Come to Expect the Best

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Revenue Cycle Management

U.S. hospitals and physician groups face numerous obstacles in their efforts to control operating costs while providing high quality care to the communities they serve.

Declining volumes, increasing patient financial responsibility, and high compliance hurdles are just a few of the challenges that are simultaneously impacting healthcare providers on a variety of fronts: revenue, cost, and risk exposure.

To help providers de-risk the impact of these challenges, we expertly combine services and technology to deliver a proven, end-to-end revenue cycle solution.

Our framework for operational excellence is built upon three foundational assets at the core of our end-to-end revenue cycle capabilities

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World Class Talent

Deep experience combined with continuous learning & development; strong team-based mentality & broad skill-sets

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Proven Methodology

Standardized revenue cycle techniques to deliver best-practice performance

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Dynamic Technology

End-to-end platform for revenue cycle workflow & analytics; significant capacity for configuration & customization to local market realities

We continuously measure the impact of our model through these key financial outcomes

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Payer Cash

Healthcare reimbursement complexity continues to rise, driven by regulatory change and market pressures to move to value-based reimbursement. As fee-for-service reimbursement decreases, at-risk payer cash is expected to increase.

Nirvana Health Group long experience in identifying and maximizing Payer Cash opportunities is evident in the tremendous improvement we have driven through for our providers clients

Our partners are achieving these results through the adoption of our sophisticated operating system. Our assets – talent, methods, and technology – are brought to life across the payer cash cycle via our disciplined operational delivery mechanisms.

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Proven Methodologies

Front-End Methodology

Scheduling/Access

Our unique focus on the entire end-to-end revenue cycle is rooted in the belief that improving process inputs drives better outputs and results. Our approach to patient scheduling and access ensures complete, accurate data capture and expedited access for patients in need of service. We put the patient experience first, while assuring that data is captured and communicated with utmost accuracy.

Insurance Verification & Authorization

Verification goes beyond simple insurance eligibility. Our methods ensure appropriate plan attribution and coverage benefit levels, all in an automated rules-based process. Our technology and operational processes are both sophisticated and flexible, focused on preventing unnecessary service delays.

Clearance & Registration Throughput

Our highly collaborative pre- and point-of-service financial clearance methods minimize revenue cycle defects, while expediting the process through maximum automation. We believe that registration should be a positive and informative experience for the patient; our approach is focused on efficiently engaging with patients when they arrive, receive medical services, and depart.

Medical Necessity & Utilization Review

Appropriateness of care is paramount to a more efficient healthcare system for all. Our collaborative techniques and expertise align incentives, provide transparency, and ensure appropriate patient classification.

Back-End Methodology

Insurance Billing

Our billing methods are differentiated through intelligent quality control to improve throughput efficiency and eliminate process defects. Same-day error resolution, reconciliation, and collaboration across revenue cycle and clinical departments represent the best chance for a clean claim and effortless payment.

Posting

Automation, quality assurance and transparency are the key approaches to our payment posting philosophy. Our methods are in 100% alignment with our customers’ transaction posting policies and procedures.

Receivable Follow-Up

We have extensive experience in maximizing payer reimbursement through proven approaches to receivable segmentation, continuous feedback, and high-quality, consistent resolution methodologies. Payer collaboration further ensures optimal payment outcomes and process efficiency.

Denial Prevention & Appeals

Our technical and clinical denial expertise enables high effectiveness in denial and write-off prevention. Our analytical approach to detecting underpayment or partial pay opportunities ensure efficient resolution of reimbursement gaps.

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World-Class Talent

Efficient and accurate payer reimbursement in today’s environment requires both significant experience as well as innovative thinking. The staff that we hire across the revenue cycle have demonstrated expertise to deliver sustainable process excellence and the leadership to deliver drive improvements in our customers’ operations. They are empowered with best practices and flexible technology that ensures providers are being appropriately reimbursed for the care they deliver.

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Dynamic Technology

Our claims workflow and denials management solution integrates business intelligence with on-the-ground operational expertise resulting in standardized workflow, best practices, and a sophisticated user interface. Users will achieve increased productivity & accelerated resolution rates providing clients yield improvement results & reduction in write-offs.

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Enrollment & Credentialing Solutions

The evolution of credentialing and provider enrollment

Credentialing and enrollment are critical business processes within the hospital, physician and allied health provider revenue cycle.

When not managed properly, they can, and will, negatively impact a healthcare organization’s revenue. With regulatory requirements becoming more and more complex, incorrectly or poorly managed credentialing and enrollment processes also put hospitals at risk for compliance violations and even liability of a false claim..

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