PV Kent & Associates increases payments from commercial insurance
carriers and other payers with across-the-board services that avoid bottlenecks and erroneous denials
in the first place.
understand that claims processing involves much more than simply
submitting a claim for payment. We free healthcare providers to
concentrate on other issues by handling the full spectrum of claims
management issues. In short, we use our own Best Practices for Reimbursement to expedite and maximize reimbursement for claims to commercial
insurance companies and other payers.
Commercial Insurer Services
Every Kent client has unique needs, which
we meet in a variety of ways. We can:
Handle issues specific to inpatient and outpatient services
Investigate and resolve issues that arise out of carrier
verification system restrictions
Request retroactive and prior authorizations
Request and provide medical records to payers, as appropriate
Ensure consistency and accuracy of universal billing and
Ensure consistency and accuracy of diagnosis and procedure
Resolve issues with primary care physician/clinician referrals
Challenge medical necessity claim denials
Request and prosecute informal internal and external reviews
Perform legal reviews, file formal appeals and pursue
litigation/arbitration/mediation, as necessary and authorized by
Kent operates based on the principle that
"A Clean Claim Gets Paid." At every point in the claims management process,
we attend to the most minute of details.
We pick up the claims process at any point that is convenient for
our client. For example, an organization might turn to us even before
they start delivering services, if they foresee a complex case.
In other instances, we help providers that have consistent problems
with a particular carrier. Most often, we pick up aging claims after
90 or 120 days.
Our specialists start each claim with an in-depth review that reveals
potential problems. They confirm the accuracy of submitted information,
verifying eligibly, authorization, and other issues, as appropriate.
In the event that a claim involves motor vehicle insurance, workers
compensation, the Veterans Administration, or other insurers, we
coordinate benefits and the hierarchy of payment, as necessary.
Our specialists submit a claim only after it meets their scrutiny.
As often as possible, the office uses electronic means to send off
referrals, claims, forms and other information, facilitating efficient
and cost-effective execution and processing of claims.
Claims Tracking and Reporting
Kent utilizes a fully automated collection/tracking/scheduling
system to expedite the reimbursement process. This system makes
it easier for our specialists to track progress. It also gives our
clients the ability to ascertain the current status of every claim
in real time.
We have customized this claims management software to generate extraordinarily
informative and effective reports for tactical and statistical purposes.
These reports provide a window into general trends, granular details,
and everything in between. Since information requirements vary greatly
among healthcare providers, we tailor reports to each client's specific needs.
We take reporting one step further. Our department managers routinely
review reports to ensure quality control and identify trends. If
they spot patterns and issues with uncollectible claims, they recommend
remedies and in-service training that will enable clients to avoid
such issues in the future. Our clients enjoy and benefit from this
element of partnering with Kent at no additional cost.
Denials and Appeals Management
Healthcare providers can lose significant revenue to denials from
commercial insurance companies. Some denials arise from unintentional and unforeseen
failures to follow insurer guidelines. On the other hand, inadequate
staffing, delays, and mistakes on the insurance companys end
is at times the source of erroneous denials.
Whatever the cause may be, Kent does the expert tracking and follow-up that most
healthcare providers simply cant afford to do. Even before
a claim is denied, our specialists discover and rectify potential
problems caused by incomplete or inaccurate forms, billing deadline
discrepancies, coding errors, and lack of referrals.
the event that a commercial insurer denies payment, we immediately
determine the cause of the denial and notify the provider. If the
denial is not well-founded, our appeals specialists submit
the information required to reverse the denial.
In the instances where standard appeals procedures
are unsuccessful and/or the carrier denies a claim for improper
administrative or other reasons, Kents legal team offers advocacy and
negotiation services, as well as litigation support. Our attorneys
have the qualifications to appeal claims to the highest level, request
and prosecute appeal hearings, pursue arbitration, mediation and initiate litigation with the appropriate court.
These capabilities make us unique in the industry.