Revenue Cycle Management

In addition to providing efficient medical practice management services, Fedora performs market research, analytical interpretation and has the technical skills to help client in informed-decision making and realize business opportunities.

We believe that doing business with Fedora should be easy. Long-term customer relationship is as important to us as project management.

Patient Enrollment
We can help enroll patients who are under-insured or uninsured to get in programs such as PAPs and other foundations.

Patient Demographics Entry & Verification in PMS / EMR
We will enter patient demographics into the system for new patients and verify that all the data entered is complete and accurate.

Insurance Benefits / Eligibility Verification and Pre-Certification
Before the provider renders any service, we can verify the eligibility and benefits of the patient’s insurance and recorded into patient’s account.

Click here for details on Insurance Benefits / Eligibility Verification.
  • For every new patient, front desk will collect insurance cards and forward it to us.
  • The insurance of the patient will be verified using the insurance company’s online verification website or by directly calling the insurance company. 
  • Complete benefits will be appended in the patients account.
  • Any limitations or pre-certification will be flagged.
  • Any patients who are very near to their life time max will be notified to concerned person.
  • Authorization for services will also be obtained

Patient Visit
After the patient visit, the patients’ documents are scanned and uploaded from your office are securely accessed by Fedora's offshore center via FTP.

Encounter Documents include patient superbill, patient charts, hospital cards, EOBs. All documents received from client are examined for their completeness.

Coding
Diagnosis, Procedure Codes and Modifiers are assigned as per latest guidelines.

We use the following industry coding standards:

  • Diagnosis Codes (ICD-9: International Classification of Disease)                             
    LCDs and NCDs will be referred to define its sequence.
  • Procedure & Drug Codes (CPT-4: Current Procedural Terminology /
    HCPCS: Healthcare Common Procedure Coding System)
  • Modifiers (as per CCI and NCCI Edits)
  • Units will be assigned according to the drug / supply usage denoted in the patient’s documentation.
Once the charges are entered in the system, all the coding will get thoroughly examined during our reconciliation process.

Click here for details on Reconciliation Process.
  • Medical records are assessed to ensure their completeness.
  • Procedure billed are verified by documentation.
  • Coding is assessed for compliance with respect to coding guidelines.
  • All data including coding, DOS, POS, HCPCS, Units, Modifier, Diagnosis and Charge Amount is verified by multiple reviewers before approving.
  • Daily reconciliation reports listing the diagnosis, procedure, modifiers are again cross-checked with patient documents.
  • Drugs entered are verified with reports on actual drugs dispensed. This ensures that correct drug name and quantity is charged to the correct patient as well as all drug usage is accounted for. This is very important for oncologists.
  • Regular Audits are done by our quality analysts to ensure that all the processes follow the pre-defined standards.

Claims Management
The claims will be generated and filed either electronic or paper as per payer standards.  The acknowledgement on the receipt of the claims will be checked to prevent any loss of claims.

Any errors resulting from the transmission either at the gateway or at the insurance clearinghouse will be resolved and resent within 24 hours, unless there are discrepancies which need to be resolved. 

Click here for details on Claims Management Process.

ERA / EOB Processing and Payment Posting
Insurance payments are posted to patient accounts from the EOBs. All the payments received will be posted within 24 hrs.

For payers who do not have Electronic Remittance (ERA), our team will manually post the insurance payments into the patients’ account matching the respective allowed amount for each charge.

To ensure that all the payments received are posted, we will compare Bank deposit vs. total payment posted in the Practice Management Software.

If the patient has co-insurance, the remaining unpaid charges will be filed to the secondary insurance as per the coordination of benefits.

Any deductibles, copays, Out-of-Pocket, and other patient responsibility stated by the insurance will be billed to the patient when the statements are generated. Before generating statements, we ensure that account balance for patients are correct and they are not billed the balances for which they are not liable.  Patients’ statements are generated on a monthly basis.

Denial Management
All denied claims are analyzed, corrected, and re-submitted within two working days on receipt of the EOBs.

Click here for details on Denial Management Process.

Account Receivables Management
The main focus of our Account Receivable department is to compare the expected collection to the actual collection received, understand the reason for the discrepancy and take measures to recover the difference.

The second challenge in Revenue Cycle Management is to keep the age of the receivables to less than 45 days. We have incorporated a systematic and regulated process at each phase to achieve our commitment.

An analysis of the receivables will be performed.

  • All unpaid claims are processed using prioritized based method.  AR analysts run reports to identify claims with high value and claims approaching insurance filing limits are given utmost priority.
  • Any underpayment in the contracted amount or reimbursement rate of the insurance company will be flagged.  (These payments are usually overlooked by most practices.)
Reports
We provide Standardized Reports applicable to all practices.
We can also provide customized reports on client’s request.
  • Production-Collection Report - This report shows the comparison of Production and Collection from current and previous months.
  • A / R Summary Report - This report reflects the age of the claims for each insurance.
  • Exceptional Reporting - Anything which is an exception to the daily work is reported in this report.
  • Cost-Profit Analysis Report - The cost-profit analysis of the drugs are summarized in this report.

  • "We have been working with Fedora Solutions for almost two years now. I must say they have been a tremendous help in working with our numerous accounts. Since they have been working with us we have been able to remain timely with our patient's accounts. I want to thank all staff members for their hard work and the many hours they have put into helping us." - Evelyn Rangel
    Account Rep
  • "I have been working with Fedora Solutions staff for the last couple of years and they have been a big help with our billing and any question we have. They are quick to respond by email or phone and they are always willing to help in anyway they can and a pleasure to work with."- Tammie Ambriz
    Insurance Supervisor
  • "It has been a great pleasure to work with Fedora Solutions for the last two years.  They have learned every aspect of our billing department and have been a tremendous help in keeping our business current.  They have taken on everything we have given them & helped keep pace with our expanding practice."- Sandra Wheeler
    Payment Coordinator
  • "It has been my pleasure to work closely with staff at Fedora for several years. The staff and Fedora are friendly and has been a great asset to our companys success. The staff at Fedora are extremely knowledgeable and are quick to solve problems such as coding and billing issues and the appeals process in the event a claim has been denied. I look forward to many more years working with Fedora and their highly trained staff."- Cynthia Hukill
    Account Rep