Healthcare is undergoing a profound transformation. The biggest challenge faced by providers in this sector today is how to improve the quality of care provided without increasing the cost. A typical difficulty in this scenario involves getting paid for services rendered. In other words, it concerns healthcare providers working hard to improve the quality of services to patients and yet, not getting paid for it at the end of the day due to an outdated, or simply inefficient, revenue cycle management process. They are falling victim to missed, inaccurate or delayed payments, which in turn are hurting their businesses.

This is where we can make a big difference. Our proactive and streamlined revenue cycle management process gives you complete visibility and assurance of your payments – starting from charge entry to claims submission through payment follow-up.

We have been successfully serving healthcare providers in every domain – physicians, hospitals, urgent cares and durable medical equipment. Our billers and coders are proficient in working in several industry-standard practice management and billing systems, and have an excellent track record in delighting each customer through their expertise, dedication and steady focus on making you realize your payments on time.

Our range of services for healthcare providers produces significant cost advantages that include, but are not limited to, savings in cost of billing operations and higher revenue & cash flow due to reduction in denial rate and increased payment from Payors

We welcome you to explore our widely acclaimed range of solutions geared for healthcare service providers just like you. We will be glad to offer you our powerful yet cost-effective services to help you take your business to the next level of success.

As health insurance is constantly evolving with newer legislations & practices, prior authorization continues to become the cornerstone of administrative functions. The in-house team can be overwhelmed by its complexities, which in turn can have a negative influence on your practice’s finances. You can rest assured that Sunknowledge & its consultative aptitude, with best-in-class solutions in prior authorization (also referred to as pre-certification or pre-authorization) will handle all operational hassles so you can focus on your care management priorities.

We are your one-stop address & the perfect mediators with the Payor, dedicated to help you remove all obstacles in your pre-cert process that are hurting your bottom line. We offer a 3600 program in practice management with an exclusive skill-set that starts with a synchronized process of collection of patient information to availing prior authorization for both inpatient & outpatient services.

We also look to add value with our thorough benefits verification services that remove unpleasant surprises in the path to claims submission and payment, thanks to our proven methodology to eliminate errors quickly and address issues effectively.

Our resources are dedicated experts with extensive knowledge about the checks & balances in practice management & help you reap real-time benefits with excellent relationship management skills with the insurers. Our zero client attrition for the last 7 years is largely due to our comprehensive understanding of Payors’ claims adjudication priorities.

We are also partners with two of the country’s largest companies in insurance dealing with health plans. Our unique best practices will help you achieve a better denial management process.

Highlights

~ Turnkey all-inclusive prior authorization services (Authorization Request + Follow-up + Approval)
~ 100% HIPAA compliance
~ Rx notification to the pharmacies (For prior authorization on medication)
~ Scheduling delivery of drugs with pharmacies
~ Competitive pricing, with no overtime and zero overhead
~ Helping you focus on patient-centric activities
~ Long standing alliances with leading health insurers
~ Flexible engagement model without lockup or binding service clauses

Our medical coding and billing services are designed to address a wide range of issues and challenges faced by hospitals and physicians while realizing payments. By leveraging efficient processes and billing workflows, we help to improve productivity and quality, which in turn reduces operational cost and boosts revenue generation. Our billing process experts can provide customized solutions to help you achieve your business objectives. These solutions not only dramatically improve efficiency in a manner which is surprisingly cost-effective, but also allow you to focus on the more important aspects of your business.

Medical billing involves accurate interpretation of SOAP notes for correct coding combinations based on payor specific guidelines. A thorough understanding of the nuances associated with various physician specialties is required. This drastically reduces denials, which in turn leads to a significant reduction in days in AR. Denials due to incorrect entry of demographics are minimized through our transaction based internal audit mechanism. Rejections are worked as a priority to reduce turn-around time and detailed analysis of denials helps identify changes in payors’ reimbursement guidelines. Systematic follow-up is also conducted that minimize the possibility of untimely denials while ensuring their early identification, requests for medical notes, etc. All claims that have not been closed out in the system are categorized by age and insurance for effective management of the follow-up process. Billings of secondary claims are also followed up to reduce the patient’s financial responsibility while ensuring better collections.

Highlights

~ Accurate coding combination, i.e. service code, diagnosis code, modifiers and place of service code
~ Error free patient entry
~ Real time transaction audits for patient and charge entry
~ Claims submission within 48 hours of receiving patient (demographic & insurance) and service information
~ Rejection follow-up within 24 hours
~ Tracking and follow-up of partial or incorrect payments
~ Denial management based on detailed analysis
~ Methodical and proactive AR follow-up
~ Timely payment posting to reflect accurate AR
~ HIPAA compliant
~ Customized reporting for

~ Claims submission
~ Collections
~ Denials
~ Accounts receivables

Providing billing services for Durable Medical Equipment (DME), or Home Medical Equipment (HME) as they are sometimes called, can be a time-consuming and tedious affair. Among other things, it requires in-depth knowledge of reimbursement guidelines of Medicare, Medicaid and Commercial Plans, and their caveat. It also requires a constant adherence to quality and staying abreast of all the changes happening in reimbursement regulations and coding & documentation requirements.

Sunknowledge has a highly capable team of DME billing experts who can make life easier for you from the very first day. With Sunknowledge by your side, you can leave all your DME billing worries to expert care. Outsourcing your DME billing requirements to us will allow you and your staff to concentrate on marketing, growing and running business operations, rather than managing a billing and collections department.

Our experience shows that the process for DMEPOS billing can be cumbersome due to its inherent nature, viz. the order getting generated from a physician’s office. This increases complications and the turn-around time as dependencies increase. DME, Prosthetics & Orthotics companies need to devote much time coordinating and communicating with the ordering physician’s office for a valid Rx, medical/therapy notes, etc. Equipment that requires prior authorization also involve innumerable follow-up calls. This is managed effectively by us through our methodical and streamlined process that tracks each request in detail ensuring timely follow-up. Payor guidelines are specific to diagnosis and a thorough knowledge of this result in drastically reducing denials. Our diligent physician and payor follow-up activities also help reduce turn-around time and improve cash flow. The process starts with entry of orders and ends when the account has zero balance. This includes conducting eligibility checks, obtaining authorization, creating sales orders, scheduling delivery, submitting claims, managing rejections and denials, and proactively following-up AR.

Highlights

~ Follow-up on incomplete prescription with physician’s office
~ Follow-up for document collection (diabetic verification forms, LMN, CMN etc.)
~ Error free patient entry
~ Error free sales order creation
~ HIPAA compliant
~ Real time transaction audits
~ Primary and secondary insurance verification
~ Insurance verification for rental items
~ Obtaining authorizations & extending authorization
~ Open order audit and clean-up
~ CPAP user compliance tracking and counseling calls to non-compliant patients
~ Claims submission within 48 hours of receiving proof of delivery
~ Rejection follow-up within 24 hours
~ Tracking and follow-up of partial or incorrect payments
~ Denial management based on detailed analysis
~ Methodical and proactive AR follow-up
~ Timely payment posting to reflect accurate AR
~ Customized reporting

~ Claims submission
~ Collections
~ Denials
~ Accounts receivables

 

Our Complete Approach to DMEPOS Billing

~ Initial Visit Appointment Setup (done by Practice)

~ Order Entry

~ Patient Account Creation
~ Patient’s demographic entry
~ Prescription information entry

~ Initial Eligibility Verification

~ Creation of Insurance verification form
~ Checking general eligibility and benefits information and updation in OPIE

~ Initial Evaluation Appointment (done by Practitioner)

~ LCodes assignment
~ Measurements (If required)
~ Creation of Evaluation form/Notes/Other Medical Records

~ Detailed Eligibility Verification & Authorization Requirement Checking

~ Re-verification of eligibility with assigned codes
~ Updating detailed code specific benefits
~ Checking authorization requirements (Code Specific)
~ Creation of Service Estimates (Payer Specific and Reasonable and Customary)
~ Sending detailed written order/diabetic verification form and other paperwork to doctor’s office for signature

~ Doctor’s Office Follow-up

~ Contacting doctor’s office for pending detailed written order/diabetic verification form and other paperwork

~ Authorization/Pre-Determination/Referral Initiation

~ Creation of Insurance Authorization Form
~ Requesting Authorization/Pre-Determination/Referral (Via Phone/Fax/Email)

~ Authorization/Pre-Determination/Referral Follow-up

~ Follow-up with payer on Authorization/Pre-Determination/Referral status
~ Completion of authorization form based on the outcome of the request

~ Final Eligibility Verification or Pre-delivery Check

~ Creation of patient financial responsibility form
~ Notes updating
~ Work In Progress (WIP) updating

~ Office Coordinator Notification

~ Patient responsibility
~ ABN creation

~ Schedule Delivery

~ Delivery (done by Practice)

~ Signing Delivery Ticket (Soft copy/Hard copy)

~ Claim Submission

~ Primary/Secondary/Tertiary claim submission (via paper/fax/electronic)

~ Rejection Management

~ Online rejection checking (via Clearing House)
~ Correction and resubmission of the rejected claims (via Clearing House)

~ AR Follow-up & Denial Management

~ Follow-up on pending AR balance and working on denials
~ Follow-up on possible reconsideration requests
~ Filing reconsideration requests & appeals

~ Payment Posting

~ Patient payment posting and adjustments
~ Insurance payment posting and adjustments

Our Accounts Receivable follow-up process monitors and proactively pursues collection of payments. All claims that have not been closed out in the system are categorized by age and insurance for effective management of the follow-up process. Calls are initiated for claims that are 31 days old or more. We attempt to identify the source of the problem through proactive calling so that the turn-around time on collections can be reduced.

Diligent follow-up for paper submissions ensures that “claims not on file” are resubmitted within filing limits. Weekly A/R Reports are analyzed and reviewed to prioritize work for the week. All interactions with payors are documented in detail, making repeat follow-ups streamlined and more effective. Our experienced team is adept at gathering information through appropriate probing questions. Findings are communicated with clients through a detailed report on a daily basis. The report also includes suggestions for actions to be taken from the client’s end e.g. resubmitting with medical notes, or with modifier/coding changes, and so on.

At Sunknowledge, every cash amount receives the same degree of attention as the other, irrespective of its size or source. Combine that with our high accuracy standards and you can rest assured that every penny you are entitled to will be claimed and recovered by us in the shortest possible time! Moreover, our knowledge of pertinent federal laws and acts such as EMTALA (Emergency Medical Treatment and Labor Act), ERISA (Employee Retirement Income Security Act), the Prompt Pay Law and others, help in resolving issues and settling accounts much faster than other A/R Managing companies.

Highlights

~ Streamlined and improved workflow using effective tracking tools
~ Multiple follow-up calls for the same claim
~ Follow-up on all paper submissions
~ Payor-specific analysis
~ Detailed reporting with suggestions for actions to be taken
~ Improved cash flow
~ Reduction in turn-around time
~ 100% HIPAA compliant

Sunknowledge also maintains strict adherence to the Fair Debt Collection Practices Act when contacting patients with the aim to collect unpaid dues from them. We understand the need to proactively communicate with patients with regards to collections. It is, therefore, imperative to understand the billing process thoroughly.

The Sunknowledge team acknowledges the need to be respectful and patient while communicating with patient debtors. The frequency and manner of communication make the difference between success and delays. Accurate and understandable information is the foundation of any effective collections strategy.

Knowledge of payment options, appointment history, payment trends, age of balance, and earlier communications hold the key to effective communication and establishes credibility in the eyes of the patients.

The team takes several steps to make the process effective and efficient.

~ Review patient’s account quickly and accurately on an incoming call/prior to placing an outgoing call

~ Communicate with the patient explaining the need for the courtesy call

~ Take a payment on the account and or record a promise to pay in the notes

~ Go over patient’s account information with the patient/responsible party/authorized person if needed, once the account is verified properly

~ Identify the patient’s difficulties to pay on the account and to offer appropriate payment plans and/or Financial Aids based upon their situations and eligibility

~ Explain and justify the charges on a statement prior to billing them to the patient

~ Track and ensure effective follow up on all accounts for better turn-around

~ Handle billing disputes and to justify if a charge is required to be written off

~ Correspond with the attorney’s office appointed by the patient/responsible party on behalf of the provider’s office

~ Communicate with payers to verify the patient’s eligibility or to discuss a claim

~ Review the past due reports at the end of the month and forward the eligible accounts over to the 3rd party collections department with proper ledger write-off in the billing/patient collections system

~ To correspond with the 3rd party collection agency regarding issues about patient’s account and to ensure that they are resolved in a timely manner

~ Maintain a healthy relationship with the patient and offer an excellent customer service experience above all, to make sure that the provider’s business experience is outstanding in terms of the services that Sunknowledge offers in this area

Medical transcription has come a long way since its early days of painstakingly transferring handwritten notes by physicians to paper-based patient’s records, kept in bulky folders that spread across walls in endless racks. Even listening to recorded tapes and manually typing their contents into an electronic system is passé.

Today, medical transcription involves smart automation, featuring voice-guided inputs, intelligent audits and the use of highly sophisticated tools that cut time, effort and errors.

Medical transcription, today, is a service that is founded on speed and accuracy. We understand. That is why we have built our services on these twin pillars, for your complete satisfaction with every medical transcription requirement.

Welcome to Sunknowledge Services Inc., your one-stop address for the most comprehensive range of medical transcription services that will amaze with their speed, accuracy and flexibility.

Our critically acclaimed medical transcription services are:

~ Affordable: We provide transcription at 8.72 cents per gross 55-character line, saving 55% over doing transcription in-house, and 32% over many of our computers.

~ Accurate: Continuous audits and stringent quality control measures ensure that every byte of transcription done by us is 100% error-free.

~ Accessible: Every account we work with, gets a dedicated manager who is your single point-of contact, around the clock, for all matters related to your transcription work.

~ Fast: Superfast turnaround time and a strict, no-fail 24-hr. delivery of completed transcriptions.

~ Secure: The highest level of privacy & data security practiced, in accordance with HIPAA requirements, for complete peace of mind.

~ Seasoned: We are not your average medical transcription partner. Our years of experience in managing revenue cycles for Providers and adjudicating claims for Payors, give us a unique understanding and familiarity with our trade!

With Sunknowledge’s medical transcription services, you get a lot more than you expect. We thrive on ensuring 100% satisfaction for all our clients. Our transcriptionists are experienced in working in various scenarios, such as:

 

When using an EMR

Forget about typing. Instead, just dictate. We import your transcripts into your EMR* from dictations recorded on a handheld recorder, mobile phone or sent via a toll-free number (additional cost may apply depending on the capabilities of the EMR).

Without an EMR

No EMR? No problem! Use our efficient document management system for free. Access past and recent transcripts, edit documents easily, sign electronically, automatically print and fax to referring physicians.

View Transcripts Online… Anywhere, Anytime

Enjoy unmatched accessibility by using your computer, Apple or Android device anytime to view notes, from office, clinic, hospital, or home!

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