NYX Health FAQ

NYX Health offers a wide range of services, including Medical Coding, Prior Authorizations, Insurance Verification/Scheduling, and Medical Claim Review. These services are customized to match your facility’s processes and needs.

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.

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.

We offer comprehensive reporting and analytics that provide insights into key performance indicators (KPIs), revenue trends, claim submission and payment metrics, denials analysis, payer performance, and more. These reports help practices make informed decisions to optimize revenue and operational efficiency.

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.

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.

Common examples include elective surgeries, advanced imaging (MRI, CT scans), specialty medications, certain prescription drugs, durable medical equipment (DME), and certain outpatient procedures.

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.

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.

We work for various specialties including Cardiology, Orthopedics, Podiatry, Pain Management, Speech Therapy, Mental Health, Dermatology, Home Health, Rheumatology, Ophthalmology, Endocrinology, etc.

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.

Clinical Documentation Improvement (CDI) is the process of ensuring that healthcare documentation is accurate, comprehensive, and reflective of the care provided. It helps enhance coding accuracy, improve patient outcomes, and optimize reimbursement.

NYX Health offers end-to-end CDI solutions, including physician education, concurrent documentation reviews, query assistance, and compliance support. Our expert team helps healthcare providers enhance documentation accuracy and streamline workflows.

High-cost procedures, complex cases, and claims flagged for potential denial benefit the most from physician review. This ensures proper documentation, justifies medical necessity, and enhances billing accuracy.