Hospital Billing Services
Reduce denials, shorten A/R days, and increase collections with AltuMED. Our enterprise hospital billing services streamline every aspect of your revenue cycle. This means you get reduced administrative burden and more autonomy to scale.
Why Outsource Hospital Billing?
Medical billing, even for a small practice, can be maddeningly complex. Do it for the hospital, and the task becomes even more convoluted.
Delegating this major operation to an RCM firm can give you the autonomy you need. It relieves you of the administrative burden and increases prospects for growth. And you save more time and resources for effective patient care.
Here is how outsourcing works for you:
- Lower operating costs through reduced FTE burden and overhead.
- Faster cash flow through tighter claim timelines and proactive follow-ups.
- Reduced denials through accurate coding and EOB remediation.
- Specialized expertise in hospital-specific coding (inpatient DGR considerations, ED modifiers, etc.).
- More opportunities to scale.
Our Hospital Specialty Billing Expertise
Charge Capture and CDM Management
For us, Charge Description Master (CDM) is a fundamental financial engine. We use it to ensure you get maximum revenue. This service includes the following features:
Emergency Department (ED) Billing
At AltuMED, we deploy the best of expertise and strategic resources to manage ED billing, which comes with quite unique challenges. We help you capture the full equity and complexity of emergency services.
Inpatient and Outpatient Billing
Service Category
| Core Processes
| Enterprise Impact
|
|---|---|---|
Inpatient Billing
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Outpatient Billing
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Telehealth and Virtual Care Billing
We handle:
- Telehealth CPT codes (99201-99215 for encounters, 99441-99443 for audio-only, and 99421 for digital self-care)
- Place-of-service (POS) modifiers, like code 02 for remote services and the GT modifier (applicable for Medicare)
- Payer-specific rules
Hospital Payment Model Proficiency
Our revenue team has specialized knowledge and skills to handle hospitals’ complex payment models. With their flawless approach, they ensure maximum legitimate reimbursement.
Payment Model
| Service Type
| Key Components
| Our Expertise
|
|---|---|---|---|
MS-DRG
| Inpatient | Relative Weight, MCC/CC capture, SOI/ROM | DRG optimization, clinical validation, CDI support |
APC
| Outpatient | Procedure grouping, status indicators, packaging | APC accuracy, device-dependent procedure coding |
OPPS
| Outpatient | Payment rates, copayments, device credits | Correct payment calculation, device-intensive APCs |
Value-Based Programs
| All | MSSP, CJR, BPCI-A | Performance tracking, cost reporting, reconciliation |
DRG Optimization:
- MCC/CC Capture: Proper documentation of major complications and comorbidities to maximize DRG weight
- Clinical Documentation Improvement (CDI): Documentation specialists who work with your clinical staff
- MS-DRG Validation: Pre-bill audit to ensure the assigned DRG accuracy and compatibility with clinical documentation
How We Help You Grow
Accurate Billing, Precise Coding, Customized RCM
We keep your hospital RCM error-free to prevent denials. With years of experience, we know exactly where to tap for efficiency. But first, we take a good amount of time to understand your requirements. We analyze your current practices and identify areas of improvement. Based on all this, we develop a billing strategy that boosts your cash flow.
Compliance and Regulatory Expertise
Compliance is a highly critical requirement of hospital billing. At AltuMED, we ensure each of your service claims adheres to the latest regulatory and payer-specific guidelines.
CMS Conditions of Participation (CoPs).
Medical Necessity Validation.
Price Transparency Compliance.
OIG Workplan Monitoring.
Technology and Integrations
Our RCM system works well with all the major EHRs. It connects with those platforms using secure HL7/FHIR and sophisticated proprietary APIs.
Other advanced features of our system include:
- Highly intelligent automatic scrubber
- Claim routing through clearinghouses
- Real-time analytics based on all the major KPIs
AI for Health System RCM
We close the loop by deploying highly expert human resources and cutting-edge tech. Our technology specifically helps you rise above RCM challenges and scale beyond limits.
Health System AI Framework
- Uses clinical indicators to flag DRG disparities
- Predicts denials for medical necessity and level of care
- Systematically looks for charge capture opportunities in clinical documentation
Enterprise Analytics
- Performance dashboards for all the departments, e.g., ED, OR, Medicine
- Payer contract modeling and performance tracking
- Real-time denial tracking and management
Data and Information Security
- HIPAA-compliant operations and Business Associate Agreement (BAA) available on request.
- Data encryption in transit (TLS 1.2+) and at rest (AES-256).
- Periodic third-party security assessments and penetration testing.
- SOC 2 Type II attestations
Why Health Systems Choose AltuMED
Capability
| AltuMED
| Typical Competitors
|
|---|---|---|
DRG & APC Optimization
| Combined inpatient/outpatient expertise | Separate teams |
Charge Capture & CDM
| Proactive management & reconciliation | Basic charge posting |
ED Billing
| Critical care, observation, E/M leveling | Basic ED coding |
Health System Analytics
| Department-level, real-time dashboards | Basic practice-level |
Average A/R Days
| <38 Days | 45-55 Days |
Net Collection Rate
| 98.5% | 95-97% |
What Our Clients Say
Increase your reimbursements with specialized hospital billing solutions by AltuMED.
Get in touch and see how we bring success to your practice.