Our Services
Benefits Verification
The process of verifying patient eligibility and benefits can be a time-consuming process for clinics and hospitals, no matter how many patients there may be. It is important that this process be done in a timely and efficient manner. Meticulous eligibility and benefit verification helps in reducing bill claim denials due to incorrect billing, which can result in significant loss of revenue for healthcare providers.
We verify a wide range of data:
Effective date and coverage details, Individual patient eligibility, Type of plan, Payable benefits, Co-pay, Deductibles, Co-insurance, Claims mailing address, Referrals & pre-authorizations & Other related information
Our verification process will check procedure-specific coverage and benefits and all out-of-pocket costs so that patients know what is due before their visit. This will help patient collections and prevent it from aging and eventually becoming uncollectable. By reducing uncertainty about payment, our insurance eligibility verification checks also enhance patient satisfaction. Through our services, healthcare providers can reduce the time required for patient check-in processes (thereby enhancing service levels) and increasing productivity.
Authorization
To ensure patient care is prioritized, authorizations for treatments and services should be obtained well in advance. This helps in avoiding delays and patient service and avoids unwanted denials.
We provide authorization services which included and is not limited to specialities like Oncology, Radiology, Infectious Diseases, Infusions, etc.
We provide multiple follow ups and accurate tracking of all the authorization requests based on the timeliness.
Billing and Posting
Adherence to all the latest billing and regulatory standards, consistently exceeding the 99% quality threshold for clients. All the charges are entered within a TAT of 24 hours from provider’s locking the notes. The charges entered are evaluated through a 3-level filter process of audit controlling the first pass resolution. From the creation of the claims to submission of the claims, we maintain the exact accuracy levels with controlled audit at 3 levels within 24 – 48 hours.
GRIISM makes sure swift and precise posting of all the required payments into the billing system. Regular auditing of all posted payments is executed by us which assists in reducing the errors being generated in the different types of medical processes and while capturing of required information. We extend our services with payment posting to help our clients enroll for ERAs, thus making their work hassle and paper less. Not only we reconcile the payments on weekly and monthly basis for our clients, but we also stretch them with Insurance payments trending analysis, which helps our providers understand the trending of their respective insurance payments and we also proactively fix the abnormal payment trends.
AR Follow Up & Denial Management
Denial rates vary widely depending on physician specialty. Denials for some specialties, such as obstetrics and gynecology, can be as high as 20 percent. Denials for primary care practices can be 10 percent or below. As a rule of thumb, a denial rate of 15 percent affects practice profitability.
Obtaining an accurate reflection of denials for a multispecialty practice can be challenging. “The denial rate for a multispecialty group practice may be 5 percent, but that overall rate may include a 20 percent denial rate for obstetrics and a rate of 1 percent for family practice. You need to look at denial rates by type of specialty. We segregate denial rates for primary care [family practice and internal medicine] from those for specialties that have potentially higher denial rates.
When the denial rate is high, it should be looked at immediately. We address two areas of denials: why they are occurring and preventing them in the first place.
Credentialing
Without being credentialed physicians can’t get paid, don’t make that mistake. Let the trusted experts at GRIISM get you off to the right start! Our team can handle new enrollments, CAQH updates, Medicare re-validation, re-credentialing with commercial plans, expirables management and much more. Let us be your healthcare credentialing partner and help you maintaining your credentialing.
New Credentialing Services:
– Completion of Credentialing Applications with Various Health Plans & Follow-Up Until Credentialed
– Review of Contracts
– Assistance Obtaining CAQH ID
– Assistance Obtaining NPI #
Credentialing Maintenance Services:
– Completion of Re-credentialing Applications with Various Health Plans
– Medicare Re-Validation
– CAQH Re-Attestations
– Expirable Management
– Assistance with Denied Claims Due to Credentialing Issues
Practice Analytics
GRIISM provides you with all the practice analytic-key performance indicators that helps you reduce operational cost, increase collection, and streamline operation.
- Weekly Reporting
- Measuring ageing reports
- Tracking Net collection rate and Gross Collection
- Identifying low paying payers
- Ad hoc Analytics Requests
- Identification of employees performing low throughout the cycle
Our analytic department reviews your account in depth on a regular basis and provides you with the targeted data and clear recommendations that can help you improve your medical practice performance and be aware of potential compliance issues you may have.