All your Reimbursement and Revenue Cycle Management needs in one place.

Your trusted partner for your insurance reimbursement and revenue management.

We offer the full range of revenue services to large residential facilities and small startup practices alike. Here is we can help you.

Provider Credentialing

Have you decided it is time to transition to an insurance model? We offer full-service provider credentialing and insurance plan enrollment solutions to help ease you into a new billing system.

Services include:

  • Provider credentialing and re-credentialing
  • Insurance contracts
  • CAQH application and re-attestation (and more)

Keeping your providers, group or facility compliant is key to avoiding disruptions to your insurance billing (and, most importantly, your patient care). We make it our job to help you stay on top of compliance issues and assist you in organizing your systems – that way, you can handle with ease any changes coming at you.

Eligibility and Verification of Insurance Benefits

The hard truth: with an increasing number of carve-outs, secondary and advantage plans, or state-specific plans, benefits can vary significantly for a single payor. Patients rarely are aware of their individual plan benefit details, and insurance carriers often provide inaccurate, incomplete, or out-of-date information. Most of the time, you are left behind when payors don’t cover your patient’s treatments.

Verification of benefits is the first and most important step in the insurance billing process. Timely verification helps you have an informative dialogue with your patient before treatment, maximizes your collections and help you to maintain a competitive edge. That is why we provide quick turnaround and a transparent process.

Our verification specialists assist with:

  • Patient policy deductible and out-of-pocket responsibility
  • Co-insurance and co-payments
  • Benefit limits
  • Pre-authorization and clinical requirements for medical necessity (and more)

Years of clinical experience make our verification processes different from other revenue cycle service providers. We provide each client as requested a custom insurance verification form and help you through the process. Most importantly, expect us to manage ongoing verifications of your clients’ insurance carriers; we want you to have up-to-date information and help you hold carriers accountable.

Prior Authorization and Utilization Management

When you are working as a behavioral health and addiction treatment provider, you need a UR team that is intimately familiar with the process and understands clinical documentation and review guidelines for each insurance carrier. We have backgrounds in long-term care, hospital-based psychiatric units, residential treatment, acute detox, halfway houses and private practices in both the private and public sectors – so call us experts in admission and continued stay criteria.

On top of handling communication with payers, we work closely with you to help you understand today’s industry standards (and we say today because it changes – constantly – and we will tell you when it does). We help with:

  • Licensing requirements and level of care guidelines
  • Intensity of service requirements
  • Individualized treatment planning
  • Clinical documentation and charting to medical necessity
  • Peer-to-peer reviews and appeals processing, and more.

Our goal: get your patients the coverage they need at the highest level of care for the longest duration possible. That is why your authorization specialist will continue to make the case for medical necessity until the client is discharged from your program.

Claims Coding and Review

At the heart of SBSC's coding service is our deep specialty knowledge and industry-leading technology. Our specialized coders combined with rules-driven analytics provide consistent coding that optimizes revenue and maintains compliance. We ensure proper diagnostic procedure codes and modifiers are assigned correctly using CPT, ICD-10 and HCPCS Level II classification.

Our clients are provided with overall and practitioner-specific documentation, guidance and feedback reports originating from research, denial management activity and government mandates (such as HIPAA, NPI, ICD-10, MIPS, NCCI) including RVUs, procedure distributions and documentation deficiencies.

Billing and Claims Management

Your talent is providing outstanding patient care. Ours is helping you increase productivity, predict future revenue, manage your facility’s growth, and collect more of your hard-earned fees. How? Customized billing and claims management and cutting-edge software.

We offer tailored claims management and collections services, such as:

  • UB04 and HCFA-1500 billing with appropriate coding
  • Claim scrubbing to reduce denials
  • Electronic claim submission and processing for fast payments
  • Consistent and aggressive followup on un- or underpaid claims
  • Denial management and appeals
  • Monthly patient statements and patient receivables management

With our billing and claims management services, you can and will:

Increase and Reliably Project Your Revenue. Our comprehensive collections and aging reports help you determine your company’s financial future and cash flow planning. The reports reflect gaps in a facility’s processes, and we relay these issues to you immediately along with our proposed solution.

Stay Updated. It is part of our services to provide you with regular reports, trend analysis/reviews, and updates so you always know how your organization is performing. When we stay on the same page, your finances stay in order.

Spend More Time on Patient Care. Our task is to lighten the load and getting the job done. That is what we are committed to do.

Patient Receivables Management

As reimbursement shifts to a larger and growing contribution from patients, SBSC collaboratively develops a strategy with clients for optimized patient collections through enhanced processes and patient convenience. We believe that a modest 5% improvement and bad debt below 10% is attainable. Keeping revenue whole while improving client satisfaction is what we will help our clients attain.

Services include:

  • Single point of service for patient inquiries, payments and payment plans
  • Monthly patient statements and identification of non-deliverable mailing addresses
  • Convenient online patient payment portal increasing likelihood of payment
  • Greater transparency to you and your patients there by increasing patient satisfaction and loyalty
  • Timely and accurate reporting and analysis of the effectiveness of the patient payment process
  • Transfer of hard-to-collect balances to partner contingency collection agency

Payor Contracting

SBSC has decades of experience with managed care and other commercial and government payors at all levels of care. We have developed relationships with major health plans in multiple regional markets, leading to insights and expertise that we bring to every client engagement.

  • Contract reimbursement design and negotiation
  • Reimbursement and rate benchmarking
  • Payor/provider funds flow design
  • Out of network analysis and management
  • Contract implementation and management

Our team of specialists is continually honing their strategic and technical skills to successfully guide clients through reimbursement strategies, price negotiations, and methodology changes. We understand the issues that are important to both providers and payors, which affords us insight into the market dynamics impacting provider reimbursement and the technical skills needed to manage and optimize our client's revenue streams.

Consulting and Business Intelligence

Are you a new provider or practice looking for guidance? An established facility or hospital looking to change or improve your revenue processes?

Benefit from SBSC's deep clinical and operational expertise combined with rigorous analytical skills.

Our consulting services include:

  • Licensing and accreditation
  • Program start-up, assessment and enhancement
  • Chargemaster review and management
  • Clinical service development, documentation and improvement
  • Business operations, expense/staff "productivity" and workflow optimization

By utilizing our consulting services, you can pinpoint issues of concern as a means of improving clinical care, streamlining processes, and increasing revenue while maintaining regulatory compliance.