We help healthcare providers with our patient contact center, practice marketing & growth services, revenue cycle management solutions, free practice management and marketing software tools , healthcare software development to improve revenue performance & patient satisfaction.
Providers are seeing rising costs, patients that behave like “high-touch” consumers, reduced payments, high deductible health plans. ever increasing healthcare regulation and oversight. With margins dwindling every year, how can provider groups expect to stay profitable?
At Nisos, we believe that only by marrying technology along with highly trained healthcare professionals, can we win this game. We are on a mission to help healthcare providers run a profitable business and provide the highest levels of patient care. We strongly believe that these two can go hand-in-hand and our mission is to show you how.
Unlike our competitors, we share all our learnings freely on our website. You can follow the exact same steps that we take to grow healthcare practices as well.
On our website, you will find free versions of the same software tools that our patient contact center and revenue cycle management teams use to help other provider groups. Should you want to upgrade for more advanced features, contact us for pricing.
You can leverage your existing staff and use these free software tools. You can hire us to grow your business as well. Our history has been in healthcare software development. You will find that we can help you solve your healthcare software engineering challenges as well.
We help large physician groups, hospitals and health systems create their own outsourced call center to improve patient satisfaction, patient experience and increase accessibility. We are strong believers that your practice locations should be staffed to handle patient care – and not to answer phone calls.
Provider groups come us and reduce their own call center’s response time to less than 1 minute. They find that it is cost prohibitive for them to staff it with on-shore talent.
We leverage our call center technology that integrates with our partners’ EMRs and Erlang-C model based workforce analysis + management to reduce abandonment rates and increase first-call resolution.
- Our transition managers conduct a detailed study of your weekly and seasonal call patterns.
- The above step allows us to determine the reason for the call . Here, we introduce our technology innovations to automate some of the call resolutions. This allows us to establish the baseline KPIs (call abandoned rates, call handling times, resolution on first contact, patient satisfaction etc)
- At the next step, we port your phone numbers and implement an interactive voice response (IVR) using Amazon Connect. This lets us handle simple queries like directions, appointment date/times, wait lists, balance inquiry and statement requests.
- Next, we set up the phone tree as it exists at your location(s) today. Here we add our call center agents to the front of the line. Based on specific queries, our agents can transfer calls back to your staff.
- We support English, Spanish and all south asian languages like Bengali, Hindi etc. At this point, we set up language specific phone tree options.
- Meanwhile, our transition managers set up a training process to perform knowledge transfer from your existing staff and to set up communication and escalation protocols.
- During the knowledge transfer process, we work hand in hand with your current staff and monitor performance indicators along with you.
- Once you are satisfied with our call handling capabilities, we transition the entire inbound call center responsibilities to ourselves
- At this point, we give you access to the same real-time call management and reporting software solution that we ourselves use.
- Moving forward, we continue having brief weekly calls to discuss KPIs
- Appointment scheduling / rescheduling
- Pharmacy related queries
- Statement requests and billing inquiries
- Bill payment via check or credit card
- Appointment reminders
- No show re-appointment
- Patient recall
- Self-pay collections
- Patient balance collections
- Billing reminders
- Address verification
- Eligibility verification
- A/R Denials and no responses from payers
As we are well aware of, our patients expect near real-time responsiveness from our practices. How many of us have the financial resources to staff a call center like that?
Scheduling & patient flow are the most important aspects of running a practice at its peak. The beginning of the week always tends to have a higher call flow than Thursdays/Fridays. Patients call, send SMS, use the appointment scheduling section of your website, send messages on Google My Business, facebook messages.. How do you keep up?
We wouldn’t be able to either – but we leverage our innovations in patient messaging technology to achieve true omni-channel appointment capture and patient scheduling success.
Your patients can reach out to you in any way they want – any channel they want, any time they want. We address these incoming scheduling requests and ensure that patient demographics are captured with 100% accuracy, patient insurance details are captured without any gaps plus patients are given their desired appointment date/times – to further reduce their chances of being a no-show.
Patient bad debt write offs are on the rise, and have been so for a while now. This is primarily because we all deal with inefficient patient collection practices. This, added to the not providing the patient with easy access to patient statements nor easy ways to pay, increase our A/R.
We can help you reduce your bad debt write-offs. We leverage technology (SMS, email, calls) to reduce patient balances, get paid faster by making it super easy to pay (just like they pay for anything online), obtain patient statements on-demand. For patients that simply do not respond to digital messaging, our agents act as a first party collections agent (i.e. call on your behalf) and ensure payments are collected on time and deposited to your bank account.
With the changing healthcare landscape and higher patient payment responsibilities, proper patient insurance eligibility and benefits verification are CRUCIAL. This alone contributes significantly to numerous expensive claim resubmissions, delayed payments, non payments, patient balance collection calls etc.
You can very easily improve A/R cycles and increase cash collections by leveraging our eligibility verification services. This helps in reducing write-offs and denials.
We can help you:
- Verify coverage on primary, tertiary, Medicaid etc – we leverage our eligibility verification solutions in addition to using payer IVRs and payer CSRs.
- Reach out to patients & get updated insurance information (if anything has changed since their last visit)
- Keep up-to-date/current member ID, group ID, coverage end and start dates, co-pay information etc
- For certain payors, obtain pre-authorization codes
- For certain payors, get PCP referrals as needed
- Keep patient demographics up to date and verify patient identity using our technology solutions
- Stay up to date on patients’ issues with coverage or authorization
Marketing your practice is tough – a LOT of work. While you are busy seeing patients, younger, more digitally savvy competitors are trying to steal your patients away from you.
Marketing your practice these days is not as easy as it used to be before and you have to manage digital, social, PPC, physician referrals channels at the same time, with the same vigor. Sites like ZocDoc, Google and Facebook reviews, healthgrades etc have upped the ante as well.
Patient consumerism is on the rise and it has been for a few years. Patients are shopping for healthcare providers like they search for products on amazon. They expect the amazon.com experience.
Larger physician groups and FQHCs that you depended on for referrals are adding specialties to capture outbound referral revenues.
What are you supposed to do?
We are yet to meet a practice that has the bandwidth or the staff to be able to market their practice effectively. We work with your team to grow your practice via various tried and tested methods.
- Our transition managers start with understanding your current marketing situation – what marketing you do (or don’t do), which channels you want to consider marketing on (we provide our recommendations as well).
- Our transition managers break down B2B (business to business – physician practices) and B2C (business to consumers – practice to patients) channels and present the strategies to you.
- We do a detailed analysis of your competitors – what’s working for them and what’s not.
- Next step is to create a strategy that we think “could” work based on our experience. We let you know our assumptions, the results we expect to see and what we want to do if we do not see those results.
- We create the necessary artifacts needed for your marketing (e.g. website, facebook, instagram accounts, google AdWords, google my business account etc)
- Here, we take the opportunity to introduce our innovative healthcare marketing software.
- We set up direct access to your EMR or we set up a process to get regular updated appointments and patient data from your team
- The communication, reporting and escalation channels are set up during this point in our partnership with you.
- All our outbound and inbound calls are set up using our own implementation of Amazon Connect at this time. Then we share the same reports that we ourselves monitor on a regular basis.
- Moving forward, we continue having brief weekly calls to discuss KPIs
- Healthcare practice website development (that’s HIPAA compliant)
- Social media presence (facebook, instagram)
- Practice reputation growth via patient reviews, satisfaction surveys
- Paid advertising
- Digital marketing services
- Community outreach – cold calls and postcard mailers to people near your practice locations
- Fax and outbound calls based physician referral marketing
- Reactivating & reappointing patients that have fallen out of care for more than 6 months
- Reducing & re-appointing no-shows
- Patient referrals (friends and family)
You are leaving money on the table. We can almost guarantee it.
As reimbursements tighten up, patients bear a larger portion of their healthcare costs per year, revenue cycle management that’s based on rock solid systems, processes and procedures has become even more crucial. Your practice’s viability, sustainability and profitability depends on the performance of your billing department.
Whether you choose to do it in-house, outsource it to an RCM firm on-shore or offshore is ultimately your decision. We can consult and work with your team or transition the entire RCM process to our RCM center of excellence to provide you with the peace of mind that you are looking for.
Most provider groups that we start working with, seem to lack robust systems, processes and defined workflows to be as efficient and lean as possible while maximizing collection rates. We can start by looking at what you are collecting per $ claim submitted, what the industry benchmarks are, the steps needed for you to reach those goals.
We are huge fans of HFMA MAP keys – in case you are wondering. Trust us to handle your revenue cycle management processes – end to end.
We follow a transition process to ensure minimal disruption and do not believe in a “boil the ocean” approach.
- Our transition managers set up meetings with your in-house or outsourced billing department to understand the current processes.
- Our team analyzes the current financial health of your practice and comes up with a plan of attack based on where we find the most pressing needs to be.
- Our team creates a plan to first address the most pressing issues, makes process improvement suggestions, creates a plan of action.
- After getting approval on the plan and the associated KPIs, our team sets to actionable items on the plan.
- Thereafter, each week we measure progress against KPIs, adjust and fine tune as needed.
- As KPIs are attained, this also allows us to slowly transition over the workflow from your existing team.
- We rinse and repeat this process with your entire revenue cycle management workflow until both parties are satisfied of smooth functioning.
- Once a transition has been achieved, we hold our own team accountable to the same measures that your current team was held against. We continue reporting on the same KPIs as well.
We find that quite a few of claims issues stem all the way upstream to provider credentialing and enrollment.
We have found situations where some providers in the same practice group are credentialed with some payers and some plans only. Some providers are contracted at varying rates as well – for the same payer, same plan, same location.
Overall, we create a provider credentialing matrix wherein we always keep ourselves and your practice abreast of what the credentialing status for each payer, plan, provider is.
This also allows us to ensure that we always know the par status before a claim is submitted. You’d be surprised at how much information you can glean by having such a provider/payer/plan matrix in front of you and how much money you might have been leaving on the table
We leverage a few of our technology solutions to help achieve the same and can help you with 855 forms, PECOS, CAQH.
- We leverage our eligibility verification solutions in addition to using payer IVRs and payer CSRs to verify coverage on primary, tertiary, Medicaid etc
- In conjunction with our patient contact center team, we reach out to patients & get updated insurance information (if anything has changed since their last visit)
- Keep up-to-date/current member ID, group ID, coverage end and start dates, co-pay information etc
- As needed, we also obtain pre-authorization codes and PCP referrals as needed
- We not only stay up to date on patients’ issues with coverage or authorization but we also keep your team in the loop about the same.
While insurance eligibility verifications is a crucial aspect of revenue cycle management, patient demographic entries play a big role in reducing denials downstream as well.
Our team ensures that there are no issues with patient demographics with respect to name, DOB, address, phone number, medical history, guarantors (if any), insurance details etc.
If any of these are missing or has been missed by your front desk, we ensure that our patient contact center team gets in touch with the patient to sort out the details.
This becomes very important if we want to avoid having to rework claims.
While a lot of this seems like manual data entry work, we actually employ several technologies to ensure proper collection of patient demographics data entry, verification of patient identity etc.
Some denials are rooted in CPT -> ICD10 coding. There’s no getting around that.
We work with your superbills and completed visit notes. While it is ideal if the ICD/CPT codes are noted in the same, it is not mandatory to do so.
Our team is equipped to work with your superbills to ensure that work can progress with as much or as little assistance as possible. We need to ensure and prevent any up/downcoding related challenges to avoid possible future denials.
We work with your fee schedules and ensure that they are as per state/provider contracts.
Our team ensures that all patient demographics have been provided in the claim and are ready to be filed. After we do this, we ensure that we run it through a round of quality checks to ensure that our clean claims rate remains at the highest levels.
First things first – we ensure that the claims are submitted electronically.
While we have met practices that do not do this, we strongly encourage our clients to submit claims electronically (we can help you with the set ups as well).
Should there be an insurance requirement for paper to be used, we can do the same with the clearing house.
Rejections are part of the day to day world of claims. While keeping our clean claims rates at the highest performant level, we will still see rejections for some reason or the other. This happens with everyone in this ever changing healthcare industry.
We ensure that rejections are corrected and resubmitted within 24 hours.
Hopefully you are enrolled in EFT/ ERA to avoid delays in payments. If you are not, we ensure that your providers are EFT/ERA enrolled to reduce the time wasted on paper checks and payments.
We post and reconcile ERA / EOB / Denials on a daily basis.
We can work using your payment management system or we can also utilize our own. Either way, the net result is that your payments are posted at the earliest.
Accounts receivables are broken down into buckets based on the age of the account. Our team analyzes the account receivable buckets and comes up with appropriate course(s) of action for each bucket.
Thereafter, we prioritize our plan and work accordingly to help you slice through your A/R and recover monies due at the earliest.
Typical to our communications plan, we keep you informed on a daily/weekly/monthly basis and also ensure that we have quarterly business review calls to be on the same page.
We believe that starting with “denials” is the basis of understanding what’s right or wrong with your billing processes. Therefore, we always start by working with your current denials, making process recommendations based on our expertise, making adjustments all the way up to provider credentialing and therefore lay a solid groundwork to take your revenue cycle management processes to the next maturity level.
Depending on the buckets we are working on – whether they are denied, underpaid, pending / no responses etc, our team will call patients, payers, 3rd party facilities as needed to ensure we maintain the latest status of why and where the claim is “stuck”. After that, we ensure that our team takes the next corrective step to ensure that the current claim is paid for. In addition to that, we ensure that the learnings from this claim are sent to the upstream teams / processes to ensure non-recurrence of the same.
Revenue cycle management is a cycle where each team feeds off the other and each team has to work tightly, hand in hand to take care of the patient account holistically.
We understand that very well and our people, processes and technologies are built to facilitate that kind of team collaboration
First and foremost, we employ technology to achieve a bulk of the work. Our IT team has developed patient bill pay solution for us (which you are free to use as well) that we use in conjunction with our patient contact center solution.
This allows us to identify all patient balances in real time. Using our solution, we send out automated balance reminders to patients. In our communications we also make it super easy for patients to just click on a link and pay via check or credit cards.
Our patient contact center team constantly monitors aged accounts, patient responses and works closely with our payment posting team to ensure that patients’ payments are posted within 24 hours.
As we all know, sometimes, patients simply do not pay regardless of how many statement balances or reminders we send them. In these cases, our team evaluates whether the balance is high enough (e.g. > $50) to call and collect or not. This decision is made in conjunction with your practice and is assisted by looking at the life time value of a patient as well.
These decisions cannot and should not be made in silos or a vacuum. You need to balance the overall life time value of a patient and make a decision on whether further attempts should be made to collect from this patient or not.
Our team reviews and corrects patient’s demographics as needed, helps patients get their balance statements, answers all patient questions in details and assists the patient with payment plans as needed.
Our team calls as first party collectors (on your behalf). As we all know, calling on patients to collect balances is a very tough balancing act. We go above and beyond to make patients happy with the outcomes so that they pay their balances and at the same time, the relationship is still maintained for future visits.
Here are some of the same tools that we ourselves use to grow our healthcare provider partners’ businesses. Feel free to use them while following our best practices guides. We are sure that they would help you grow your business as well.
- Patient Appointment Reminders
- Patient Recall
- Patient Bill Pay
- Patient forms / intake
- Patient Messaging
- Patient reviews software
- Patient CRM
- Provider CRM
- Insurance eligibility & prior authorizations
We work with healthcare payers, providers and independent software vendors to help them:
- Re-engineer legacy software for AWS or Azure
- Launch custom mHealth apps
- Health IT integrations/interface development (API, HL7, FHIR, CCDA)
- Custom portal development
- Referrals management
- Patient Engagement
- Surgical coordination
- Reporting & Business Intelligence
- Cloud contact center solutions (Amazon Connect)
- Payer member management apps
- Health and wellness apps
- HIPAA secure messaging/chat apps
- Clinic management software
- Claim reimbursement solution
- Provider directory solution