Reimbursement- Billing & Coding Services

Reimbursement optimization is more complex today than ever before. When fully implemented, the Affordable Care Act will place enormous pressure on reimbursement teams, especially because of ICD-10s' inevitable utilization. The need for in-depth understanding of these new systems and their billing procedures will place new demands on the science of optimizing reimbursement for performed services.

Coding and coverage access are increasing in complexity, especially in the details of specialty or surgical procedures. Whether you just need a code for a new procedure or want to hand over coding and coverage access to our specialty professionals, help is a phone call away. Live touch access to people who know what you need is our specialty. Our expertise is in providing live access to people who know what you need and give you help when you need it.

Provider & Facility Reimbursement "Hotline" Services
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Provider & Facility Independent Reimbursement Services (click for more)

Physician & Staff
Training, Education
and Support
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Obtaining insurance coverage pre-approval and prior authorization has never been more difficult. From workers compensation to private insurers, everyone has a different policy. Allow the experts at SHA to assist your practice in obtaining invaluable pre-approvals and prior authorizations for your surgical cases.
Prior-authorization denials and coverage rejections occur on a daily basis and complex appeals are time consuming and require diligent responses to the all too often knee-jerk denial. Let SHA's experienced professionals work the difficult cases and reduce your time spent waiting for each appeal to move through the process.

Let our proprietary work flow process guide you through your prior-authorizations, denials, appeals, and complex procedure submittals, and distinguish those that are everyday cases from those that need special assistance.

Reviewing your claims pre or post submittal will optimize your reimbursements and assure you of compliance with specialty procedure coding guidelines. Guidelines change constantly and up to date coding is a must to assure accuracy and compliance for each case you report.

Claim submissions for complex cases that combine multiple procedures and diagnoses can become a challenge for even the most experienced practices. SHA has the expertise to make sure you report correctly and within payor guidelines so you can maximize reimbursement without risking non-compliance.

As an independent third party, SHA professionals will compile essential information detailing the valuable EOB claim data collected. This information can then be utilized by a provider or a facility for a number of potential uses, including health plan contracting. In addition to collecting and summarizing data, SHA can assist with using the data for health plan negotiations.

The need for education never ends when compliant coding and reimbursement is a moving target. SHA can provide on-site and up to date coding presentations tailored to your specific needs. Surgeons, practice staff and facility personnel require the latest information and current coding complexities that payors demand for correct claim submission and final reimbursement. Let our experienced educators create a curriculum and interactive sessions to put you in front of the curve.
Is on-site education not ideal for your practice or group? SHA can provide personalized educational curriculum
through Webinars.

SHA provides reimbursement, coding and coverage presentations that address current "hot topics" or teach groups "coding & reimbursement 101". SHA coding professionals can deliver the CEU for member associations and affiliated groups, with topic specific accuracy and interactive learning environments.