FAQ
How does your company ensure compliance with healthcare regulations?
Our company stays up-to-date with all relevant healthcare regulations, including HIPAA, HITECH, and CMS guidelines. We implement robust compliance measures, conduct regular staff training, and utilize secure technology to safeguard patient information and ensure regulatory compliance.
How can Revenue Cycle Management (RCM) services benefit my healthcare practice?
By outsourcing RCM services to our company, healthcare practices can improve revenue capture, reduce claim denials, accelerate payment collections, enhance billing accuracy and compliance, streamline administrative tasks, and gain access to valuable analytics for financial decision-making.
What is a prior authorization?
A prior authorization (also known as pre-authorization, pre-certification, or pre-approval) is a process used by healthcare insurers or payers to determine if they will cover the cost of a prescribed medication, medical procedure, test, or service before it is performed or administered to a patient. It involves obtaining approval from the insurer or payer before the healthcare service is rendered.
Why should I outsource prior authorizations?
Outsourcing prior authorizations to NYX Health leverages our expertise in navigating the complex process. Our dedicated team with knowledge of payer requirements, medical coding, and documentation standards, which can lead to faster and more accurate approvals and fewer denials.
What types of medical services typically require prior authorization?
Common examples include elective surgeries, advanced imaging (MRI, CT scans), specialty medications, certain prescription drugs, durable medical equipment (DME), and certain outpatient procedures.
How long does the prior authorization process take?
The timeframe for prior authorization approval varies depending on the insurance company, the complexity of the request, and the urgency of the medical need. It can range from a few days to several weeks.
What is medical coding?
Medical coding is the process of translating healthcare diagnoses, procedures, medical services, and equipment into universally recognized alphanumeric codes. These codes are used for billing, insurance claims, reimbursement, and statistical analysis.
Why should healthcare providers outsource medical coding services?
Outsourcing medical coding services allows healthcare providers to focus on patient care while ensuring accurate and efficient coding processes. Professional coding services can enhance revenue cycle management, minimize coding errors, and improve compliance with coding guidelines and regulations.
How do medical coding services benefit healthcare organizations?
Ensure accurate and compliant coding practices.
Expedite the billing and reimbursement process.
Maximize revenue by optimizing coding accuracy and efficiency.
Reduce the risk of claim denials and audits.
Enhance data integrity and analysis for improved decision-making.
How does NYX Health ensure coding accuracy?
We employ certified medical coders or coding specialists who undergo rigorous training and certification in medical coding standards and guidelines. They also implement quality assurance measures, coding audits, and ongoing education to ensure accuracy and compliance.
We utilize internationally recognized code sets such as ICD-10-CM (International Classification of Diseases, 10th Edition, Clinical Modification) for diagnoses and CPT (Current Procedural Terminology) for procedures, along with HCPCS (Healthcare Common Procedure Coding System) codes for additional services and supplies.
Claims denied by insurance companies and/or Medicaid.
Claims pending additional information or documentation.
Claims with payment discrepancies or underpayments.
AR follow-up services are crucial for optimizing revenue cycle management and cash flow in healthcare organizations. They help identify and resolve unpaid claims, reduce accounts receivable aging, minimize revenue loss, and improve financial performance.
Our experienced team proactively identifies, and resolves claim denials and rejections by conducting thorough root cause analysis, appealing denied claims when appropriate, and implementing corrective measures to prevent future issues. We work tirelessly to maximize reimbursement for our clients.
We are a patient advocate company and not a collection company. We understand the unique challenges patients face when they are ill and don’t have enough money to pay their medical bills. That is where NYX Health comes in – we are here to walk you through the tedious process of applying for government programs. This is a FREE service provided to you by the hospital you visited. With our caring, experienced team, we can help you focus on feeling better, not worrying about paying your medical bills. Our knowledgeable staff works with uninsured patients, who are uncertain if they qualify for benefits, to apply for assistance programs like Medicaid and other state and federally-funded programs like these to help cover their medical expenses. Visit our patient page to contact us and get your applications started today.
No, our patient advocate representatives do this for you.
Revenue cycle utilization management helps healthcare organizations maximize revenue, control costs, improve efficiency, and enhance quality of care by ensuring that resources are utilized effectively and reimbursed appropriately.
Inpatient pre-bill claim review services typically involve the review of claims related to in-patient hospital stays, surgeries, procedures, treatments, and related services. These claims may include diagnosis-related group (DRG) payments, surgical procedures, diagnostic tests, medications, and ancillary services.
Common reasons for claim denials or underpayments in in-patient settings include coding errors, insufficient documentation, medical necessity issues, coverage limitations, billing discrepancies, and payer-specific guidelines or policies.
Access to specialized expertise and resources for claims management and revenue recovery.
Reduced administrative burden and costs associated with in-house review efforts.
Improved cash flow and revenue optimization through timely resolution of claim denials and underpayments.
Enhanced focus on core patient care activities and strategic initiatives.