Trust our services for your Medical Billing and Coding Needs
Expert Assistance and Start-up Solutions for Clinical and Pathological Labs
If you’re a newly formed physician group or a laboratory looking to establish your presence but are concerned about the paperwork, licensing, or insurance credentialing, including Medicare and Medicaid enrollment, Apex Pros is your trusted partner to handle all these critical tasks.
Once you sign a service agreement with Apex Pros, your practice will be assigned a dedicated, full-time account manager who will initiate the necessary paperwork and provide regular updates on progress.
We are dedicated to ensuring the success of your practice and will invest significant efforts in boosting your revenue through our systematic, step-by-step transition process.
Don’t hesitate to explore our services for your practice, and without delay, get in touch with us today for expert guidance.
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360-Degree Revenue Cycle Management
At Apex Pros, we are a dedicated service provider specializing in revenue cycle processing and receivables management services for hospitals, physicians, laboratories, billing companies, and healthcare practices. Our primary focus is on minimizing the administrative workload for your staff, allowing you to concentrate solely on patient care and business growth.
We are well-equipped to oversee the entire revenue cycle of your practice, starting from appointment reminders, claims submission and reconciliation, to patient statement follow-ups. By entrusting us with your billing cycle management, you can liberate yourself from the complexities of billing and follow-ups, redirecting that valuable time towards providing superior patient care.
When you choose Apex Pros as your outsourcing partner, you can confidently expect the following benefits:
- Substantial reduction in time spent on licensing and credentialing.
- Elimination of expenses related to staff training on compliance and audits.
- Implementation of a structured workflow for efficiency.
- Enhanced financial transparency through timely reports.
- Accelerated cash flow for your practice.
- A high percentage of first-pass billing and payment collection rates.
- Regular monitoring of every facet of the revenue cycle.
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Insurance Credentialing and Contract Management
Surveys in healthcare management have underscored that inadequate follow-up on accounts receivables results in substantial revenue losses, affecting a majority of physicians, often up to 20%.
At Apex Pros, we place significant emphasis on the critical role that accounts receivables play in maintaining healthy cash flow. We offer dependable services to ensure that all rendered services are promptly and completely compensated for.
Our expertise extends to the analysis of complex Aged Trial Balance reports (ATB), which primarily focus on the age of claims, outstanding dollar amounts, and the responsible payer. We employ an advanced automated tool infused with intelligence to expedite the recovery of outstanding payments.
Another key area that can obstruct cash flow is claim denials. When left unaddressed, denials can lead to reduced first-pass payments and an increase in repudiations, prompting insurance carriers to request additional medical records. Apex Pros utilizes an intelligent machine learning program to dissect denials, pinpoint the root causes, and offer logical solutions that not only rectify the denial but also generate appeals to payers.
At Apex Pros, we provide cutting-edge technology and resources that adhere to industry-standard days in accounts receivable (AR) and elevate first-pass collections.
Effective Account Receivables Follow-up and Denial Management
While credentialing may appear to be a mere form-filling exercise, its significance lies in the trust patients place in their healthcare providers. This meticulous and systematic process involves the declaration of a healthcare provider’s credentials to insurance carriers. It entails submitting details such as the physician’s educational background, career history, training experience, residency, specialized licenses, and certificates. Importantly, this process is not a one-time affair; it requires periodic and timely revalidation with payers.
This process holds immense importance because improper credentialing can lead to revenue losses and expose patients to potential medical errors. Shockingly, statistics indicate that nearly 100,000 Americans succumb to medical errors each year. This alarming figure emphasizes the need for industry leaders to demand higher standards of competence and enforce disciplinary actions against healthcare workers.
In today’s healthcare landscape, the insurance credentialing process is increasingly vital. Healthcare organizations are seeking cost-effective approaches to enhance patient safety. Evaluating the qualifications and experiences of healthcare professionals can shield healthcare organizations from various liabilities, compliance risks, and unwarranted legal actions.
At Apex Pros, we meticulously gather and review all the necessary documentation of healthcare providers to ensure completeness and accuracy before submitting records to payers.
Our automated processes save your staff and providers from the time-consuming tasks of enrolling and re-credentialing with both government and commercial payers. We trigger validation or revalidation of healthcare provider data in a timely fashion.
Furthermore, Apex Pros has cultivated strong relationships with network managers of major insurance companies. This allows us to negotiate your existing contracts effectively.
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Risk Adjustment Coding Solutions
Our HCC coding services identifies care gaps and missed HCC opportunities during the retrospective review process to optimize your operational efficiencies. Highly effective coding review teams utilize CPC® and CRC® certified coders to assess diagnostics, health history, medication lists, treatment plans, imaging reports, and additional clinical documentation to capture all HCC diagnoses
Our retrospective risk adjustment services:
• HCC capture
• HCC adds/edits/deletions
• Precise RAPS/EDS submission
• Map clinical documentation gaps
• Optimal and accurate reimbursement
• Educate physicians with insightful analytics and live examples
• Clinical Documentation Improvement (CDI)
• HEDIS review
• Chart retrieval
Apex Pros is a leading provider of revenue cycle management services. Whether you are a hospital, physician, independent lab, or a healthcare practice, partnering with us means a commitment to reducing collection costs, improving efficiency, increasing cash flow, and enhancing patient satisfaction.
Whether you’re in the process of setting up a new laboratory, planning to establish a medical practice, or running an established one, Apex Pros can provide industry expertise tailored to your needs. Our billing, coding, and credentialing solutions can significantly increase your collections by 10-20%.
Account Receivables Follow-up Excellence
We understand that account receivables are the lifeblood of cash flow and require consistent and dedicated follow-up. Our services guarantee that all services rendered are paid for promptly and in full. Additionally, we offer customized plans to recover any outstanding legacy account receivables if you’re planning to transition to different EHR and billing platforms.
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