Management Services
Administrative, Operational and Financial Services
Providing financial resources to develop, train and hire personnel including providing office managers, certified coders, licensed mid-levels, scribes, certified medical assistants, and patient advocate team members
Providing resources that protect providers and their patients from insurance clawbacks, recoupments and offloading and costs to patients
Providing oversight on certifications, fraud and abuse programs, conflict, audit and monitoring services, contract reviews and independent chart review services by independent certified ERISA experts.
Information Technology Services
HIPAA compliance software applications
Computerized order entry and Documentation support services
Secure patient friendly registration services that are android and apple friendly
ERISA revenue recovery services
Patient notification services
Patient monitoring applications and services
Integration services with vendors that minimizes faxing, emailing, scanning and paperwork burden associated with outsourcing services to a vendor
EMR software services with established billing support services
Contracting and Credentialing Services
Credentialing resources allow healthcare facilities and providers to reduce errors and high costs often associated with maintaining and obtaining appropriate licensure, certification, and other qualifications. Kokua’s team of certified professionals have worked on government and large institutional contracts and assisted clients with obtaining:
CLIA / CAP / COLA Certification
DMEPOS Certification
NCPDP Pharmacy Certification
PECOS Enrollment
CONTRACTING NEGOTIATIONS
Hiring and placement of CMA’s, Nurse Practitioners, Physician Assistants, IONM and Certified Coding specialists
Revenue Cycle Management
Most providers and facilities are not familiar with the Employment Retirement Income and Securities Act (ERISA) which often regulates how plans are funded, created and managed. ERISA is a governing principle that holds insurance payers accountable when determining fee schedules, identifying and documenting medical appropriateness and determining what a service is worth and how it should be paid based on the level of care or location of the treating provider. These regulations often follow NCD, LCD and federal policies that providers are simply just not trained on. Most billing companies focus on charge entry….. our team want to educate providers so we can prevent problems in advance.
Kokua is comprised of a team of companies including Cornerstone Forces and Summit Health Services that allow us to collectively provide specialists that help healthcare facilities, treating providers and patients identify the most cost-effective treatment plans that will reduce out-of-pocket costs, reduce denials and reduce time spent on prior authorizations. We do this by focusing on the core competencies for a clean claim:
Coding and Fee Schedule reviews….. understand how fee schedules are actually created when a fund is created to pay for claims…..
SOAP Template reviews and assistance in developing documentation that utilizes LCD and NCD guidelines to improve reimbursements… crosswalks are imperative in understanding what meets medical necessity
Independent Audit Guards to prevent SIU and RAC audits….. each claim is verified before a claim is submitted…. how many billers ensure a claim is clean before it is submitted?
Real time verification of services to identify products and services that are covered… do you know what a 270/271 is? its an eligibility check specific to a service, this is better than a general ask of whether a patient has insurance on the date of service……
Prior Authorization and Claim Status Checks services…. our team can simplify the process so your staff can focus on patient care coordination..
ERISA appeals on partially paid and/or denied claims…. providers have no rights to argue a claim due to CPCP insurance policies….. patients rights however supercede how a claim is supposed to be paid…..
Claim settlements when insurance payers arbitrarily underpay a claim….. when in doubt…. take the win but do it when you have the right documentation to support payment…..