Scope of Services
Fedora provides an end-to-end solution for all client's Revenue Cycle Management needs, including front end processes.
Eligibility/Benefits Verification
Pre-Certification/Authorization
Billing
A/R and Denial Management
The end goal for every client is minimization of avoidable denials.
Eligibility & Benefits Verification
Client-specific processes will be implemented to maximize collection of outstanding patient balances based on practice's approach
Billing
Our billing process goes through three levels of scrubbing across multiple individuals to minimize billing errors
Subprocesses include:
Submission of all visits and charges
Reconciliation of ASC and office charges
Ensuring all add-on codes and modifiers are captured correctly
Daily reconciliation process prior to submission of claims
Full scrubbing prior to claim submission
Our goal is to ensure both that billing is fully correct to minimize potential denials and ensuring that every charge is captured
Pre-Certification/Authorization
Fedora's authorization staff is fully trained in obtaining any required pre-authorizations for scheduled patients
Our services include (but aren’t limited to):
Identifying whether the patient plan requires pre-authorization for specific services
Initiating and submitting the case for authorization with all relevant patient information needed
Continual follow-up with the insurer if response is delayed
Pursue the escalation process if needed
Denials and A/R Management
Fedora has 14 years of experience in managing A/R. We will rigorously pursue all denials
Our first step is to conduct an A/R analysis of old denials (up to two years prior to inception of services) and re-initiate the best course of appeal with the highest chances of revenue recovery
Every new denial will be analyzed within 48 hours of receipt, at which point the best course of action to receive payment is identified and then followed
Pursue any potential alternate forms of recovery if appeals are denied
Continual follow-up with the insurer if response is not received on appeals within anticipated time frame
Our deliverables include, but aren't limited to
| Eligibility/Benefit Verification | Daily report to front desk staff with list of patients with expired eligibility 3 days in advance and 1 in advance of visit |
| Authorization | All payers/services requiring authorization initiated by Fedora |
| Patient authorization status updated regularly within EMR to reflect current status | |
| Daily report indicating patients who have not received authorization provided X days in advance of visit | |
| Billing | Daily submission of all charges downloaded from client system after claim scrubbing complete |
| Accounts Receivable | Denial management work begins within 48 hours of denial receipt |
| All follow-up work completed regularly and timely | |
| All steps taken to maximize likelihood of payment | |
| Reporting | Regular reporting and discussion of key performance metrics (determined with consultation with client) with client stakeholders |