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Revenue Cycle Management Solutions

Revenue Cycle Management Solutions

One of the most important parts of your business is the cycle of revenue: from payor credentialing to billing services, and through collections. Novigo has spent more than 14 years reviewing, revising and optimizing the complete revenue cycle for healthcare. Our billing experts have an intimate understanding of state plans for Medicaid, Medicare, third-party insurance, managed care plans, and government-funded programs. Our defined KPIs (key performance indicators) are industry standard to ensure you are measuring the success of your program against actionable and meaningful metrics.

Benefits of an End-to-End RCM Solution from Novigo:

  • Enhanced client stickiness and retention

  • Build recurring revenue

  • Continuous learning through training

  • Proven solution that you can bring to market quickly

  • Low development cost for new service developments

  • Experience working with multiple specialties and myriad practice management platforms

  • Millions of transactions processed per year

With redundancy models are second-to-none and fully defined disaster recovery models, we are ready for any eventuality. Our highly efficient processes will give you a level of comfort that will surprise and delight you; and our detailed analytics and reporting will give you a deeper and more actionable insight into your core business. Our professionals have a solid proficiency in a number of different EPM systems, and leverage their knowledge of the industry as a whole to build the best and most automated solutions you will find anywhere.

From the very first patient encounter to reimbursement, we manage all administrative functions including checking medical eligibility, registration, verification of benefits, patient scheduling, and collection of revenue. We take a comprehensive, expertly managed and well-structured approach to each process in an effort to find the most effective solution to overcome it.

Our coders undergo continuous training, and we have an excellent team of well-qualified medical coders who are certified in the latest standards with an expertise that crosses dozens of specialties. Our compliance programs are industry-leading and we have a foolproof Quality Assurance program.

  • Patient Registration/Demographics entry

  • Eligibility Verification

  • Coding

  • Charge Entry & Audit

  • Claims Submission & Clearinghouse rejections

  • Payment Posting

  • Payment Reconciliation

  • Contract rate Verification

  • Receivables follow-up

  • Credit Balance

  • Denial Management

  • Patient Calling

There are a number of different relevant standards in coding, and we are prepared to work with any and all of them. Our core coding is based on AMA and CMS guidelines, and we fully understand the LCD and LMRP requirements that are needed before we assign a payable diagnosis, in an effort to avoid rejections and denials. Our expert coding teams are fully engaged with ICD-10, and this big transition was accomplished in October 2015 with minimal client impact. NCCI (National Correct Coding Initiatives) drive our well-trained coders, who understand the importance of correct coding, and who have a thorough knowledge of medical anatomy and terminologies, that allows them to select the most accurate and appropriate CPT/HCPCS code, and the code that will allow for the most effective reimbursement for the provided services.

We work with our customer teams to define our medical coding for diagnosis, procedure codes and modifiers to assure they meet with your guidelines and descriptions. We also understand when codes can be slightly modified and when specific insurance carriers require the standard ASA code. The coding process includes the below steps:

  • Patient documents, files or reports are scanned at your offices and then securely and seamlessly provided to Novigo’s teams via an encrypted connection.

  • All documents are validated and verified by our teams, who then break the files into batches in order to review them for readability, quality and completeness.

  • Modifiers, procedure codes and diagnosis codes are assigned per your requests.

  • Cash posting and charge entry is completed.

Patient responsibility is a hot topic in healthcare, with major trends impacting and continuing the uncertainty around regulatory changes, healthcare reform, and current and expected changes from a paper-based workflow to more electronic transactions. Patients are increasingly responsible for their own healthcare payments, which can be confusing and frustrating for patients as well as healthcare workers as they attempt to navigate the Affordable Care Act. Patient bad debt and liability are on the rise as the shift away from insurance and towards personal responsibility for healthcare payments continues to accelerate. Healthcare providers are under tremendous pressure around margins and revenue due to this shift and to the extended recovery cycle for revenue. When you need to provide your patients with detailed and highly accurate descriptions of the service, Novigo can help support your needs.
The multitude of changes in healthcare means that there are a lot of surprising statistics, some that are even shocking. If you have an average medical practice, less than 70% of your insurance claims ever actually result in money coming back into your business – meaning up to 30% are lost in limbo. Even if your claims are submitted in a way that is completely clean, there are no guarantees that it will be paid accurately or at all. The rules that payers use are increasingly complex, and include loopholes with the sole purpose of limiting approvals of payments. What this frequently means is that practices do not get paid for the valuable services that they offer to patients on a daily basis. No two businesses are alike, so our denials management practice is personalized to each customer’s revenue cycle and practice needs – but all are focused on how to return needed cash flow to the practice.

All of our reports are technology driven, based on business and use cases that have been tested over a period of many years. Novigo allows you the opportunity to dive deep into the metrics around your business, checking the filing status of claims with insurance carriers, doing detailed analysis of denied claims and action by the denial management team, see how follow-up with patients is going, details of insurance follow-ups and next steps, the ability to see when insurance claims are being re-filed, and how many steps are left before customers will be able to obtain payment details from insurance carriers. All of these steps help you see where your cash flow is at each piece of the process, and make realistic projections about your future profitability.

There are several gateways to increase your overall cash flow, and we help overcome all of them. We process millions of transactions per year, and work with over 20+ different types of billing software, across 60 different specialties, and for thousands of physicians across the country. Our insurance verification processes are some of the most secure and effective in the world, and our comprehensive coding initiative is in full compliance of LMRP’s & CCI. We have a deep understanding of contracts for reimbursements and Payer procedures, and a robust denials analysis. All of these different pieces work together to form a cohesive organization that can support your needs on many different levels.

Our Certified Medical Coders adhere to the latest CMS coding standards, and undergo a series of programs designed to not only educate, but also elevate skills and expertise in a way that benefits our customers.
Our BMP (Business Process Management) solutions are innovative and far beyond the simple “transactional” services that were the standard in the past. Rapid changes due to the Affordable Care Act (ACA) required that we evolve as a strategic partner to a point that we can deliver solutions that have a high value to our customers – all while maintaining and exceeding industry standards for legacy processes. When you need a partner that can leverage global best practices that go beyond a simple workflow, then you need Novigo.

  • CPT, ICD-10 and HCPCS coding across various specialties.

  • Coding for PQRI reporting.

  • Insurance and federal regulatory requirements.

  • Payer specific coding requirements.

Medical coding can be the lifeblood of your cycle of revenue; their accuracy and efficiency can have a serious impact on the overall health of your business’s bottom line. Our professional and experienced medical coders understand that their tasks are both complex and time sensitive and have a daily impact on the revenue of your organization. They are accurate and professional, as well as being highly productive and experts a wide range of different inpatient and outpatient coding types. Our medical coders pride themselves on staying up to date with the latest news in patient care in the hospital and clinical setting, and understand the importance of strict enforcement of coding compliance guidelines, a commitment to ongoing education and continued review processes. Data integrity and utilizing the proper claims submission forms are equally important to the various medical coding teams, and you will notice the difference that efficient and accurate coding will make to your overall operations through reduced backlog and improved compliance to standards. Better yet, we help you reduce your overall coding cost while allowing you to flexibly scale your organization’s medical coding needs.

Billions of transactions are created every year in the healthcare industry, and with a large percentage of these still on paper that means there are massive opportunities for error. While digital data is more accessible and faster to process, there are still times where bad data infiltrates your systems. While high-touch processes such as claim submission, eligibility and benefit verification, claim status inquiries, prior authorization and remittance advice transactions could save millions by moving to a digital workflow, paper will not disappear anytime soon.
With the overwhelming volume of transactions, your teams can fall behind – meaning delays in billing and revenue recognition as well as data entry errors as under-qualified teams attempt to scale up. Fortunately, Novigo understands your needs, and offers comprehensive data entry solutions that will develop superior collections rates by improving overall efficiency and reducing costs. With our guaranteed turnaround times, improved first-pass rates, and accuracy levels nearing 98%, you are freed up to focus on keeping your patients healthy and growing your business.
Our focus on continuing education for our billing and coding professionals as well as our technology investments means you can leverage global best practices to support your business – no matter your size. Get real-time insight and visibility into your production status, auditing and exception management as well as an intuitive storehouse for images that allows you to easily retrieve just what you need, when you need it.

  • Demo and Charge capture

  • Claims Data Entry

  • Coverage Eligibility

  • Payments/Denials posting

  • Credit Balance Resolution

  • Bad Address

  • Indexing

  • Data Validation

Insurance and eligibility verification is more critical than ever with the growth of the Affordable Care Act (ACA). Patient responsibility, when not defined upfront prior to the visit, can result in rampant growth in receivables – creating problems downstream as far reaching as decreased patient satisfaction, nonpayment, increased errors, reworks, and delayed payments. Many retail healthcare end-customers would be willing and able to pay between $200 and $500 in additional funds at the time of their visit if they were provided with an estimate at the time of care, according to a 2009 McKinsey Quarterly survey. We have the staff, technology, management expertise and understanding to deliver cost-effective patient insurance eligibility and high-quality related services on time, every time.
When you are validating your benefits and eligibility data, you will have the option to utilize payer web sites, interactive voice response systems, phone calls and more to contact patients to get updated insurance information before it becomes problematic. You can also provide end-customers with eligibility and benefit information such as Group and Member ID, start and end dates for coverage and information about co-pays as well as offering pre-authorization numbers.

Collections are a big part of your business, especially with the influx of newly insured participants who are entering the system as part of the Affordable Care Act (ACA). Revenue cycle operations are also being pressured due to the greater adoption of high-deductible plans, which are making it more difficult to collect patient payments. It is critical to your operations that you have access to a large group of qualified and trained resources who can process payments in a timely manner, and correctly provide bank-to-book reconciliation.
Our Accounts Receivable analysts are experts at denials processing, claims follow-up, secondary claims submissions, appeals and even at cleaning up aged A/R accounts. Denials are processed in batches on a daily basis by our stellar team of billing personnel. Drop the number of days your accounts stay in A/R substantially by utilizing our claims follow-up team to aggressively follow up with both insurance companies and self-pay patients to clear non-payment issues and improve collections ratios.
Novigo has a dedicated and fierce focus on process improvement as a means to drive enhanced profitability and cash flow for our customers. We are constantly scanning our processes for places where we can make changes to exceed industry best practices. Audits assist in the process of reconciliation of duplicate or unidentified payments, and individuals as well as insurance companies are contacted in an effort to reduce or eliminate payment redundancies.
Appropriate technology drives everything we do – and Accounts Receivable Management reaps the full benefit of the process improvement in which we invest – meaning you get access to the latest reports, tools and processes that will help you evaluate your business’s performance, including our predictive revenue and collection metrics which can have a significant positive impact on your organization’s cash flow.
We do not just provide you with reports. Instead, we give you actionable metrics that suggest ways to improve workflows and resolve issues that are expanding your A/R period and reducing collections so you can focus on finding big wins. Our combination of business intelligence and analytics means you will receive the tools you need to solve real business problems. Our automated and efficient workflow tools give our customers an extremely thorough and detailed view reporting all claims that are working during a specific time period.

  • Denials Processing

  • Claims follow-up

  • Appeals

  • Secondary Claims submission

  • Old AR Clean-up

Time is money, and nowhere is that as apparent as when you are working through provider credentialing. This time-consuming and painful process is required throughout the healthcare industry, yet can be a major bottleneck unless your processes are optimized.
Provider credentialing is critically important, and our credentialing specialists will work with you every step to of the way to ensure that you are always up to date with the status of your credentialing process. While the entire process can take from 90-270 days, during which time you should not accept patients who have an insurance that has not fully credentialed as insurance will not backdate effective dates. There are some leniencies with Medicare and Medicaid, but these depend on the state in which your practice resides.
Once your application is processed and approved, our credentialing specialist will contact you with effective dates and a Provider ID#.
We also provide the following services on an ongoing basis for your peace of mind:

  • Maintain all credentialing documents (State License, CDS, DEA, Malpractice insurance, Board Certificate, etc.)

  • Update documents to provider’s CAQH profile and re-attest at regular intervals.

  • Track and provide notification of expiring documents like license, CDS, DEA and more.

  • Re-credential and re-validate providers with insurance companies on an as-needed basis.

  • Renegotiate the existing contracts with insurance companies to get better rates.