Fee Analysis and Review

Fee Analysis and Review

To assure the effective billing and collection of all accounts referred by physicians, specific procedures and services have been designed to enable us to meet performance standards that have placed Sierra in the forefront of accounts receivable management.

We maximize your practices collections through the analysis of the fees that are currently charged for service by calculating a "practice conversion factor" using the current fee schedule and the RBRVS units for the procedures/services being performed. We provide a recommended fee structure to assist you in making informed fee decisions.

All of Sierra''s staff of expert coders have been Certified by the American Academy of Professional Coders and will complete all claims on behalf of our clients. We will periodically review all reports or charts to insure that the CPT codes are consistent with published AMA guidelines and that the ICD-9 codes are appropriate.

We will develop internal control procedures that are appropriate to your practice to insure the timely and accurate capture of all demographic, insurance and charge information. All demographic and charge information will be logged in at the time of receipt and at the time that the information is inputted to our Internal system.

Sierra Health constantly evaluates the practice''s accounts receivable to determine current collection performance for each carrier type (e.g., Medicare, Medi-Cal, Medicaid, commercial insurance). Existing problems will be identified and solutions devised and implemented.

We generate all claims to Medicare, Medi-Cal, HMO''s, PPO''s, commercial insurance, and Workers Compensation as soon as the demographic data and charge data match up in our system. Where available, all claims will be submitted electronically. All other claims will be submitted on the HCFA 1500 form directly to the appropriate carrier''s claim submission address.

We will maintain file copies of the practice''s contractual arrangements with third-party payers. If, in our review, an underpayment or inappropriate denial is identified, an appeal will be filed with the carrier seeking the additional reimbursement.

We produce and mail billing statements to patients or responsible parties on the day that the charge data and demographic data are matched up in our system. The billing statements can be customized to match the specific needs of our clients practice to facilitate prompt patient payment.

We back up our system nightly, weekly and monthly and store these tapes off premises to protect against possible loss from fire or other natural disasters. Because our system is fully integrated, access to certain areas of the system is restricted by a variety of security levels for all personnel.

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