Business Services

Business Services

Business Services is the key area of support THS can provide. Best-in-class billing and collections professionals will optimize your revenue cycle and ultimately reduce bad debt and days in A/R. Business services will make guarantees to reduce A/R days, boost TOS collections, and actively manage denials and other negotiations. We will implement contract validation to make sure you are being paid on the contracts you have.

Service Description
Provider Support Services (Credentialing) THS Credentialing department manages provider enrollment for Commercial and Governmental payers; manages hospital privileges, reports and maintains Continuing education requirements, national supplier clearinghouse enrollments.
Payer FFS Contracting and Payment Integrity THS Contracting methodology reflects a price to profit strategy through competitive pricing, contract language terms , and the costs associated with payer specific medical policies..
Insurance Refunds Insurance refund requests are reviewed by the centralized staff of the Payer integrity department; each refund is reviewed for accuracy, legitimacy, validity under contractual refund terms are approved. All refunds require dual approval
Insurance Support Services (Billing) THS Billing services utilize GE Centricity Groupcast as its practice management system, RcX rules for pre-submission audits and, Ingenix claim solution for secondary/corrected claims. Clients run 99% accuracy for claims; 95% of primary claims and 88% secondary claims file electronically. Benchmarks are measured by the Arrowlytics Dashboard, custom reporting and consistently outperform industry standards.
Customer Services Support THS Customer Service is a high-volume call center is responsible for incoming patient calls regarding patient statements. Staff are trained to read/research accounts, accept patient payments and preform claim rework when necessary. Currently 97% of all call are answered live, abandonment rate is less than 4%.
Account Support Services (Collections) THS account support services manages guarantor balances, patient collections, patient statements, payment plans, Internet payments and bank reconciliations
Denials Management THS denial management team manages insurance denials, insurance requests for additional information. The team quantifies and benchmarks payer specific denials, denial trending, lodges appeals and reports success as a successful recovery.
Banking and Revenue reconciliations (Payment Posting and Correspondence) THS team manages Electronic Remittance Advices and Electronic Fund Transfers to account for 95% of all payments on account. Payments are posted within 24-48 hours upon receipt with less than a 1% rejection rate.
Centralized Utilization Review (Benefit verification, Authorizations, Prior Approval, Surgical deposits) THS Utilization review department performs Insurance Eligibility checks on new and established patients. All copays and coinsurances are imported into the GE Groupcast Practice Management system in support of Time of Service Collections. Any scheduled procedure, diagnostic imaging, or therapy is screened for eligibility and if necessary, Authorizations/Prior Plan Approvals are obtained. THS UR also creates financial estimates for surgical patients, MRI patients and high $$ medications. Estimates are based on contract allowables for the scheduled procedure and applied to patient benefits. Any patient liability is then collected prior to receiving the service.
Worker's Compensation Services ( IME. CSO, Utilization /Authorizations/AR THS Worker's compensation team works much like the Insurance Support Services and Utilization department but for Worker's compensation only. THS WC obtains Authorizations and Prior-plan approvals for services. The team also handles all W/C billing, insurance services, payment posting, denials and denial management.
 


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