Secure Your Revenue & Patient Trust with
Revenue Management
HEALTHCARE
Managing the healthcare revenue cycle is a complex task, laden with administrative challenges and profound ethical responsibilities. At Sibernext, we provide comprehensive medical billing, coding, and accounts receivable management services to navigate this landscape. Our core mission extends beyond financial performance to an unwavering commitment to the highest standards of integrity, with HIPAA compliance as the absolute bedrock of our operations.
We understand that protecting patient data is not just a regulatory requirement but a sacred trust. Every process we design and every action we take is governed by a rigorous, multi-layered framework built to exceed HIPAA mandates. This includes robust data encryption, stringent access controls, comprehensive employee training, and continuous auditing to ensure the complete confidentiality, integrity, and security of all Protected Health Information (PHI).
Our end-to-end revenue cycle solutions—spanning pre-service eligibility, coding, and post-service payment posting—are infused with these best practices. By partnering with Sibernext, you secure more than a service; you gain a dedicated guardian of your data. We empower your organization to improve reimbursements, prevent denials, and reduce costs, all within a secure environment that prioritizes patient privacy and your ethical obligations above all else. This commitment ensures not only enhanced financial performance but also unparalleled peace of mind.
Front-End Services
Sibernext establishes a robust financial and administrative foundation through our comprehensive front-end services. We specialize in meticulous patient scheduling, registration, and eligibility verification, ensuring every patient interaction initiates a clean and efficient revenue cycle. Our processes are designed to accurately capture demographics, verify insurance benefits, and secure necessary authorizations upfront. By focusing on precision from the very first point of contact, we prevent downstream denials, enhance patient satisfaction, and set the stage for seamless claims processing, instilling confidence in your practice's operational workflow and financial health.
Patient Registration
Accurately collect and verify patient demographics and insurance details. This ensures eligibility and prior authorization requirements are met upfront, preventing claim denials and ensuring a smooth revenue cycle start.
Appointment
Management
Manage schedules effectively with automated confirmations and reminders sent to patients and providers. This reduces no-shows, keeps schedules full, and improves patient attendance and satisfaction.
Prior
Authorization
Obtain necessary pre-approvals from insurers for services. Our meticulous process ensures compliance with payer requirements, avoiding claim denials and ensuring reimbursement.
Meticulously manage and update patient personal and insurance information. Accurate data is the foundation for clean claims, preventing denials and ensuring timely reimbursement.
Patient Demographics
Mid-Revenue Services
Our mid-revenue cycle expertise ensures the critical link between patient care and accurate reimbursement is seamlessly maintained. Sibernext excels in clinical documentation improvement, precise charge capture, and expert medical coding, including specialized HCC review. We focus on translating the clinical narrative into compliant, optimized revenue data. Our diligent audit processes and utilization review support ensure coding integrity, mitigate audit risk, and protect revenue, providing a crucial layer of financial protection and compliance assurance that bridges your clinical and financial operations with unwavering accuracy.
Charge
Capture
Accurately record and translate all billable services and procedures into charges using appropriate codes. This prevents revenue leakage and ensures all provided services are captured.
HCC Coding
Review
Specialized coding for risk adjustment models (HCC) to ensure accurate reflection of patient complexity. This maximizes appropriate reimbursement in value-based care settings.
Charge
Audit
Review coded charges for accuracy, compliance, and optimal reimbursement. We identify errors, inconsistencies, and missed revenue opportunities before claim submission.
Utilization
Review
Review medical necessity of services using evidence-based guidelines. This ensures care appropriateness, optimizes resource use, and reduces denials.
Back-Office Services
Sibernext safeguards your revenue integrity through our diligent back-office services. We manage the entire claims lifecycle, from scrubbed creation and clearinghouse submission to meticulous payment posting and remittance analysis. Our team proactively manages accounts receivable, conducts expert denial management and appeals, and executes precise patient billing and collections. Supported by actionable business intelligence reporting, we provide full visibility into your financial performance. This comprehensive approach ensures maximum reimbursement, accelerates cash flow, and closes the loop on an efficient and resilient revenue cycle, delivering peace of mind and financial stability.
Perform automated and manual audits to check claims for errors, coding accuracy, and compliance before submission. This significantly reduces denial rates.
Claim
Scrubbing
Clearinghouse
Submission
Electronically submit claims to payers via clearinghouses for validation and routing. This ensures efficient, secure, and tracked claim delivery.
Process Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA) files. We interpret payer payments, adjustments, and denials for accurate reconciliation.
Remittance
Accurately post insurance and patient payments to patient accounts. Our meticulous reconciliation ensures your financial records are always up-to-date.
Payment
Posting
Secondary Claims / COB
Submit claims to secondary or tertiary insurers after primary payment. We ensure correct coordination of benefits to maximize recoverable revenue.
Generate and send clear, accurate patient statements for patient-responsible balances. Our streamlined process improves patient understanding and timely payments.
Patient
Billing
Denial
Management
Analyze denied claims to identify root causes, correct errors, and efficiently re-submit appeals. We recover lost revenue and prevent future denials.
Manage the entire appeals process for denied claims, including writing compelling appeal letters and submitting supporting documentation to overturn denials.
Denial
Appeals
Clinical
Documentation
Improve the accuracy and completeness of medical records. This supports proper coding, reduces denials, ensures compliance, and accurately reflects patient severity and care provided.
Benefits Verification
Confirm detailed insurance benefits and coverage for specific services. This clarifies patient financial responsibility and helps secure prior authorizations, reducing denials.
Optimize physician calendars and reduce patient wait times by matching patient needs with provider availability. Our streamlined process minimizes no-shows and maximizes operational efficiency for your practice.
Patient
Scheduling
Accurately prepare and format claims with all necessary patient, provider, and service information. This ensures clean, submission-ready claims for faster reimbursement.
Claim
Creation
Patient
Collections
Manage patient AR with respectful and effective follow-up on outstanding balances. We offer flexible solutions to improve cash flow from patient payers.
A/R
Follow-Up
Proactively manage aging accounts receivable. We conduct persistent follow-up with insurers on unpaid or underpaid claims to accelerate cash flow.
Payer
Adjudication
Monitor and track claims through the payer's review process. We follow up to ensure timely adjudication and address any payer requests for information.
Assign standardized ICD-10, ICD-11, CPT, and HCPCS codes to diagnoses and procedures. Our certified coders ensure accuracy and compliance for clean claim submission.
Medical Coding
Financial
Counselling
Assist patients with understanding costs, exploring financial assistance options, and setting up payment plans. This improves collections and patient satisfaction while ensuring care access.
Eligibility Verification
Verify insurance coverage and active policy status electronically before services are rendered. This determines financial responsibility and prevents claim rejections due to eligibility issues.
Advancing healthcare
through partnerships
WE RENDER TAILORED SOLUTIONS TO
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