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REVENUE CYCLE MANAGEMENT SERVICES
We help you get your revenue cycle back on track, reduce costs, and drive revenue.Poor billing practices can result in financial losses and potentially put at risk the ability to deliver quality care. Striving to improve and streamline core operational procedures can help providers remain financially sustainable. The move toward value-based reimbursement and more holistic patient care compelled healthcare providers to take a closer look at their approach to revenue cycle management.
Home Health and Hospice Billing
Home health and hospice care providers struggle with the complexities of billing processes, which can be time-consuming and prone to errors. That is why providers often leave their billing requirements to outsourcing companies. At Cliniqon, we alleviate your billing difficulties by offering comprehensive solutions covering both front-end and back-end billing needs. By partnering with us, we guarantee enhanced accuracy, secured patient data, maximized revenue, and faster claims processing.
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Denials Management
Managing claims denials in the home healthcare industry can be cumbersome and time-consuming, often leading to revenue losses. Our denial management specialists at Cliniqon utilize denial management strategies to maximize revenue and minimize the impact of denied claims.
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Patient Collections
We handle various components of the Patient Collections process, such as debtor location and contact, account updates, and payment processing. By relying on our experts, you can expect improved financial performance, increased operational efficiency, and a smoother experience for both patients and staff.
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Home Health Prior Authorization
Seeking approval from insurance companies is tedious, requiring providers to navigate different guidelines and documentation requirements among various insurance plans. Moreover, ongoing authorizations are frequent in home healthcare, increasing providers' administrative burden. By outsourcing prior authorization needs with Cliniqon, providers can focus on direct patient care and leave the administrative workload with our team of experts.
Read moreHOME HEALTH AND HOSPICE BILLING SERVICES
At Cliniqon, we understand the crucial role that efficient and accurate billing plays in home health and hospice care. Understanding the daily time constraints home health and hospice care providers and patients face, we offer comprehensive end-to-end home billing services. Through streamlining processes and reducing operational costs, we aim to pave the way for substantial revenue growth.
Our Home Health and Hospice Billing Services
At Cliniqon, we offer a comprehensive range of tailored services to meet your billing needs. Regarding claims submissions, patient follow-up, dealing with insurance companies, denials management, and collecting payments, you can rest easy knowing that we have it covered. Our home health and hospice billing specialists expertly handle the entire billing process, from Front-end to Back-end billing.
Front-end Billing
Pre-registration and RegistrationOur home health and hospice billing specialists at Cliniqon accurately start the billing process by gathering patient demographic and insurance information during registration. We maintain standard operating procedures for patient registration to minimize errors and enhance the quality of patient data.
Our skilled staff verifies insurance eligibility, ensuring the patient’s health plan covers the home health services required. We confirm effective dates, patient responsibilities (coinsurance, copay, deductible), and plan benefits specific to the service’s specialty and location. In addition, we obtain the necessary preauthorization that insurers often require.
We determine patient financial responsibilities based on verified benefit information. We collect copays, deductibles, coinsurance, or balances due. This enhances revenue, minimizes debt and write-offs, and reduces administrative burden. Additionally, this improves cash flow, operational efficiency, and lowers billing disputes.
We generate encounter forms, which include patient demographics and medical codes, to facilitate efficient communication about the type and number of services provided to the patient.
Our staff assists in scheduling follow-up appointments when necessary, ensuring the completion of encounter forms by providers.
Back-end Billing
Charge EntryWe meticulously translate encounter forms into accurate charge entries, capturing services rendered and associated payments.
Our specialists generate claims by accurately creating claim numbers for all charges and grouping them into batches, as stated in the Billing Options.
To further ensure accuracy and maximum reimbursement, we utilize claim scrubbing tools to review each claim before submission. We scrub claims to ensure all codes, patient information, and visit details are accurate and complete. This helps identify potential errors, inconsistencies, and missing data in claims. By ensuring any potential issues are addressed before submission, your claim denials rate is reduced while simultaneously increasing your reimbursement rate.
Cliniqon revolutionizes claims submission, streamlining the path to revenue optimization. Our core service seamlessly integrates with your EMR system, pulling patient visit details and relevant data into standardized claim forms to submit to the insurance provider.
Our home health and hospice billing specialists’ jobs don’t conclude with claims submission. We diligently track claim statuses daily, ensuring transparency in the adjudication process. With clear insights, we act promptly to address any discrepancies or queries.
We post the payments received by insurance companies to our patient accounts. Our staff matches expenses to the respective patient accounts, rectifying whether payments are made according to their claim and confirming data to match payments.
When denials occur, we swiftly address them, deciphering denial codes and rectifying issues. At Cliniqon, our expert billers collaborate to create appeal letters when necessary, maximizing the potential for successful claim reconsideration.
This is the final phase of the billing process. Our specialists perform the timely mailing out of home health and hospice bills and meticulously follow up with overdue accounts, ensuring that patient financial responsibilities are met within the designated timeframe. After payments are successfully collected, our integration with accounts receivable (A/R) management provides accurate tracking and posting of revenue.
Credit balances are a substantial risk for home healthcare providers. That is why our billers also identify credit balances, mitigate potential risks, and promptly facilitate refunds where necessary. Our diligent approach prevents legal and financial repercussions, ensuring compliance and financial stability.
Advantages of Choosing Cliniqon for Your Home Health and Hospice Billing Needs
Increased Work EfficiencyFiling claims and invoices or managing an in-house billing team can take up much of home health and hospice providers’ time, which they can spend directly on patient care and serving more patients. With Cliniqon, home health and hospice workers get to focus on core responsibilities, improving work efficiency.
With the frequent changes in guidelines in medical billing and coding regulations, providers often find it challenging to stay updated, which can lead to errors. This can cause denied claims or delays in payments, increasing expenses.
With Cliniqon, you can trust our specialists to stay up-to-date on changing regulations. Moreover, they are highly trained to perform the billing process accurately and efficiently, ensuring smooth financial operations for home health and hospice agencies.
Furthermore, we proactively identify errors before claim submission using our claim scrubbing software. This verifies that claims are accurate and align with payer requirements.
Hiring in-house biller staff can increase costs for home health and hospice providers. These costs include infrastructure installation, software investment, onboarding, training, salaries, and benefits. Partnering with Cliniqon lets you be at ease, knowing that experts handle your billing needs without worrying about overhead costs.
Additionally, outsourcing your billing needs to Cliniqon reduces the costly rework of the claims denials process since our specialists ensure accurate claims submission.
Partnering with Cliniqon accelerates claims processing through streamlined processes and advanced technology. Our skilled billing specialists systematically deal with large volumes of records proficiently. We guarantee faster claims processing with our enhanced workforce, upgraded resources, and advanced technological support. Consequently, this accelerates the claims processing from patient encounters, reducing delays and shorter revenue cycles ultimately facilitating quicker reimbursements.
Patient satisfaction is increased when choosing Cliniqon as a trusted partner for your home health and hospice billing services. Our expertise in the timely processing of claims expedites insurance reimbursements, resulting in quicker resolutions and easing patients’ concerns about prolonged payment delays.
At Cliniqon, we ensure that your patient’s records are protected. We utilize robust data security measures and up-to-date software that adhere to industry standards and compliance regulations to prevent potential data breaches and data loss. Moreover, our staff are signed in and trained on HIPAA compliance protocols. This ensures patient data's confidentiality, integrity, and availability at every stage of the billing process.
Outsourcing your home health and hospice billing needs with Cliniqon helps bring in more revenue for your home health and hospice agency. Additionally, it also helps speed up the revenue cycle. Our billing specialists are competent in the claims approval process, reducing the claims denial rate, leading to faster payment collection, and maximizing provider revenue. Moreover, our specialists ensure that every service is correctly billed, minimizing missed revenue opportunities.
DENIALS MANAGEMENT SERVICES
Home Healthcare providers potentially lose thousands of dollars in annual revenue due to denied health claims. However, these financial risks can be effectively mitigated by implementing denial management strategies. To address this challenge and optimize revenue cycles, a highly effective solution is to engage a clinical processing outsourcing service like Cliniqon for comprehensive denials management.
Our Denials Management Services
Our denials management team at Cliniqon comprises experienced experts who:
- Investigate the cause behind every denied claim
- Focus on resolving the identified issues
- Re-submit the claim to the insurance company
- File appeals whenever necessary
- Implement strategies to prevent future denials
At Cliniqon, we efficiently handle the denials management process and rectify inaccurate or invalid medical codes, offer to support clinical documentation, appeal prior authorization denials, and conduct effective follow-ups.
Comprehensive Denials Analysis
We thoroughly analyze denied claims to uncover the underlying reason for denials. We identify the root causes and patterns of the denied claims and implement targeted solutions to prevent similar denials in the future.
Skilled Appeals Management
When claims are denied, Cliniqon excels in crafting well-structured appeals. Our denial management specialists provide the necessary documentation and arguments to support the claims, increasing the chances of successful reprocessing.
Benefits of Choosing Cliniqon for your Denials Management
Streamline and Expedite the ProcessThe denials management process can severely impact home healthcare agencies' time since it involves several steps, including identifying and analyzing denials, categorizing denials, preparing appeals, resubmitting claims, tracking claim status, implementing strategies to prevent denials, and continuously monitoring denials even after implementing process improvements. Cliniqon’s denials management team efficiently handles the denials management process, freeing up home healthcare agencies’ time.
Most denials often result from common errors that a systematic review process can easily prevent. These encompass claims lacking specificity, submitted after deadlines, containing incomplete or inaccurate details, featuring incorrect diagnosis coding, and lacking proper documentation. By avoiding common denial claims, home healthcare companies can lower their overall denial rate and enhance the integrity of their revenue cycle procedures. By partnering with Cliniqon, common claims denials are avoided since our denial management specialists thoroughly review each claim before submission, ensuring accuracy.
Our team of experts at Cliniqon competently identifies and rectifies issues that lead to claim denials, ensuring that home healthcare providers receive the accurate and fair compensation they rightly deserve for the services rendered. We provide improved revenue capture and quicker payment cycles, ultimately increasing the home healthcare provider’s revenue.
Home healthcare providers' primary responsibility is direct patient care. However, when they manage claims denials independently, a significant portion of their time is consumed by interacting with insurance companies and pursuing claims. This can take much time away from their core patient care responsibility. Therefore, entrusting the denials management process with Cliniqon offers a viable solution. By relying on Cliniqon’s expertise, home healthcare providers can redirect their focus to patient care while ensuring effective resolution of claims denials.
Having an in-house denials management team can increase costs for home healthcare providers. These include costs of hiring, training, and managing the in-house staff. Additionally, overhead costs are increased, including rent for office space, cost of utilities, and computer software. Home healthcare providers can reduce these costs by outsourcing their denials management needs with Cliniqon while guaranteeing quality in their denials cycle management.
By partnering with Cliniqon, home healthcare providers gain access to specialized expertise. Our specialists have in-depth knowledge and proficiency in handling insurance claims. They are also well-equipped to tackle various challenges that lead to claim denials.
With our specialized expertise and deep understanding of the complexities of insurance claims, Cliniqon ensures that all processes adhere to the latest compliance requirements and industry best practices.
PATIENT COLLECTIONS SERVICES
Handling patient collections can pose a significant challenge for home healthcare providers. Balancing exceptional patient care and maintaining a consistent revenue stream can be overwhelming. This is where outsourcing your patient collections with Cliniqon becomes a strategic choice. By entrusting Cliniqon to handle the Patient Collections process, you can expect better financial outcomes, efficiency improvements, and a smoother experience for patients and staff.
Our Patient Collections Services
At Cliniqon, we have a dedicated team of experts who handle the patient collections process with a commitment to efficiency, compliance, and professionalism.
- Debtor Location and Contact
- Record-Keeping
- Account Updates
- Payment Processing
- Claims Review and Resolution
- Follow-ups
- HIPAA Compliance
Our specialists are skilled at contacting debtors to address overdue payments.
We maintain comprehensive records of all debts and payment activities, ensuring transparency and accountability in the collections process.
We proactively collect and update information on client accounts and payments, ensuring that your records are always current and accurate.
Our team handles payment processing with precision, guaranteeing that all transactions are secure and properly documented.
We conduct meticulous reviews of claims to verify their accuracy and work to resolve any discrepancies or outsourcing balances.
Our team conducts follow-ups for insurance reimbursements.
Our collection specialists manage home healthcare clients' accounts and review detailed patient information for payment resolution while adhering to all HIPAA guidelines. They maintain the highest privacy and security standards in handling patient information.
Optimize Patients Collections with Cliniqon
Expertise in Patients CollectionsOur team of professionals deeply understands the complexities of the patient collections process. Their expertise enables them to streamline and improve collections, optimizing your revenue cycle management and ultimately improving financial performance.
When home healthcare providers handle the patient collection process, they must manage multiple responsibilities simultaneously. Administrative tasks, such as patient collections, consume time they can spend on delivering exceptional home healthcare. By partnering with Cliniqon, home healthcare providers can offload this time-consuming task to our specialized experts and focus on direct patient care.
Patient collections require strict compliance since they involve sensitive patient data. At Cliniqon, we ensure compliance with HIPAA regulations and other home healthcare regulations to ensure that all patient information is handled with the utmost care and confidentiality.
HOME HEALTH PRIOR AUTHORIZATION SERVICES
Home healthcare providers must seek approval from a patient’s insurance company before proceeding with specific services. Managing the prior authorization process is a time-consuming task, which adds a significant administrative burden to home health providers’ workload. At Cliniqon, we expedite the prior authorization process for home healthcare providers, reducing the administrative burden and allowing them to focus more on providing exceptional patient care.
Cliniqon provides prior authorization services for various home healthcare services, including skilled nursing (SN), physical therapy (PT), occupational therapy (OT), and speech-language therapy (ST). Prior authorization helps ensure that the recommended home health services are appropriate for the patient’s condition and treatment plan. It also helps prevent misunderstandings or disputes about insurance coverage and ensures patients receive appropriate care while complying with insurance policy guidelines.
Cliniqon is the perfect solution to overcome challenges in the Prior Authorization Process.
The Prior Authorization Process is essential in home healthcare but does not come without challenges. In response to these persistent challenges, home healthcare providers are increasingly exploring the option of collaborating with outsourcing companies.
Below, we’ll delve into the typical challenges encountered during the prior authorization process and demonstrate how Cliniqon is the perfect solution to conquer them.
The Prior Authorization process can lead to delays in patients receiving necessary services, impacting patient outcomes in time-sensitive conditions. Cliniqon’s approach to overcoming this challenge is rooted in efficiency and patient-centeredness. Cliniqon ensures patients receive timely access to care by streamlining the prior authorization process through expert management and precise documentation. This strategic handling helps mitigate the impact of delays on patient outcomes, enhancing the overall effectiveness of their home health journey.
Home health agencies often hire additional personnel to handle the administrative tasks associated with prior authorizations. Hiring and training staff for these tasks can increase labor costs. Moreover, they may need to invest in certain software or electronic systems, which is often costly. They will also require infrastructure to house staff and equipment, increasing their annual costs.
Cliniqon alleviates the need for additional in-house staff by offering specialized outsourcing services. We also utilize and invest in the latest software and equipment. Therefore, partnering with Cliniqon reduces costs and ensures that resources are allocated carefully, enabling home healthcare providers to maintain financial stability without compromising patient care.
Successfully navigating the prior authorization process demands a synchronized effort involving multiple teams, from pre-admission to intake and even involving IT personnel. In the absence of effective collaboration, it’s common for prior authorization lapses to occur. With expertise in facilitating efficient collaboration across diverse teams, Cliniqon bridges potential gaps and guarantees that all aspects of the prior authorization process are meticulously managed.
The criteria for prior authorization can be complex and vary among insurance plans. Home healthcare providers often have to navigate different guidelines and documentation requirements, leading to confusion and potential errors. Cliniqon excels in simplifying this intricate process and translates complexity into clarity by leveraging its expertise and staying on top of the latest industry developments. Partnering with Cliniqon empowers providers to overcome the complexities and deliver optimal care confidently.
It’s a frequent occurrence in home healthcare that the necessity for services could go beyond the original authorization. For example, consider a patient who undergoes surgery and receives home healthcare services for post-operative care. The initial authorization might cover one month, but the patient’s recovery takes longer due to some complications. As a result, the need for services extends beyond the initially approved period, which typically requires another prior authorization.
Moreover, some insurance companies authorize only one medical service at a time. This means that home healthcare providers need to initiate the authorization process for each subsequent appointment or service, which can be time-consuming and demanding. Therefore, entrusting an outsourcing company like Cliniqon offers the perfect solution to avoid the hassle of submitting multiple authorization requests. With Cliniqon as a home healthcare partner, providers are ensured that their authorizations are proactively managed and renewed.
Cliniqon’s prior authorization specialists are home healthcare professionals who specialize in navigating the complexities of the prior authorization process. They deeply understand the requirements and guidelines set by insurance companies, regulatory bodies, and home healthcare providers. Their main role is to help get necessary medical services approved by working with home healthcare providers and insurance companies. They work closely with home healthcare providers to gather and organize the needed paperwork, medical records, and evidence that support the requirement for a particular medical intervention.
At Cliniqon, our prior authorization specialists ensure that all necessary information is complete and accurate before they submit the prior authorization request to the insurance company. Beyond their paperwork skills, our specialists also excel in communication. They interact with insurance company representatives to advocate for the patient’s needs and make a compelling case for approval.
Our prior authorization specialists at Cliniqon are also equipped with the essential training to excel in their roles as prior authorization experts. Moreover, they continuously keep learning and adapting to changes in the home healthcare field. They stay informed about evolving insurance policies and new regulations, ensuring they stay up-to-date with the latest industry knowledge.
In conclusion, selecting Cliniqon as your trusted partner in prior authorization is a decision that embodies efficiency, precision, and exceptional care. Our dedicated team of experts stands ready to navigate the complexities of the prior authorization process on your behalf, allowing you to concentrate on elevating patient experiences and advancing medical excellence.
Our Home Health Scheduling Services
Efficient SchedulingAt Cliniqon, we understand that smooth coordination is crucial in providing top-notch home healthcare services. Our dedicated team of home health schedulers plot visits directly into the electronic medical records. This ensures that all essential information is at the fingertips of our caregivers, leading to streamlined and precise care plans. With Cliniqon’s commitment to accuracy and innovation, you can rest assured that every visit is thoroughly scheduled and documented, enabling our home healthcare professionals to deliver the best possible care to their patients.
At Cliniqon, we prioritize ensuring the availability of clinicians for every visit. We know your time is valuable, and disruptions to your home healthcare schedule can be stressful. With Cliniqon, you can trust that our team of home health schedulers is committed to coordinating appointments that fit effortlessly into your routine. Our scheduling system, combined with open communication channels, guarantees that our clinicians’ schedules perfectly align with those of their patients.
Cliniqon’s commitment to guaranteeing seamless home health scheduling extends to ensuring patients are readily available for their crucial visits. Cliniqon’s client-centered approach places your time and convenience at the forefront, allowing home healthcare providers to focus on patient care while we handle administrative tasks.
We understand that a Clinician’s time is a valuable resource that should be optimized to the fullest. When a patient is unavailable for a scheduled visit, we employ a strategic approach to ensure that no time goes to waste. Our home health schedulers efficiently arrange appointments and can expertly fill gaps to maximize each clinician’s availability. Our team leverages real-time scheduling data and comprehensive patient profiles to identify alternative appointments or tasks that can be easily accommodated within the clinician’s schedule.
At Cliniqon, we recognize the paramount importance of accuracy in home healthcare delivery, and that’s why we utilize a meticulous approach to ensure that all visits are impeccably integrated into the EMR system in accordance with the designated frequency. Moreover, we understand that every patient’s journey is unique, and adhering to the prescribed visit frequency is pivotal to successful outcomes. Our commitment to precision goes beyond scheduling; it extends to the thorough plotting of visits, aligning with the specified frequency of each patient.
Missed visits lead to lost revenue and represent a longstanding concern impacting resource utilization and potentially comprising high-quality home healthcare services. Besides patient-related issues, which potentially affect patient no-shows, scheduling-related problems also contribute to missed appointments. Studies show that if an appointment has a high lead time (e.g., having an appointment several weeks later) between appointment booking and the actual visit, it increases the likelihood of them being missed.
At Cliniqon, our home healthcare scheduling team is dedicated to optimizing appointment scheduling by utilizing proactive communication and efficient scheduling strategies. We ensure that patients are always notified or updated regarding their appointments to guarantee their availability and mitigate the likelihood of missed visits. Moreover, our team also bridges the gap between appointment scheduling and actual visitation to prevent potential lapses due to changes in availability or unforeseen circumstances.
Furthermore, our home health schedulers diligently reach out to patients in the event of missed visits as part of our stringent protocol. This approach reflects our strong dedication to maintaining the utmost level of patient care and enhancing clinician productivity. By doing so, we ensure that our scheduling process is optimized and aligned with the highest standard of professionalism.