As a provider, especially in these trying times, you need an orthotics billing partner, offering you a robust redundancy plan to assist your process of business continuity. Over the last decade, Sunknowledge Services Inc has emerged as a complete orthotics billing company. We have a unique presence of working with both providers and payer, extend actionable support in accounts receivable collections with top priority on high dollar value accounts.
We have a unique expertise in front end activities and currently extends a host of back end activities in Orthotics billing. Our experience in working with leading providers, proficiency across multiple software systems, ability to work as a dedicated operational extension, make us a champion RCM destination.
o Initial visit appointment Setup (Done by Practice)
o Order entry.
§ Patient Account Creation.
§ Patient’s demographic entry.
§ Prescription information entry.
o Initial Eligibility Verification.
§ Creation of Insurance verification form.
· Checking general eligibility and benefits information and Updating in Software.
o Initial Evaluation Appointment (Done by Practitioner)
§ LCodes assignment.
§ Measurements. (If required)
§ Creation of Evaluation form/Notes/Other Medical Records
o Detailed Eligibility Verification & Authorization Requirement Checking
§ Re-verification of eligibility with assigned codes.
· Updating detailed code specific benefits.
§ Checking authorization requirements. (Code Specific)
§ Creation of Service Estimates (Payer Specific and Reasonable and Customary)
§ Sending detailed written order/diabetic verification form and other paperwork’s to Doctor’s office for signature.
o Doctor’s office follow-up.
§ Contacting Doctor’s office for pending detailed written order/ diabetic verification form and other paperwork’s.
o Authorization / Pre-Determination / Referral Initiation.
§ Creation of Insurance Authorization Form.
§ Requesting Authorization/Pre-Determination/Referral (Via Phone/Fax/Email)
o Authorization / Pre-Determination / Referral Follow-up.
§ Follow-up with payer on Authorization/Pre-Determination/Referral status.
§ Completion of authorization form based on the outcome of the request.
o Final Eligibility verification or Pre-delivery Check.
§ Creation of patient financial responsibility form.
§ Notes Update.
§ Work In Progress (WIP) updating.
o Office coordinator notification.
§ Patient responsibility
§ ABN creation
o Schedule Delivery.
o Delivery (Done by Practice)
§ Signing Delivery Ticket. (Soft copy / Hard copy)
o Claim Submission
§ Primary/Secondary/Tertiary Claim submission (Via paper/fax/electronic)
o Rejection Management.
§ Online Rejection checking (Via Clearing House)
§ Correction and resubmission of the rejected claims (Via Clearing House)
o A R follow-up & Denial Management
§ Follow-up on pending AR balance and working on denials
§ Follow-up on possible reconsideration requests
§ Filing Reconsideration Requests
§ Filing Appeals.
o Payment posting
§ Patient payment posting and adjustments
§ Insurance payment posting and adjustments
Let our team give you a complete tour of our best practices success stories with some of the best names, how we can transform your Orthotics billing with us working as your Orthotics billing partner.