1. Transitioning Your Billing In-House

2. Zarina Nagrani President Professional Revenue Recovery Solutions

3. Choosing the Challenge of Revenue Cycle Management
Verifying Benefits
Utilization Management
Billing and Coding
Collections
Managing Your Payments Properly
Managing Your AR
Payer Relationships

4. 5 Critical Things to Know When Deciding to Take Your Billing In-House
Staffing and Training
Choosing a Software
Separating from Your Current Billing Vendor
Understanding Payer Policies and Procedures
Transition Support Teams

5. Staffing and Training

6. Staffing and Training
Building a highly skilled team requires a significant investment in time, training, cost and more. Hiring experienced, motivated staff and providing them with the necessary training on every aspect of revenue cycle management should be your primary focus PRIOR to billing your first claim

7. Staffing and Training
Hire Staff with Industry Knowledge, Experience and Credentials
Train, Train, Train
Monitor and Audit
Establish a Quality Assurance Team and Policies
Retrain Regularly

8. Software Solutions

9. Choosing a software solution can be challenging.
Knowing which software can address your specific revenue cycle management needs is important. Research and testing take time but are necessary if, you want to avoid costly time consuming changes in the future

10. Software Primary Purpose and Design Who Owns the Data
Training and Support
Customization and Collaboration
Integration with Current Systems

11. Transition from an Outsourced Vendor

12. Your current vendor may:
Your current billing vendor may make transitioning to an in-house model seem impossible
Your current vendor may:
Obscure vital information
Revoke Access to Your Billing and Payer Portals
Threaten to Report Shortfalls to the Payers
Stop Work on Your AR
Withhold Valuable Reporting Data
and Threaten Legal Action if You Terminate Services.

13. Understanding policies and procedure for each payer

14. Understanding policies and procedure for each payer can seem like an exhausting task
Private health insurance companies change their policies on billing and medical necessity so frequently it may prove difficult for a new team to keep up. Understanding and assimilating these changes into your own policies and procedures are essential to optimized reimbursement.

15. Understanding policies and procedure for each payer can seem like an exhausting task
Medical Necessity Criteria
Diagnosis Coding Changes
Billing Practices by Payer
Collection Laws
Appeals Processes and Rights
Payer Policies and Procedures for Verification, UR, Billing etc.

16. Transition Support Team

17. Transition Support Team
Hiring a Transition Support Team can help mitigate all these challenges. - A strong support team, like PRRS, can provide training and staffing support, software recommendations, protection against unfair retaliation and clear and concise support on payer and internal policy and procedures.

18. Transition Support Team
Staffing and Training
Software Assessment and Recommendations
Account Review and Support
Policy and Procedure Development
Ongoing Training and Monitoring
AR Review and Recommendations

19. For More Information Professional Revenue Recovery Solutions

20. Professional Revenue Recovery Solutions
Thank You
Zarina Nagrani
President
Professional Revenue Recovery Solutions