We can guide practices in enrolling both underinsured and uninsured patients to foundation and PAP support programs.
Prior to service being rendered by the provider, we verify the patient’s current insurance eligibility, update the patient’s account with current insurance eligibility status, and red flag any issues.
Prior to service being rendered by the provider, we verify patient benefits and deductible balances in the patient’s account.
We initiate and aggressively follow-up on pre-authorizations with payers wherever required to ensure that clients can deliver their services to patients without fear of non-payment.
We follow a rigorous process of scrubbing claims during the charge posting process oriented towards maximizing first-time payments from insurers and minimizing denials.
All claims will be generated and filed either electronically or via paper as per payer standards. The acknowledgement of receipt of the claims by the insurer is checked to prevent any loss of claims.
Any potential errors resulting from the transmission either at the gateway or at the insurance clearinghouse will be resolved and resent within 24 hours barring clinical discrepancies.
Insurance payments are posted to patient accounts from the EOB. All payments received will be posted within 24 hrs.
For payers who do not have Electronic Remittance (ERA), our team manually posts the insurance payments into the patient’s account matching the respective allowed amount for each charge.
To ensure that all payments received are posted, we compare bank deposits with the total payment posted in the PMS.
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 the patient account balance is correct and they are not billed for balances for which they are not liable. Patients’ statements are generated on a monthly basis.
All denied claims are analyzed, corrected, and re-submitted within two working days upon receipt of the EOBs.
Account Receivables Management
Our Accounts Receivable team compares expected and actual collections, understands the cause for discrepancies, and takes corrective measures to recover the difference.
Fedora's systematic and regulated processes during each phase of the revenue cycle allow our AR team to keep Days in AR to below 25.
An initial analysis of old outstanding receivables will be performed whenever a new client joins Fedora, and corrective action will be taken to recover as much revenue as possible from claims filed prior to the client joining Fedora.
Unpaid claims are processed using a prioritization based method, with high value claims and claims approaching the insurance timely filing limits given top priority.
Any underpayment in the contracted amount or reimbursement rate of the insurance company will also be flagged and corrective action undertaken.
We can provide customized performance reports based on our client’s needs.
Insurance / Clearinghouse Credentialing
We have staff specializing in healthcare insurance enrollment & credentialing.
Our singular focus is to eliminate errors, foresee potential obstacles, and avoid delays getting you on the insurance panel of a participating provider while ensuring that you stay current. Fedora guarantees the confidentiality and security of provider information.
We help physicians obtain NPIs. Any delay in obtaining a NPI risks practice cash flow, and Fedora is committed to preventing NPI related delays from negatively impacting your practice.
Revenue Recovery Services
Auditing / Compliance
Assess medical records for completeness and accuracy
Assess documentation accuracy
Assess compliance with respect to coding and billing
Discover lost revenue
Look for coding irregularities
Medical Billing Analysis
Review of entire billing process, including software
Coding practices and billing methodology
Unbilled charges and services
AR characteristics and type of denials
Revenue flow and A/R recovery
Dead AR recovery
ICD-10, CPT-4 and HCPCS coding
Under-coding E/M visits or vice versa
CCI and NCCI Edits
Accurate, ethical and compliant coding
Contracted amount vs. payment collected
Drugs P&L Analysis
Underpaid and undervalued charges
Out of Network payment analysis and negotiation
Software Transition Support
Migration to EMR System
With the growing need for an electronic medical record (EMR) system, Fedora can support your practice transition rollover with support in transitioning patient data from physical charts into the EMR system quickly and efficiently.
Transition from old to new Practice Management Software (PMS)
If you are planning to change your PMS, we can assist you in moving the data from the old PMS to the new PMS. Important data such as active patient demographics, recoverable patient balances, and collectible AR will be transferred, allowing you to be back in business in minimal transition time.
Provide full-featured licensed PMS free of cost
Fedora can provide an in-house Practice Management Software (Medisoft Version 12 SP2) which also includes an appointment scheduler via VPN at no additional cost to the practice.
Setting up a gateway is both one of the most important and most daunting tasks for a practice. We can guide clients in selecting and configuring the right gateway for their needs.
We can enter new patient demographics into the EMR and PMS system with checkpoints that verify all data is complete and accurate.