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.
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.
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.