Serving as a fully integrated extension of a client’s business office, we specialize in capturing targeted data from records for optimal reimbursement leveraging our highly skilled workforce and proprietary technology and processes.
When you partner with ROI, you can focus more time on higher priority large dollar claims, maximize the potential cash flow including for small dollar outpatient accounts, and reduce bad debt write-off expenses.
ROI is a leading provider of revenue cycle services to the healthcare industry, specifically with AR Conversion projects. ROI’s staff has the expertise required to manage an entire revenue cycle business process such as:
- Patient Access
- Business Office
- Insurance Denials
- Underpayments and day one low dollar accounts
- System Conversions
- AR projects
- Managed Care retrospective payment projects
Our suite of business process solutions focuses on improving cash collections by reducing or eliminating the obstacles to payment.
We understand the ease of doing business is important to many of our clients, and each of our programs is designed through VPN connectivity and quick implementation timeframe to create a vendor friendly relationship. Our flexible on-site and off-site delivery models, coupled with rapid implementation timeframes, means that our programs can start within just three to four weeks.
With more than 10 years of revenue cycle experience and domain expertise on a variety of Patient Accounting systems, ancillary tools and bolt-on technologies, ROI has earned its reputation as an innovator in generating revenue for healthcare providers.
As a fully integrated extension of a client’s business office, ROI’s Active Receivables Management Services streamline billing and reimbursement workflows, reduce outstanding receivables and increase cash flow.
ROI’s billing and follow-up services include:
- VA Coding and Insurance Billing
- Eligibility verification
- Initial and rebilling of primary insurance
- Secondary and additional insurance billing
- Denial management and follow-up
- Continued follow-up on open accounts
- Credit balance resolution
- Coding review and recommendations for HELD and DENIED claims
ROI representatives follow up with insurance companies to check the status of insurance claims. Depending on the response received, one or more of the following may take place:
- Medical records are requested to be sent to the carrier
- Rebills are generated
- Secondary claims are generated
- Account is researched for disputes or missing payments
- Patient is contacted by phone or letter for additional information
- Appeals are sent on denied claims
- Coding recommendations are made on HELD or DENIED claims
- Follow-up with insurance companies is completed to continue the account resolution
The spectrum of Langley Provider Group resources represents over 15 years of business experience addressing the professional needs of healthcare providers throughout the Private Sector and Veterans Administrations. As a full-service Revenue Management firm, as well as a GSA Schedule Holder, Langley Provider Group services are designed to increase client productivity, profitability, and cash flow by:
- Execution of technology-based solutions with experienced personnel.
- Reducing Administrative Costs in a declining reimbursement environment.
- Improving our client’s utilization of internal FTE resources and patient relationships.
Comprehensive Extended Business Office Solutions
- ICD-10 Transition Services
- Medical Record Coding
- Medical Record Coding Audits
- Quality Assurance Program
- Accounts Receivable/Cost Recovery
- Patient Access Management
ICD-10 Transition Services
A successful transition to ICD-10-CM and ICD-10-PCS will require a comprehensive review, analysis, and transformation of the Clinical and Revenue Cycle Operations. Langley Provider Group is pleased to offer a full-service solution to this need.
- Project Management
- Readiness Assessment
- Risk/GAP Analysis
- Coding Services
- Billing Services
- AR Cash Acceleration
Medical Record Coding and Compliance Audits
Capturing targeted data from the clinical medical record for appropriate reimbursement is our expertise. Langley Provider Group’s national team of credentialed coders has extensive experience in applying accurate, complete and consistent coding for the production of high-quality healthcare claims. We also provide educational programs to enhance the quality of clinical information, provide interim coding staff, and provide management support.
- Inpatient Coding Support
- Outpatient Coding Support
- Coding/Compliance Audits
- Documentation Assessments and training
Medical Record Coding Certification
License Instruction Through an AAPC Approved CPC and CPC-H curriculum to include classroom instruction, materials, AAPC membership and testing fee.
Langley Provider Group believes that this role is an integral part of the revenue cycle. Applying accurate, complete, and consistent billing practices are crucial to the submission of high-quality claims data. Our experienced staff has a proven track record of achieving maximum reimbursement through accurate and timely billing processes.
- Inpatient Billing Support
- Outpatient Billing Support
- Adherence to (OIG) Compliance Program Guide
- Track and Analyze Billing Denials
AR Cash Acceleration
Langley Provider Group offers an intensive Cash Acceleration program to achieve optimum reimbursements. Our experienced staff has a proven track record of achieving maximum reimbursement through consistent communication with Payers to determine proper protocols. This allows for a streamlined approach to claims processing and payment.
- High-end analysis to develop client specification plan.
- Action plans are customized based on balance and financial class.
- Analyze denials to pinpoint reasons for denied or delayed payment.
- Identify opportunities to recover lost revenue.
Patient Access Management
Our experienced staff has a proven track record of expediting maximum reimbursement through accurate and timely registration, pre-certification, pre-authorizations, and insurance verification processes.
- Patient Liability Determinations
- Insurance Verifications
Effectively working accounts in the Outpatient Self Pay financial class can only be done at the expense of properly handling larger dollar accounts. As such, the prerequisite outbound calling efforts required to maximize self-pay collections is seldom part of any hospital’s strategic plan. Unfortunately, for most hospitals, this part of the receivable makes up the single largest portion of bad debt write-offs.
ROI’s Self Pay Conversion Program offers a solution!
ROI assumes full responsibility for all activities associated with Self Pay outpatient accounts, including high volume outbound calling efforts, printing and mailing initial itemized statements and other correspondence, verifying, billing and following up to payers when insurance information is uncovered, administering hospital approved payment plans, and assisting patients in applying for Medicaid or other available charity care programs.
While accounts remain “active”, all collection efforts are conducted in the name of the hospital. Patient correspondence is printed on hospital letterhead with a return phone number automatically forwarding to ROI – all transparent to the patient. ROI will also transfer accounts to bad debt and handle them as a collection agency. To ensure no conflict of interest, the fee will not change after accounts are moved to bad debt.
Benefits to the hospital include:
- Maximized recoveries for outpatient Self Pay accounts in the shortest period
- Improved productivity in other portions of the receivable
- Improved patient relations as ROI contacts patients in a positive, customer service oriented manner
- Most importantly, reduced bad debt expense
Current industry standards indicate that 2 out of every 3 Medical Assistance applicants do not qualify for coverage due to patient non-compliance with program requirements. ROI Eligibility Services enhance client revenue reimbursement through Federal, State and Local jurisdictional assistance programs. ROI’s PC based application facilitates all aspects of the Medicaid Eligibility process.
The ROI Medicaid Eligibility program include:
- Inpatient Medicaid Certification Programs
- Emergency Room Medicaid Certification Programs
- Outpatient Medicaid Certification Programs
- Medicaid Secondary Certification Programs
- Financial Assistance/Charity Care Evaluation Programs
- Social Security Disability Entitlement Programs
Backed by over 20 years of Medicaid eligibility experience, ROI will respond and interact within your specific departmental needs and provide your office with the highest level of professionalism and decorum. Our specialists foster cooperation among related healthcare providers, government, and human services agencies. As the aged Medicaid population continues to grow, consider ROI Eligibility Services as your best option to maximize revenue reimbursement with this labor intensive payer class.
Your bottom line is enhanced when you hire ROI – because we specialize in getting the Medicaid reimbursement your in-house staff cannot economically achieve.
If you need to increase revenues for Medical Assistance, consider using ROI’s seasoned Medicaid specialists using state of the art database technology.
Medical Bureau of Economics, a subsidiary of ROI, includes a full service consulting practice that provides a unique Charge Master Review program and “friendly” Management Workshops. An ROI Charge Master Review reduces billing errors, identifies revenue opportunities and minimizes financial risks. This comprehensive study assesses the quality, appropriateness and compliance of 100% of hospital charges – both coded and uncoded. More than 100 hospitals have taken advantage of this program to date. The Charge Master Review includes numerous detailed reports that support our findings and recommendations and includes a formal exit conference to review project results. Each project includes:
- In-depth Medicare APC analysis
- Laboratory and Rehab fee schedule comparison
- Identification of potential compliance issues
- Validity test for HCPCS and revenue coding
Please Contact The ROI to see how we can help your company.
A healthy Charge Master or Charge Description Master (CDM) is essential to your hospital’s financial and compliance livelihood. It needs constant attention. CDMaintain© is a simple cost-effective Charge Master maintenance program that will help you keep your CDM current, complete, and coded accurately. CDMaintain© requires no complex system installation. There is no lengthy contract. Its focus is on customer service.
- Quarterly reviews
- Unlimited Questions
- On-site Services
- A Single Consultant That Works for You
Please visit http://cdmaintain.theroi.com for more information.
ROI delivers competitive rate structures to provide clients with the highest net back return ratios. We also drive superior results through our advanced patient accounting system, sophisticated interface development, advanced predictive dialer campaigns and state of the art skip tracing. Our staff is trained and developed through an extensive program prior to making any calls to patients. Keys to our success are:
- Regional Collection Call Centers
- Exclusively Healthcare Collectors
- An experienced management team dedicated to exceeding client expectations
- Secondary Bad Debt Collection Programs
ROI has 15+ years of Out of State Medicaid Billing experience in all 50 states. Most facilities are not registered with Medicaid in every state. Because of this, if a patient is treated at a facility but the facility is not registered in the patient’s state, the facility would write off the cost of all of the treatment. With ROI’s program, we handle everything for the facility and do the work to ensure payment. We take accounts from the facility, complete the enrollment packages, return them to the facility for approval, submit the claims, follow-up on the claims, and confirm payment. By utilizing ROI’s services, facilities that do not currently have an Out of State Medicaid program no longer have to write these accounts off as lost money.
Below is an overview of ROI’s Out of State Medicaid program:
- Referral Process
- Manual or electronic placements
- Enrollment Process
- ROI obtains and completes forms
- We also provide re-enrollment and keep facilities up-to-date and active with payors
- We ensure payment and report back on claims (i.e., performance reporting)
- Need facility credentials and facility sign-off
- Verification Process
- Online Tools
- Remote System Access
- Handle Straight Medicaid and Medicaid Managed Care
- Billing Process
- Submit Directly on Payor Site
- Paper billing
- Adjust claims to State-specific Requirements
- Handle Straight Medicaid and Medicaid Managed Care
- Individual Claim Status
- Performance Returns – About 70% of the accounts are converted
- Direct Payment Deposits
- Some states offer or mandate direct deposit of paymentS
- Rate Structure
- Contingency is the typical rate structure
- ROI can also provide a flat fee per account
A healthy Charge Description Master (CDM) is essential to your hospital’s financial and compliance livelihood. It needs constant attention. CDMaintain© is a simple cost-effective Charge Master maintenance program that will help you keep your CDM current, complete, and coded accurately. CDMaintain© requires no complex system installation. There is no lengthy contract. Its focus is on customer service.