Our client driven approach provides outstanding customer service, support and training for providers, staff and patients. Our experience in multiple specialties and continuous education for our staff proves to be advantageous to clean up practices with diminished revenue and maintain high standards in customer service and paid claims.
We continuously monitor and follow up on claims status and denials. Reporting and revenue cycle meetings are provided to ensure all provider staff possess the same knowledge and has a clear understanding of their part in the revenue cycle.
All staff has an impact on claim payments and creating the best practices for each department and constantly communicating effectively is a key component to running an efficient practice. We strive to work as one with your team and provide support for questions or concerns.
We are your "business office" as we manage the services from claim entry through its completion and all steps in between (claim submission, providing requested information to insurance companies, appealing denials, and suggesting coding tactics to maximize charges). We have processes and policies that will integrate to your practice and workflow, but is customizable to make our combined processes easier and more efficient.
We use your current practice management system as we have experience using a large variety of PMs.
On a daily basis we download EFT/ERA's for posting and reconciliation.
Your A/R over 30 days is worked regularly to ensure the highest level of paid claims to maximize your income. Patient and insurance questions will be handled by our expert billing staff.
We will adhere to your office policies for collection guidelines and ensure we are abiding by all state and federal standards.
With our expertise we understand that FQHC, CHC and "look-alike" billing demands attention to unique federal and state reporting criteria. That is why we take extra time to ensure the highest level of Medicaid and Medicare paid claims, maximizing your cost report reimbursement and PPS/incentive payments.
We possess the knowledge of how to submit Medicare claims to Part A with the correct revenue code, roll up configuration and required HCPCS codes.
We monitor patient household assessments and federal poverty levels to ensure they receive their necessary sliding fee discount prior to being billed. We monitor Medicaid retroactive patient eligibility so claims can be submitted and paid at a later date and included in your incentive payments.
We stick to the strict collection policies and guidelines required of FQHC's to ensure we are abiding by all state and federal standards.
We completely support your mission and are honored to be involved in helping the under-served, uninsured, homeless and under-insured population.
We are empowered to provide the absolute best support and guidance for your patients and staff. We are not only concerned about reimbursement, but pride ourselves on going above and beyond to serve the community with you.
Due to the challenging process demanded by the insurance companies, many providers have trouble with denials related to credentialing and re-credentialing. We provide full insurance credentialing services.
We have Credentialing Specialists and Community Health Credentialing Specialists using the latest insurance credentialing software to submit applications for your new providers and monitor the re-credentialing of your present staff and facilities. We are familiar with CAQH, NPPES and RWHC.
Reports and spreadsheets can be produced to provide status updates based on your needs. Constant monitoring of credentialing status is necessary and handing this task over to Plexus will allow you time to focus on patient care.
Our contracted clients will realize that all of our staff is cross trained in multi-specialty billing, working the A/R and answering all patient calls. With this expertise, we can create manuals, "cheat sheets", and step-by-step guides on most processes within your practice.
Reception staff has benefited from our training by learning what questions to ask at check in, what information is needed from the insurance card and driver's license to produce a clean claim and eliminate insurance fraud, and how to ask for payment.
Clinical staff has benefited from our specialty specific coding training, which included CPT, CDT, HCPCS and ICD. We review active cases and questionable scenarios to answer the challenging coding questions.
Office managers will learn what aspects of the staff, practice and KPI's need to be reviewed and monitored and what trends to look for so all potential problems are averted.
HIPAA is not a topic that has much gray area, and all of your ancillary staff will benefit from our HIPAA training. It includes take home material, certificate of completion and real world examples that will help your staff protect patient's PHI and access it in a secure manner.
Our staff is knowledgeable in HRSA, Medicare, WI Medicaid and FQHC guidelines along with best practices for medical and dental offices. We can provide review of any or all processes from appointment scheduling through claim payment. This includes review of correct insurance and demographic information entry, correct claim submission, general coding and coding for PPS rates, claim error/rejection/denial review, credit/refund processes,
ERA/EFT set up, collection processes, credentialing and much more.
After the review process we will provide feedback on our findings, which include recommendations, tip sheets, training and guidance.