Outsourcing Solutions for the Healthcare Industry.

Scio Management Solutions

Revenue Cycle Management

Simply put, revenue cycle management is the complete end to end process of making sure you get paid timely for what you do. SCIO combines people, processes, and technology to ensure you have complete solution for effectively managing your practices financial health.

CBI

What most practices fail to realize is that 95% of this battle occurs before the patient even enters the office. And while automated eligibility checks may sound like the answer, they often fail to provide the necessary information to ensure collection on anything other than an office visit. SCIO Management Solutions offers a cost effective solution to ensure your practice has the information it needs to collect your dollars. Insurance plans have become increasing more complex and vary from member to member drastically. Most physician groups are providing specialized services which have there own specific benefits unlike a typical office visit. A typical plan may have different coverage for surgery, labs, radiology, chemotherapy, etc. This critical information is most often not available from automated eligibility providers. One of the most common reasons for claim rejection or denial is patient insurance ineligibility. SCIO's sophisticated combination of technology and specialty trained staff ensure that your new patients and special procedures are covered.

  • Eliminate Rejection, Denials, and Write Offs for high dollar procedures and services
  • TOS of Collections Real time adjudication estimates of a patient's time of service (TOS) payments prior to visit (Co-pay, Co-Insurance and Deductible)
  • Receive real-time access to critical patient and insurance information, including coverage dates, benefit ceilings, co-pays and more

Treatment/ Procedure Authorization

Verification of complex procedures including surgery, diagnostics, pathology, and laboratory to ensure medical necessity.

PCP/ACO Referral Determination

Determine if patient requires referral or is part of ACO or other Risk Based Plan.

Receive access to critical patient and insurance information

In addition Our Comprehensive Benefits Tools integrate with many leading practice management & EMR tools.

Coding and Medical Necessity

Accurate coding and documenting medical necessity are vastly becoming one of the key areas of healthcare. It is no longer enough ensuring that claims go out accurately, but that providers are accurately coding and documenting medical necessity to withstand the audit process.

SCIO provides professional coding and audit services to ensure appropriate medical necessity is met. Our coding team is comprised of Certified Professional Coders (CPCs) accredited by the American Academy of Professional Coders (AAPC). They adhere to the guidelines set by the CPT-4, HCPCS, ICD-9-CM, LCD/NCD and CCI EDITS. Our coders work in accordance with updated standards and methodologies laid down by CMS, Medicare contractors, AMA, medical societies, and federal organizations. In addition to this we provide extensive training sessions and mentoring program.

Our Coders have extensive experience in multi-specialty / multi-discipinary environments including:

  • Medical Oncology
  • Radiation Oncology
  • Hematology
  • Cardiology
  • Dermatology (MOHS)
  • Radiology (Diagnostic & Interventional)
  • General Medicine
  • Pathology
  • Surgery
  • Gastroenterology
Accounts Receivable

Maximizing your cash flow by utilizing SCIO's Real Time Accounts receivable approach.

We approach A/R on a real time basis unlike most departments which focus on outstanding claims by buckets current, 30, 60, 90 days cycles. Our solutions prioritize unpaid claims in real time so that our trained professionals are addressing issues at the earliest stage to ensure you get paid. Staying on top of accounts receivable is one of the most tedious and labor intensive aspects of medical billing. However, it is also the only way to get the dollars in that you have earned.

Our Technology, People & Processes allow us to have insight into:

  • Unpaid, Denied, Non-Response Claim analysis and workflow
  • Detailed claims analysis and resolution procedures
  • Appeals preparation
  • Denials Audit
  • Rebilling Corrected Claims
  • Claims submission errors
  • Organize and create effective collections tasks

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