Provider Reimbursement and Billing Services

The Pinnacle Health Group provides the services and support your organization needs to maximize your reimbursement within the appropriate and current coding and billing standards while complying with the numerous rules and regulations in effect. The Pinnacle team can evaluate your organization's billing and coding practices to ensure your claims are submitted properly, accurately and up to date, leading to less claim denials and optimizing your reimbursement. We implement programs and procedures to review your billing practices on an ongoing basis. Our experts identify, evaluate and resolve issues and barriers that will allow your operation to run smoothly and in accordance with industry standards and government regulations.

Coding and Billing Support

Credentialed professional coders at the Pinnacle will design comprehensive strategies to help manage your accounts receivable. We design customized programs to avoid excessive time and resources to analyze coding, billing and collection strategies for your clients. We ensure collection of appropriate receivables from Medicare, Medicaid, commercial insurance companies and patients. We will help to negotiate managed care pricing and coding strategies as part of your organization's accounts receivable management program. Our specialized medical billing associates are dedicated to providing timely, comprehensive and accurate billing, collection and management services. The Pinnacle services and support include:

• Coding Analysis and reimbursement review
• Accounts Receivable Management
• Collections
• Customized Monthly Reporting
• Monthly, Quarterly and Annual Business Reviews
• Coding Audits and Billing Practices Evaluation
• Clinical Documentation Audits
• Managed Care Contract Negotiation Support
• Pricing Strategies
• Evaluation and Management Coding Strategies and Management Review Tools
• Coding and Billing Forms

Compliance and HIPAA Audits and Programs

The creation, implementation and ongoing adherence to a compliance program is evidence of your organization's intent to follow governmental health care program rules and regulations. With increasing scrutiny of various state and Federal agencies into billing practices and procedures, it is imperative you r organization have effective compliance programs in place. Compliance programs are also the key to successful reimbursement and meeting your organization's mandatory HIPAA requirements. The Pinnacle provides programs and services to meet these obligations. We develop customized compliance programs that comply with documentation, reimbursement, HIPAA and the performance standards outlined by governmental agencies. Our team can assist with the implementation of your compliance program and provide ongoing education and auditing plans and procedures to ensure continued compliance. Our compliance services and support include:

• Development of a Customized Compliance Program
• Development of Compliance Policies
• Appropriate Overview of Compliance Regulations and Components
• Educational Compliance Programs
• Compliance Audits
• Compliance Audit Tools and Training
• Continuous Updates regarding Compliance Standard Changes
• HIPAA Compliance Programs and Audits