· Insurance Verification Specialists enter the most accurate demographics and insurance information by using Transunion’s TLOxp software along with Waystar and Solution Group’s Black Ink scrubbing software
· Trained Billing Specialists review patient care records in its entirety
· Choose the most appropriate ICD10 codes, HCPCS level of service code, and origin and destination modifiers
· They build a summary of the patient care records that explains the medical necessity that further backs the level of service billed
· Each biller is on a full review process until they meet the <5% error rate
· Our team of account receivable experts work denials and follow up on unpaid claims
· All team members attend frequent training sessions to stay up-to-date on changes in law and best practices
Our team of billing experts will monitor your existing subscriptions to ensure accurate billing per the provider contracts/agreements that are in place.
Jan-Care Diversified’s Compliance program focuses on detecting, preventing, and correcting non-compliance in the EMS industry. Our staff will look specifically for fraud, waste, and abuse while upholding the complexities of healthcare compliance. Additionally, we strive to be up to date on all federal and state rules and regulations for every payer we encounter.
· Auditing and monitoring process
· Implementing a Compliance plan
· Reporting issues to appropriate departments
· Response and prevention
· Self-disclosure protocols and plans
· Protocols for handling subpoenas, investigations, and search warrants
The Medicare Prior Authorization requirement can seem daunting; however, Jan-Care Diversified is well trained in overcoming and succeeding over the issues with the prior authorization model. Jan-Care successfully manages to obtain authorization on hundreds of repetitive patients. We use our expertise to establish the framework of success in securing approval based on our knowledge of the medical necessity requirements set forth by Medicare and insurance carriers. Jan-Care will review and request medical records to support the medical necessity while also acknowledging when transports do not meet medical necessity requirements.
· Review medical necessity documentation
· Review reasonable and necessary documentation
· Patient termination
· Documentation and physician certification requests and requirements
· Education of proper onsite assessments
· Verification of NPI and OIG exclusions
Documentation is an essential part of EMS billing. Jan-Care prides itself in offering top-of-the-line training to all of our customers. Our training department focuses on providing the skills to crew members to effectively document a patient encounter. Additionally, the training focuses on how to determine and support the medical necessity for the transport and the lack of medical necessity if appropriate.
· Improve individual documentation with regards to the condition and medical necessity of the patient
· Understand the requirements for legible and complete medical records
· Understand the requirements for meeting “reasonable and necessary” and “medical necessity” regulations
· Understand how to “paint a picture” or document a clear, concise reflection of the patient at the time of transport
· Understand the importance of documenting the reason for the transport, whether it be an appointment, test, or discharge
· Understand how to document the importance of the reason for the encounter, relevant history, assessment, and impression of the patient
· Understand the importance of signatures and the regulations involved for signatures
· Understand how to document to support the required level of care
Proper accounts receivable management is an integral part of ensuring payments are made timely and consistently. Our experts will evaluate your accounts receivables and identify the unpaid claims, denied claims, and low payments. We will provide recommendations on minimizing past due invoices and your staff's time and effort to handle the outstanding claims while improving your cash flow and revenue cycle.