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 and call or appeal immediately after denial or a request for information is received. 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 FQHC. 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 the claim/superbill 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 understand that FQHC, CHC and "Look-alike" billing is unique and demands attention to additional areas that other clinics do not need to monitor. That is why we take extra time to ensure the highest level of Medicaid and Medicare paid claims to maximize your cost report reimbursement and 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 back-dating and retroactive eligibility so claims can be submitted and paid months later and included in your incentive payment. We stick to the strict collection policies and guidelines required of FQHC's to ensure we are abiding by all state and federal guidelines. We completely support your mission and are honored to be involved in helping the under-served, uninsured, homeless and under-insured population.
Our staff acknowledges that this patient base does not always receive the best customer service, but that empowers us 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 our contracted clients the option of full credentialing services. We have experienced 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 how to PDFs 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 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.