Our processes are therefore a hybrid of automated systems and human-directed analysis and service.
Code it right
The correct coding of an anesthesia claim is one of the most important elements in appropriately maximizing revenue. Our staff has 40+ years of experience in dealing with the complexity of coding anesthesia claims.
All of our coders are AAPC certified and enter coding for every case utilizing both the billing slip and facility medical records. We understand how to evaluate surgical and pain procedures, clinical factors, and payer specifics to code every claim correctly.
In addition to ensuring that we don’t under/over-bill for services, we also have automatic checks in place to help prevent common errors such as accidental overlapping of billed time. This avoids the hassles and embarrassment that can result from mistaken improper billing.
At Fusion Anesthesia, we check claims multiple times through automated systems, humans in-house, and statistical sampling of all claims for auditing.
Submit it fast
Our standard turnaround time is three business days from the receipt of the billing information to the submission of the claim. Timely submissions keep the cash flow smooth and, if needed, allow for us to discuss any questions with the doctor while the case is still fresh in their minds.
Claim tracking
Our systems track both electronic and paper claim submissions. We make sure that every claim item submitted is tracked through our clearinghouses, payers, lockbox, and banking partners. We continuously monitor the claims process outside our walls so that we can follow up as appropriate, as soon as it’s appropriate.
Exhaustive follow-up
Accuracy, diligence, and a high degree of automation in the claims preparation and submission processes yield a higher than average number of claims paid and collected correctly the first time.
However, it will surprise no one that many cases require more follow up than just cashing the check. It’s for these complex situations that Fusion Anesthesia’s specialty expertise and experience come into play.
We intimately understand any given payers’ process, benefits, payment contracts, and fee schedules. Our experienced staff understands exactly how and when to get involved to collect the maximum contracted amount for every service.
Meticulous reconciliation
As part of our exhaustive follow-up process, we maintain a proprietary contracted rates database with up-to-date information for every payer, every procedure, and every provider in our universe. This customized reconciliation software goes through line item by line item to ensure that all payments match the correct contracted rate. If it doesn’t, we return it to the payer for correct payment. This seemingly simple process is a major factor in increasing our clients’ bottom line.
Remittance process
Our in-house receivables staff is well trained in even the most complex payment issues from self-pay and payment plans to workers’ comp and liability claims. This high level of receivables expertise ensures the fastest and most accurate handling of remittance.
Compliance
We take compliance very seriously. Claim audits for appropriate procedural and diagnosis coding are performed on a continuous basis by certified professional coding staff. Our internal controls have been established around the entire revenue cycle and are enforced to maintain compliance with Federal, State, and private payer agreements.