To assure the effective billing and collection of all accounts referred by physicians, specific procedures and services have been designed to enable us to meet performance standards that have placed Sierra in the forefront of accounts receivable management
Coding is a labor-intensive process that requires training and expertise. All of Sierra’s staff of expert coders have been Certified by the American Academy of Professional Coders and will complete all claims on behalf of our clients. We will periodically review all reports or charts to insure that the CPT codes are consistent with published AMA guidelines and that the ICD-9 codes are appropriate. We train the appropriate personnel to insure that all procedures are coded to generate maximum revenue for the practice and to insure that all coding is consistent with all compliance regulations.
The information required for the proper billing of all services provided by the practice can be accepted by Sierra on electronic media or as hard copy forms. We will develop internal control procedures that are appropriate to your practice to insure the timely and accurate capture of all demographic, insurance and charge information. All demographic and charge information will be logged in at the time of receipt and at the time that the information is input to the Sierra system.
Accounts Receivable Management
Concise reporting keeps you informed of the status of your receivables. Sierra constantly evaluates the practice’s accounts receivable to determine current collection performance for each carrier type (e.g., Medicare, Medi-Cal, Medicaid, commercial insurance). Existing problems will be identified and solutions devised and implemented. Collection standards will be established based upon our knowledge of each geographic locale and the expectations for each practice.
- Audit of coding accuracy of various practices on a daily basis by a Certified Procedural Coder
- Monitoring of practice collections by management staff identify any downward trends
- Evaluate carrier payments to confirm adherence to contracted rates
- Analysis of the clients aging reports comparing them to Sierra’s benchmarks
Communications with Patients & Third-Party Carriers
Elimination of patient confusion about the status of their account is a priority. All patient statements include the toll-free phone number assigned to your account and the mailing address that you have selected. The biller assigned to your receivables will promptly and courteously answer phone calls. Correspondence and phone contacts are documented in our system, changes in financial class are performed immediately, and the appropriate claim routine is initiated that day. We recognize the importance of public relations and professionalism when dealing with patients, insurance carriers, and staff. Our staff members are carefully trained in courteous phone manners and are not assigned to answer the phones until they have satisfactorily completed this training.
Insurance Claim Submission
We generate all claims to Medicare, Medi-Cal, HMO’s, PPO’s, commercial insurance, and Workers’ Compensation as soon as the demographic data and charge data match up in our system. Where available, all claims will be submitted electronically. All other claims will be submitted on the HCFA 1500 form directly to the appropriate carrier’s claim submission address. Submissions will be made using the insurance data (group, policy and insured’s numbers) and the claim submission address that has been verified through our matching program or by phone call to the carrier, the insured’s employer, or the patient, as appropriate.
Third Party Carriers, Follow-Up and Collections
We will follow-up on all delinquent insurance and other third-party payments using internal past due reports. We will render balance due statements to the patients following payment by the third-party carriers and file secondary insurance claims directly with the carrier when such information is available.
Sierra will maintain file copies of the practice’s contractual arrangements with third-party payers. If, in our review, an underpayment or inappropriate denial is identified, an appeal will be filed with the carrier seeking the additional reimbursement.
We produce and mail billing statements to patients or responsible parties on the day that the charge data and demographic data are matched up in our system. The billing statements can be customized to match the specific needs of our client’s practice to facilitate prompt patient payment.
We back up our system nightly, weekly and monthly and store these tapes off premises to protect against possible loss from fire or other natural disasters. Because our system is fully integrated, access to certain areas of the system is restricted by a variety of security levels for all personnel.
The Sierra system has the ability to produce a wide variety of customized reports to meet the needs of your practice. Our goal is to produce simple, clear and concise reports, which are made available to you via hard copy or on-line.
Client Service Representatives:
- Monitor and evaluate the AR to identify and address any problem areas within it
- Attend monthly meetings
- Prepare and discuss monthly reports
- Will act as an liaison between Sierra and the practice