REVENUE CYCLE MANAGEMENT
The private health insurance industry is handling nearly $900 billion a year in medical billings.
The ever present challenges of accurate processing and timely payment receipts can provide reliable revenue streams for healthcare providers. Quality of revenue cycle management (RCM) and insurance billing solutions are critical drivers to the financial success of any healthcare organizations today.
Penguin Healthcare Solutions provides unique revenue cycle management solutions for your growth. Cutting through the complexity with expertise, operational excellence, and a sophisticated approach.
Learn more about our comprehensive range of revenue cycle management solutions, serving thousands of hospitals and healthcare organizations nationwide. Contact our team to know more.
ACCOUNTS RECEIVABLE (A/R) MANAGEMENT
Are you having trouble keeping your Accounts Receivable (A/R) days under control?
Is a lack of skilled resources leading to a backlog of claims that need to be processed? With ICD-10, the potential for the number of denials is certain to go up if you are not prepared.
It is critical to success to have access to a large pool of qualified resources that work in any Practice Management System and understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R.
Analysts who trend denials and look for patterns of deficiency will increase cash flow and reduce aging A/R. Penguin A/R Solutions can lower internal costs, increase collections, and improve your cash flow.
Specialize with us in enhancing the financial performance of our clinic by seamlessly supporting Revenue Cycle Management (RCM) and related processes. As a partner to our clients, Penguin serves as a direct RCM extension to Hospitals and Physician Practices by leveraging healthcare expertise, technology and qualified resources.
Penguin provides access to a scalable and large pool of resources experienced in multiple Practice Management Systems to increase your collections ratio. Our sophisticated A/R workflow tool seamlessly performs skill-based routing.
It also generates customized intelligent reports that help quickly identify and resolve unpaid accounts. Our skilled staff is trained to identify patient accounts that require follow-up and take the necessary action to collect unpaid/underpaid claims. Don’t leave money on the table.
Up to 70% of your denied claims can be recovered. The Penguin A/R team can see your denied claims are recovered. We are known for high performance in the following: Clearinghouse Rejections Rejections are resolved within 48 hours No-Response Follow-Up Perform status checks on higher dollar balances and identify issues proactively to reduce aging and maintain an untouched ratio of under 3% of the overall inventory Denial Management Address all denials within 7 days Analytics Identify trend by CPT codes, insurance and denial type; implement process improvement initiatives to increase the clean claim ratio
CHARGE POSTING
Patient collections are on the rise with many newly insured participants in Affordable Care coverage.
High-deductible plans are putting added pressure on revenue cycle operations and the drive to collect patient payments.
Having access to a large pool of qualified resources to process payments timely, correctly and provide full-service bank-to-book reconciliation, which are critical to your operations.
Penguin has experience in working with all the leading practice management systems, including but not limited to Cerner, Epic, McKesson, NextGen, Allscripts, MEDITECH GE/IDX, Siemens, Athena Health, and Medical Manager.
Our expert data capture services are driven by iP2P (Intelligent Paper to Payment), our proprietary workflow application engine.
This solution automates the receipt, processing and posting of all RCM paper documents including charges, demographics, insurance payments, patient payments and correspondence.
The iP2P Client Portal provides full visibility into real-time production status, exception management and auditing, along with an image repository for easy retrieval and viewing of the scanned documents.
FOLLOW UP AND DENIAL MANAGEMENT - INSURANCE
The healthcare environment is changing. The Affordable Care Act and the transition to ICD-10 put an added layer of expense and complexity on our already burdened system.
Patient volumes are on the rise with the newly insured, and high-deductible plans are putting added pressure on revenue cycle operations and their drive to collect.
The key to success is access to a large pool of qualified denial management resources that work in any Practice Management System and understand how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R.
Analysts adept at trending denials and looking for patterns of deficiency will increase cash flow and reduce aging A/R. Penguin provides the access to a large and scalable pool of resources experienced in multiple Practice Management Systems.
PATIENT REGISTRATION AND DATA ENTRY
Scheduling the most important factor in the success of a practice is patient flow. An office that can successfully smooth out the spikes in its schedule can see more patients more efficiently, which reduces wear and tear on office staff and physicians.
Efficient patient scheduling is key to improved patient experience prior to and after the visit. The Penguin Patient Scheduling Service analyzes the peaks and valleys of patient flow and seasonality to manage the schedules.
Reduce the wait time for new patient registration/enrollment.
Keep the flexibility to manage the call flow for appointments.
Are you worried with your existing partner turning away any patients?
The staffing schedule is planned in line with the seasonality and can ramp up at short notices to manage the patient flow for a superior patient experience.
Successfully managing patient flow takes thought and careful planning. It is by far one of the most challenging aspects of practice management. Yes!
But when done correctly, smoothing the patient schedule will increase the capacity and efficiency of your practice without increasing your overhead.
Eligibility Verification and Pre Authorization With the Affordable Care Act, insurance and eligibility verification is absolutely critical. Identifying patient responsibility upfront prior to the visit is critical to managing the receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created — delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment.
To avoid problems, Penguin provides a remotely-hosted Centralized Eligibility Unit for hospitals, faculty practice plans, PMS/EMR vendors, and billing companies.
The solution consists of Penguin staff, technology, management and expertise that delivers high-quality, cost-effective patient insurance eligibility and related services. Penguin Eligibility Verification Services has the potential to: Improve A/R cycles (reduce A/R days) Increase cash collections by reducing write-offs and denials.
Eligibility and Benefits Verification Receive schedules from the hospital via EDI, email or fax Verify coverage on all primary and secondary payers by utilizing sites like WebMD, payer web sites, interactive voice response systems, and phone calls to payers Contact patients to get updated insurance information.
Provide the clients with the results, which include eligibility and benefits information such as member ID, group ID, coverage end and start dates, co-pay information, and much more Other Optional -Related Services Obtain pre-authorization number Obtain referral from PCP Enter/update patient demographics Remind patient of POS collection requirements Inform client if there is an issue with coverage or authorization Process Medicaid enrollment
CODING AND MT
Our FlexSource solution provides you with a customized solution for your needs.
You get to pick the delivery location that meets your specific scope, preference and budget. Whether you need coders onshore or offshore or in both locations the choice is yours. In addition to that you get access to our technology and best practices as part of the solution.
Technology: At Penguin, we keep it flexible to work within using your technology or our proprietary iCode Workflow coding software, which enables faster and more accurate coding.
