Global Expertise in Healthcare Service Management
Healthcare organizations have issues related to excessive or superfluous care demands, providing patients with quality care, preventing the flow of capital or revenues, changing the paradigm from volume care to value-based compensation, and lacking mechanisms for transparency.
Value-Centric solutions have always been offered by Augustus Healthcare Solutions as the industry leader. We think that the clever investment is in the Human Resources, the Methodologies, and their inventiveness. Our ability to manage any amount of deliverables for our clients effectively is facilitated by our global presence and talent accessibility.
Provider Solutions
PROVIDER SOLUTIONS
Volume Care Payments vs. Value Care Documentation Services: The value that clinicians bring to the care they provide to patients determines how much Medicare and payers will pay them, not the number of patients they see.
CDI Services, or Clinical Documentation Improvement: Medical coding is based on clinical notes and charts that are created by clinicians. To ensure that procedures are medically necessary and that payment is made lawfully, our highly skilled staff reviews the documents. In addition to improving payer reimbursement, this assessment helps to prevent Recovery Audit Contractor (RAC)/Zone Program Integrity Contractor (ZPIC) recoupments, fines, and sanctions.
To support providers in staying compliant, we offer the following services: Star ratings and quality data reporting requirements, such the Medicare Access and CHIP Reauthorization Act (MACRA) – Merit-Based Incentive Payment System (MIPS), Meaningful Use (MU) – Electronic Health Records (EHR) Stage-II, Value Based Modifier, and Physician Quality Reporting System (PQRS). These services are the new rules that suppliers must follow to stay in compliance with the market. In order to ensure compliance and prompt payment, we assist providers in navigating these important areas.
End-to-end revenue cycle management services: We handle medical billing, coding, accounts receivable follow-up, and prepayment/post-payment audit compliance for hospitals and traditional providers. The services offered by Augustus HCS include charge capture, electronic clearing service (ECS), accounts receivable follow-up, electronic clearing house (ECS), demographic entry (CMS-1500/UB-04), and support with compliance.
Follow up
To assist providers in concentrating on their therapeutic areas, we offer end-to-end revenue cycle management (RCM) services. Our services can be purchased as an all-inclusive package or separately:-
- Eligibility Verification
- Claim-Generation: – Demographic Entry and Charge Capture (CMS-1500/UB-04 Forms)
- Medical Coding-ICD-10-CM/PCS, CPT-4, CDT-5 and HCPCS-II. Charge/Demographic Entry
- Claim Submission
- Payment Posting and Electronic Remittance Handling
- Denial Analysis & Insurance Follow-up
- Compliance
Follow up
We run a specialized call center for accounts receivable (AR) follow-up. Expert call center representatives with specialized training in the US healthcare system oversee the follow-up for accounts receivable (AR) using AVR/IVR systems and conduct direct teleconferences with Claim Processing Executives at Payer’s offices. The following goals are the main emphasis of our AR-Follow-up services: –
- Reduce the average AR days to less than 45 days
- Reduce the AR over 90 days to less than 10% of the total AR
- Increase the collection from the current level to a higher level
- Keeping claims error-free
- Improve collections while accelerating cash flow
- Reduce your administrative costs
- Achieve efficiencies not attainable by billing process operated in-house
- Expert revenue cycle specialists
Hospice and Home Health Care Coding: Revenue for home-health agencies (HHAs) is derived from the Home Health Prospective Payment System (HH-PPS). The following issues are met by our qualified and highly skilled Home Health and Outcome and Assessment Information Set (OASIS) coding specialists for HHAs:OASIS-C-1 and soon-to-be OASIS-C-2 congruency, as well as evidence of the medical necessity of expert care and therapy.
PBQM/Outcome-Based Quality Improvement (OBQI) in moderation to achieve compliance with Star Rating and Quality Assessments Only (QAO) requirements.
Reduced chance of receiving Additional Document Requests (ADRs) during Recovery Audit Contractor (RAC)/Zone Program Integrity Contractor (ZPIC) audits.
Interventional Radiology Coding: Our knowledgeable and skilled coders examine the intricate clinical anatomy of the cardio-vascular circulation, taking into account various aspects of patho-physiology, as they process the IVR charts and assign the codes.
Access sites and the families/orders of the boats that were accessed
Locations of the agreed catheters and tents
Additional actions
To make your work easier, all of our IVR coders are certified life science graduates with the designation Certified Interventional Radiology Cardiovascular Coder (CIRCC) (AAPC).
Coding inpatient procedures using ICD-10-PCS: Coding inpatient procedures using ICD-10-PCS is the responsibility of specialized coders who possess the knowledge of surgical anatomy and the ability to follow fundamental features of surgical procedures, including Medical System, Root Operation, Approach, Qualifier, and device(s) used.
Our ICD-10-PCS coders are all AHIMA/AAPC qualified in ICD-10 systems, and they assist surgeons in creating surgical notes that accurately reflect the procedure(s) they do in order to receive the best possible ICD-10-PCS codes for maximum payment.
Since the Affordable Care Act went into effect, medical documentation has become more difficult than it has ever been.
The issues facing the suppliers of better clinical documentation are proving the medical necessity of the services and excluding culpability for medical malpractice.
The major difficulty for the provider community is whether or not a provider is an Accountable Care Organization (ACO) when it comes to Utilization Reviews conducted in light of the trinity of Cost/Quality/Patient Satisfaction. With our onsite and remote training, consulting, and support services for all kinds of providers, we make it simple. The following list includes some of the major verticals in the field of cautious clinical documentation:
- Prepayment and Post payment audits revolve around inappropriate usage of modifiers 25, 59 and 91. New modalities appended to modifier 59 (XE/XS/XP/XU) add up to the challenges of clinical documentation the providers should made.
- These modifiers are on the lens of Office of Inspector General (OIG) Program to ensure providers just don’t try to get escape from National Correct Coding Initiative (NCCI) edits by using inappropriate modifiers.
- Evaluation and management E/M coding and EM levels determination is made easy with the help of expert and certified Clinical Documentation Improvement (CDI) specialists on our board.
In accordance with the Ambulatory Payment Classifications (APC), Augustus HCS handles hospital outpatient billing under the Outpatient Prospective Payment System (OPPS) and hospital billing under UB-04 (DRGs).
Our skilled, qualified, and seasoned coders are proficient in both OPPS and the Inpatient Prospective Payment System (IPPS). They are also certified in ICD-10.
Our services assist hospitals in reducing the amount of discharged non-final billed (DNFB) while also assisting them in generating careful clinical documentation that is finished concurrently with the patient receiving acute care.
In order to prevent hospital readmissions under the Improving Medicare Post-Acute Care Transformation (IMPACT)-Act-2015, we closely collaborate with inpatient clinical providers and guarantee that clinical documentation complies with Present on Admission (POA) requirements, Major Complication or Comorbidity (MCC), and Complication or Comorbidity (CC) standards.
