To assure the effective billing and collection of all accounts, specific procedures and services have been designed to enable us to meet performance standards that have placed Sierra in the forefront of Revenue Cycle Management.
All Sierra’s coders are Certified by the American Academy of Professional Coders, and Sierra ensures the coders certifications remain current and support their continuing education. Coding is periodically reviewed to ensure all charts are being coded consistent with the AMA guidelines to include CPT, ASA and ICD-10 coding. All coders are trained to ensure all chart are coded to generate maximum revenue for the practice and to ensure all coding is consistent with all compliance regulations.
The information required for proper billing of all services provided by the practice can be accepted by Sierra via electronic media or paper copies. We work with all the major electronic medical records (EMR) companies and have develop working relationships with them. All electronic files will move through an intensive testing phase before they are put into live production. Sierra has a SQL-based tracking system that logs all batches from time of receipt through charge entry, eliminating the possibility of mis-queued batches. All charges are entered into the billing system and released within 48-hours of receipt.
Insurance Claim Submission
We generate all claims to the applicable payer via electronic data interchange (EDI) partner where available, a small portion of claims will submit on HCFA-1500 due to payer restrictions. Electronic billing edits are received, all denials are reviewed, worked and resubmitted within 24 hours.
Accounts Receivable Management
Sierra has developed a system to maximize revenue through timely billing and thorough accounts receivable follow up. Each client has an experienced manager and staff assigned to their account. Electronic billing edits are reviewed and corrected within 24 hours of submission. Denial reports are queued to the staff daily and completion reports reviewed by manager. All no response claims are also queued to be worked based on payer specific timelines. Claim closure reports are reviewed with staff to ensure actions taken are resulting in client revenue.
Fee Analysis and Review
We maximize your practice’s collections through the analysis of the fees that are currently charged for services by calculating a “practice conversion factor” based on the current fee schedule and the RBRVS units for the procedures/services being performed. We provide a recommended fee structure to assist you in making informed fee decisions.
Communications with Patients & Third-Party Carriers
All patient statements include the toll-free phone number to Sierra. 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.
Third Party, Follow-Up, and Collections
We follow-up on all delinquent insurance and other third-party payments using internal past due reports. We render balance-due statements to patients following payment by the third-party carriers, and file secondary insurance claims directly with the carrier when such information is available.
Claims Appeals and Denial Management
Sierra maintains file copies of the practice’s contractual arrangements with third-party payers. If, at time of posting the payment, 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. Sierra will follow physician/practice specific self-pay collection and write-off policies.
Bad Debt Assignment & Recovery
It is Sierra’s policy to submit to the client a list of patient accounts which are deemed ready for bad debt collection prior to assigning them to an agency. We work with several agencies and prefer the client choose their agency of preference.
All mail received by Sierra, at the address agreed to by you, is carefully controlled to ensure against loss. Deposits are made in accordance with the banking arrangements established by you.
Our Director of Credentialing has over 12 years of experience with physician and hospital credentialing, insurance credentialing and re-credentialing. We constantly analyze your existing, current, and future contracts to ensure that you are getting the best rates possible.
Business Advisory Services
We review, advise, and negotiate contracts with managed care and third-party payers, and present contracts for approval. We create and maintain a contract matrix for the group that will include the terms, contact people, and rates for all contracts.
Insurance Eligibility & Verification
Our proprietary billing software contains a real time insurance verification component to confirm a patient’s insurance prior to the claim being submitted, virtually eliminating insurance eligibility denials.
Manual Data Entry Services
As a sequential process, scanned or hard copies of the encounters received from the providers are coded by our qualified coding team and sent to the data entry department. The data entry team enters all information into the billing system within 24 hrs. Claims are created and submitted to the payers for payment processing accordingly. The team also enters any payment that needs to be posted manually.