by the volume of monthly collections:

Monthly Collections      Charge

$1 - $100,000                  12%

$100,001 - $200,000    11.75%

$200,001 - $300,000    11.5%

$300,001 - $500,000    11%

$500,001 - $1,000,000 10.5%

$1,000,001+                    10%