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What services do you offer?
At Practolytics, we provide one-stop solution for Revenue Cycle Management services for our clients. This includes eligibility verification, claims submission, denial management, AR follow up, contract negotiations and credentialing, predictive analytics, billing and coding.
What if your Practice Management software doesn’t interface with my EMR?
Our PM currently interfaces with more than 200 EHR systems and with our open API, we can often build a new interface through third party.
Who do my patients call when they have a question about their statement?
All patient communication happens via our Columbia, South Carolina office and patients can call at the same office for bills related queries.
Whom do I connect with at Practolytics?
We assign a dedicated account manager to all our clients. This manager becomes their single point-of-contact with Practolytics.
Will you assist us with coding?
Yes. In addition to offering charge entry services, we have certified professional coders who reviews all charts to ensure claims are coded correctly and with the correct modifiers. We also ensure that claims are billed at the appropriate level for the services rendered. We also provide feedback to the physicians regarding any necessary documentation improvements.
What is your refund process?
We will speak with the insurance company and try to get the details whether the refund request is correct or not. If the refund request is correct, we will make the attempt to offset the payments with the future payments and communicate the same to the practice. If the insurance will not accept the payments to be offset, then we will communicate the same to the practice and practice can issue the refund.
Will we have the access to the billing system?
Yes, we believe in complete transparency. You will have full access to review our work and run reports at any time.
What reports do we receive?
We provide each practice with detailed reports at regularly scheduled intervals. These reports are tailored not only to the information you want to see, but when you want to see it.
Will we have someone from Practolytics onsite for training and ‘go-live’?
Yes, you can contact our sales team and they will help you in this regards.
Is there a way to share paper EOB’s and charge slips?
All the practices have access to sharefile (HIPAA Compliant FTP)
Do you provide contract negotiation services?
We do provide contract negotiation services. We negotiate on behalf of you and have your inputs before we send the letter of intent.
Which practice management software do you use?
We use AdvancedMD. With more than 20 years in the practice management software industry and more than 21,000 active providers, AdvancedMD has the most robust PM system available today.
Will Practolytics submit claims on the practice behalf?
Yes, we are partnered with state of the art PM/EMR system and clearing house, we will take care of your electronic as well as paper claim submission.
What is the TAT/lag days for claim submission?
We submit claims within 24-48 hours from the charge receipt time. You will have access to the lag days through the PM/EMR system as well as through several reports.
Will we have full access to view our claims and payment details?
Yes, based on your request, your staff will be provided with full access to the system where you can review your claims and payments.
Whom do we reach out to on our billing and collections questions?
You will have a dedicated account manager who will be available on email and phone.
Does Practolytics send daily billing and collection status?
Yes, you will be receiving daily emails on the billing and collections.
How often do you work on rejections and denials?
The clearing house, payer rejections and denials gets worked on daily basis and gets shared with practice on weekly basis in a consolidated report.
Do you collect EOBs/ERAs and post them into the system?
Yes, we reconcile all the ERAs/EOBs and it gets posted on daily basis.
What reports will be provided from your end?
You will have full access to the reporting module of the billing system and any and all customized reports can be shared with the practice on request. Once decided these reports will be shared with you in the scheduled intervals. Our reports include but not limited to: charges Vs payments, patient volume, CPT volume, payment per encounter, payer mix charges, payer mix payments, provider/location wise reimbursement reports, payroll reports, outstanding insurance and patient AR reports etc.
Do you send statements to patients?
Yes, statements are sent to patients on regular intervals . The billing cycle can be customized based on your business requirements.
What if our patients have questions on their bills, whom do they reach out to?
We have dedicated customer service experts working based out of our South Carolina office and they will assist the patients on their questions on bills and payments.
Do you work with any collection agency?
We have a partner collection agency based out of South Carolina and we also work with collection agencies of your choice.
How will Practolytics help us in the eligibility process?
We take the appointments from the scheduler 3 days in advance and will provide you the benefit details via email and also the notes will be posted to the PM/EMR system which practice can access.
What if we have add-on patients on the day before or same day of the appointment?
We assist practices on-add on patients within few hours from the time the patient gets added in the scheduler.
What happens when a patient's policy is inactive or their plan doesn’t cover certain services?
Practice will be alerted on these issues few days in advance so that they can contact the patients and make necessary arrangements.
Will we be provided any tool to run eligibility at our end?
The partnered PM/EMR system has real-time eligibility capability and practice will be provided access to this where they can run eligibility within a few seconds.
Do you provide the Eligibility & Benefits by the CPT code?
Yes, we do provide the Eligibility by CPT code, for eg: in Behavioral health we provide the benefits for evaluation, therapy services and TMS services by CPT codes.
Which all specialty authorization do you work for?
We work for a wide range of specialities like Pain Management, Podiatry, Orthopedic, Cardiology, OT/PT, Speech Therapy, Mental Health, Dermatology, Rheumatology, Ophthalmology, Endocrinology etc.
Will you notify us if a patient’s authorization is being expired?
Yes, you will get an alert within the PM/EMR system as well as by us when an authorization is to be expired. We also keep a track of this and initiate the prior authorization before they expire.
How long does pre-authorization take?
It typically takes 2-3 days for the charge to be removed from your debit/credit card/bank. From our end it is voided immediately.
Does pre-authorization guarantee payment?
No. It comes with a disclaimer saying, ‘This is not a guarantee of payment’. It totally depends upon the discretion of your insurer
What happens if my insurer denies pre-authorization?
If you think your pre-authorization was wrongly denied, you can always file an appeal with your insurer. This works best when your doctor endorses that the coverage you seek is justified and necessary for your treatment.
What is the credentialing process for healthcare providers?
Credentialing is the process of obtaining, verifying, and assessing the qualifications of a medical practitioner to provide services for a healthcare organization. Credentials are essentially documented evidence of license, education, training and experience.
What are the steps that credentialing process consists of?
A typical credentialing process consists of four steps, namely; Onboarding, Application, Follow-up and Completion.
How does provider credentialing work?
It is the process by which a health insurer assesses a care provider’s qualifications and competencies through the submitted documents along with the CAQH profile.
What does a credentialing specialist do?
A Credentialing specialist is supposed to maintain active status of all providers by successfully completing initial and subsequent credentialing packages as required by care centers, commercial and federal payers.
How long does medical credentialing take?
Owing to its intensive verification processes, this may take 3-6 months based on the insurance companies.
Do you review our medical records and code the claims by referring to it?
The team of certified coders are well versed with several EMR systems and we do review the charts/medical records in the EMR and code the claims right from there.
We want to code the claims on our own. Will you be reviewing them before they are submitted?
Yes, certain specialities involving specific CPT/ ICD codes choose to code the claims and our team reviews the codes based on which feedback is provided as needed. We also add appropriate modifiers to the claims, which would be compliant and can get you maximum reimbursement.
Do you review the claim denials pertaining to CPT and ICD codes?
Yes, we do review the denials, make the corrections and resubmit the claims with appropriate changes to CPT, ICD, POS, Modifier, etc. while also being compliant.
How many specialities of coding do Practolytics cover?
We cover most of the specialties based on the practice requirements (Hospital coding, Pain Management, Internal Medicine, Orthopedics, DME, Behavioral health, Spravato, OBGNY and many others.
What is the TAT for coding?
We typically code the charts within 24 hours from the time the medical records get signed by the provider.
What is a compliance audit in medical RCM?
It is the process of assessing historical & current claims and ensuring that claims are submitted in compliance with Local and National Coverage Determinations and payer-specific guidelines(LCD).
What are the different phases of the audit process?
There are four main phases of the entire compliance audit cycle. They are Preparation, Performance, Reporting & Follow-up.
Why do we use encrypted emails and password protected attachments?
Encryption of emails protects the contents of the email and the content of the attachments when it reaches unintended recipients. We mandate emails to be encrypted and passwords to be protected in our organization as increased security and compliance measures.
Why is it necessary to record the payer denial code/reason on the patient’s account in the billing system?
It is an appropriate audit trail. It ensures appropriate follow-up action is taken. It tracks and establishes trends of potential billing and/or coding problems. This report can be utilized for account analysis as well.
How can we get our doctors to follow documentation guidelines?
Education, feedback and more education. You must be persistent and follow through to show your commitment. We audit doctor’s medical records and any inconsistency is taken as an education source to educate physicians.
If someone other than the physician documents the history, ROS, medical, social, family history, can I use it when determining the level of E&M cpt?
You can use the ROS, past medical, social & family history. The provider’s documentation should support that they reviewed the ROS and PFSH documented by the ancillary staff. The history of present illness needs to be taken and documented by the physician.
How often do employees need compliance training?
Employees working in various healthcare roles, including coding and billing, should be trained in appropriate areas (HIPAA, HITECH, etc.) immediately upon hire and at least annually thereafter. Employees should be trained when existing regulations change or are updated and when new regulations are put into place. Our experienced training team ensures this is being followed to all our employees on board.
What resources are used as compliance reference resource?
Resources that included for references are: OIG, the Centers for Medicare & Medicaid Services, the U.S. Department of Health & Human Services, and AAPC. These organizations provide informational articles, auditing software, news about updates and alerts, compliance ideas, and more.
What is Practice Consulting?
It is a strategic consulting service offered by us which covers all aspects of your business. Right from medical billing, medical coding, eligibility benefits & pre-authorizations to compliance audits, process mapping, resource allocation, medical transcription & contract negotiation. We enable your business by providing end to end management of your revenue cycle.
Do you also help the practices with selecting & adopting technology integrations?
Yes, we help you select the right mix of technologies, and then implement them to upgrade your entire tech infrastructure.
Can you help me to manage the resource effectively and efficiently?
Yes, we do help businesses by re-imagining workflows & processes to do away with inefficiencies. We help organizations with innovative resource allocation strategies to optimize processes and minimize costs. The strategies are customized and varies from business to business.
Is my business data secure if I engage with Practolytics?
Yes, your business data is 100 percent secure with Practolytics. All our solutions are HIPAA compliant and we take special care dealing with the privacy & confidentiality of the user data.
Does Practolytics handle Practice Consulting on site?
Yes, we do the Practice Consulting on site by reviewing the work flows, reviewing the documentation and Standard Operating Procedures built by the practice, having conversations with the employees etc.
What is a provider contract in healthcare industry?
Provider agreement is a contract between a healthcare provider and an employee benefits plan. The agreement states that the provider will accept payments from the plan for services provided to patients covered by that plan.
What is negotiated rate health insurance?
A negotiated or an adjusted rate is the amount an insurer is obliged to pay under contract for all the procedures and services a doctor or medical facility covers.
How can Practolytics help me?
We make sure that you do not have to pay an attorney to negotiate contracts ever. We take care of the entire process to give your business a positive outlook.
When should I review contracts?
You must review contracts well ahead of their expiry dates. You should notify the company if you want any changes or cancellations.
What is the timeline required to negotiate the rates?
It typically takes 3 to 4 months to get a favorable outcome, based on the practice location, demographics, suite of services provided by the practice etc.
What kind of medical transcriptions do you provide?
We provide end to end medical transcription services covering all aspects of your practice. For example, medical history transcription, patient chart transcription, physical report transcription, surgery notes transcription, discharge summary transcription, clinical summary transcription, emergency room report transcription, progress notes transcription, etc. You name it, we do it.
Would my patients’ data be safe?
Yes, absolutely. We are a HIPAA compliant organization. All our processes and technology integrations are leak proof. Data security is paramount to us.
We are a chain of clinics at multiple locations. Can you help?
Yes, we totally can. We have a lot of doctors dictating from different locations. We have experienced programmers who create custom workflows to complement your requirements.
What is your turn around time (TAT)?
Typically, it takes us about 120 minutes to transcribe about 75 percent of our jobs. However, if you seek a custom TAT, we also offer that. It doesn’t take more than 24 hours for us to share the transcription copy with you.
Where can I access my transcribed medical records?
We provide you with a secure login to your dashboard where you can access all your transcribed medical records. You can use any browser to access them.
Will Practolytics be doing the Eligibility & Benefits and Pre-Authorization process during Spravato billing?
Yes, Practolytics does Eligibility and Benefits to ensure right patient gets enrolled in Spravato REMS program. We will help you to obtain the Pre-Authorization within 4-5 business days after practice consent.
Does Practolytics deal with the Janssen Buy & Bill program?
Yes, we will guide you on when it is beneficial to avail the Janssen Buy & Bill program to maximize your revenue potential.
How do you ensure that the correct CPT codes are used?
Practolytics helps you in coding the treatment as per the guidelines of evaluation and management services. Codes are implemented specific to the patient’s condition and services provided. The requirements of the Insurance payer and local payment policies are adhered to as well.
Do you provide access to any EHR and PMS system?
Practolytics provides access to the cut above Practice Management and EHR technology and the cost is absorbed by us. We help you with the software support, training and customization to meet your specific needs.
Is there any periodic reporting done to have control on the processes?
Practolytics does weekly reporting of denials with coordinated follow – ups and attorney oversight of appeals. 30+ AR reporting is done which enables to identify, analyze and make corrections of aging receivables, for rebill. Any additional customized reporting is also provided as per your specific needs.
Do you have any question?
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