Medical procedure abstracting and coding 

Provider Enrollment Services Medical and Physician Credentialing

Contracting 

Code Auditing/Fee Schedule Review and Implementation 



Improvement of commercial payer contracts can result in significant revenue gains. TAG has extensive experience assisting providers in managed care contract analysis, negotiation, and revenue capture. We have expertise in every step of the managed care process, from defining the contracting strategy, to modeling the revenue impact of contract terms, to negotiating contracts and resolving payment disputes. The result of these projects is often thousands of dollars in extra revenue. We can provide assistance with specific components of the managed care cycle or serve as the managed care department for the provider.


Ansa provides outsourced credentialing services including provider enrollment and primary source verification. We work with all medical specialties and assist with enrollment in all insurance networks (Medicare, Medicaid and Commercial Insurance). We can customize a credentialing solution to fit any size need or organization.



What services does the Ansa Group offer?

  1. Medical procedure abstracting and coding
  2. Medical claim charge entry and insurance claim submission and A/R management
  3. Provider enrollment services/ Medical and physician credentialing services
  4. Contract negotiations
  5. Code auditing/Fee Schedule review and implementation
  6. Chart/Practice Audit
  7. Physician/staff training and education
  8. Reporting
  9. Revenue cycle management consulting


Ansa’s coding professional’s abstract clinical data from health records and assign appropriate procedure and diagnosis codes. These codes are used for classification, reimbursement, planning, and research.


Comprehensive training for inpatient and outpatient coding is provided in the Ansa Group’s office/physician training

PROFESSIONAL

MEDICAL INSURANCE CLAIM SUBMISSION

AND REVENUE CYCLE MANAGEMENT SERVICES

Ansa Group SERVICES

(303) 777-3788

2014 S. Pontiac Way Denver CO 80224

Chart/Practice Audit “Missing Items”

REQUIRMENT #3: Physician/Staff up-training & Reporting

  1.  Financial Totals
  2. Health Agencies
  3. HIPAA Security
  4. Marketing
  5. Master Files
  6. MU/Quality Measures
  7. Patient Billing
  8. Patient Listing
  9. Patient Management
  10. Period Reports
  11. Procedure Codes
  12. Providers/Groups
  13. Referring Provider
  14. Transcription



Reporting is the cornerstone of any good practice management. Ansa’s robust reporting capability is powered by AdvancedMD and offers nearly unlimited reporting options. The following are but a few of the standard reporting topics that contain anywhere from 1 to 23 different reports. In the event that the 148 available reports is still not what you need, custom reports are available by request.




Specific areas in which we can be of assistance include:

  1. Evaluate payer mix to maximize reimbursement
  2. Evaluate “carve-out” opportunities based on provider specialty
  3. Negotiation and negotiation support
  4. Point out those contract provisions that cannot be administered without undue additional cost or complexity
  5. Evaluate proposed contract language to ensure consistent and specific terms and eliminate ambiguity
  6. Review contracts and recommend potential changes to achieve acceptable rates based on consideration of market environment/ philosophy /strategy factors
  7. Contract Modeling to compare multiple fee schedule scenarios to determine if payer offer will increase or decrease current contract
  8. Identify the impact of a contract change to each procedure code group using actual payment history with each payer
  1.  Scheduling
  2. FlexReports
  3. Advanced Insight
  4. Appointments
  5. A/R control Center
  6. Audit
  7. Billing
  8. Carrier
  9. Charge Slip Printing
  10. Claim Inspector
  11. Diagnosis Codes
  12. EDI Reports
  13. EMR
  14. Financial Class


  1. On-site/Web coding training for physicians & billing personnel
  2. Front office and process consulting
  3. Weekly project and logistics status webinars


 




Billing charge entry and insurance claim submission process

  1. Receive Super Bill/Charge Master weekly
  2. Enter charges and submit insurance claims within 48 hours
  3. Follow up unpaid claims with payers
  4. Research denials and file appeals
  5. Post payments to patient accounts
  6. Self-pay collection efforts
  7. Write off bad debt to collections

Ansa’s Enrollment and Physician Credentialing Services We Help With:

  1. Commercial Insurance Provider Enrollment and Credentialing (i.e.. Aetna, Anthem, BCBS, CIGNA, TriCare, Humana, United Healthcare, etc.)
  2. Medicare and Medicaid Provider Enrollment and Credentialing
  3. Medicare Revalidation
  4. CAQH Registration
  5. NPI Registration (Type I and Type II)
  6. Reimbursement Issues
  7. Managed Care Contracting Issues

Revenue Cycle Management Consulting & Physician/Staff Training 

The Ansa Group understands the challenge of keeping medical staff well versed with constant updates in coding changes, compliance issues, documentation requirements, etc…


To meet these demands, the Ansa Group offers continuing education and weekly project status meetings and physician training sessions. Our coders will audit procedure documentation (abstract) to determine if appropriate level of services or codes are being utilized for surgeries, consultations, procedures, etc. These meetings will be designed to communicate the latest information to you physicians and staff in order to keep them abreast of the latest changes, yielding maximum reimbursement.


Continuing training and education is a priority at the Ansa Group. TAG is prepared for ICD 10 the implementation coming in October, and we are will assist our clients 

Coding competencies include:

  1. Accurately apply diagnosis and procedure codes utilizing ICD-9 (soon to be ICD-10-CM, ICD-10-PCS) CPT®, and HCPCS
  2. Interpret coding guidelines for accurate code assignment
  3. Identify the importance of documentation on code assignment and the subsequent reimbursement impact
  4. Practice Ansa’s standards of “Ethical Coding”

Reporting

with the transition to minimize the expected interruption in reimbursement and the overall impact on your cash flow. 

Areas of opportunity are found throughout the Revenue Cycle, starting with data capture and front office procedures. TAG’s expert staff helps our provider clients develop the most efficient and cost effective processes, resulting in increased production and reduction of waste and cost. Type your paragraph here.




To ensure maximum reimbursement for our provider clients, the Ansa Group offers insurance claim/reimbursement auditing services.


We thoroughly review existing payer contracts to understand exact reimbursement guidelines. We then sample random claims and compare the payer obligation with actual reimbursement.


In addition, we review the actual coding used for these claims to evaluate if claims are indeed submitted with complete and accurate codes.


Anomalies, errors and trends are identified for correction and training. If reimbursements are identified to be lower than that which is allowable, fee schedule adjustments are developed and implemented to maximize revenue.

 


Ansa’s credentialing highlights include:

  1. Provider enrollment services for all medical specialties
  2. Medicare provider enrollment and re-validation services
  3. Credentials verification for physician and ancillary healthcare providers
  4. Medical practice credentialing specialists
  5. Experienced and knowledgeable staff
  6. Rapid turnaround for insurance credentialing applications
  7. State-of-the-art software to manage credentialing files and enrollment applications 


Ansa takes pride in going the extra mile to maximize charge capture with utilizing our internal controls and conducting routine audits.


PM reporting on unbilled claims or missed appointments ensures that we capture all charges that may have otherwise slipped through the cracks in the office.


For those charges outside of the office…. hospital access has provider daily schedule reporting capability and this allows us to reconcile a hospital daily schedule with the offices scheduled visits to ensure these also aren’t going unbilled. Experience shows a common source of missed charges are these hospital consultations, urgent surgeries, etc. We also are prepared to monitor the provider call schedule so we can anticipate when each provider should have a higher number of consultations to be billed!


  1. Obtain hospital access
  2. Reconcile hospital procedure schedule with items coded and charged
  3. Capture any missing items, enter into PM, code and bill