Services Provided

🔹Referral Management

• Receive and process new referrals (fax, email, portal)
• Verify completeness of referral documentation
• Communicate with referral sources for missing info

🔹Insurance Verification

• Confirm active insurance coverage
• Check eligibility and benefit details
• Determine authorization or pre-claim requirements

🔹Patient Intake

• Create patient profiles in EMR
• Input demographics and clinical information
• Assign clinicians based on location and case type

🔹Documentation Collection

• Obtain signed physician orders and F2F documentation
• Track and organize all intake-related documents
• Ensure compliance with payer requirements

🔹Communication & Coordination

• Coordinate with schedulers, nurses, and authorizations team
• Provide real-time intake updates via EMR or      communication board
• Notify field staff of admission readiness

🔹Quality Assurance

• Audit intake files for completeness and accuracy
• Monitor timeliness of admissions from referral receipt
• Flag high-priority or urgent cases

🔹 Claims Submission

• Generate and submit clean claims for Medicare, Medicaid, and commercial payers
• Ensure accurate coding and billing in accordance with payer rules
• Submit RAPs/NOAs and final claims timely

🔹 Payment Posting

• Post payments and adjustments accurately in EMR
• Reconcile EOBs, EFTs, and paper checks 
• Identify and report discrepancies or underpayments

🔹 Denial Management

• Track and manage denials
• Resubmit corrected claims with supporting documentation
• Appeal denied or partially paid claims promptly

🔹 AR Follow-Up

• Monitor outstanding balances
• Perform timely follow-ups with payers on unpaid claims
• Document collection activity and payer responses

🔹 Compliance & Reporting

• Ensure billing compliance with CMS and payer guidelines
• Generate financial reports upon request
• Collaborate with QA and clinical teams for billing accuracy

🔹 Coordination & Support

• Communicate with intake, QA, and clinical staff to resolve billing issues
• Support agencies during audits or payer reviews
• Provide updates on billing trends or payer changes

🔹 Authorization Submission

• Prepare and submit authorization requests for skilled nursing, therapy, and aide services
• Include required documentation (485/POC, F2F, SOC notes, evaluations)
• Submit through payer portals, fax, or phone as required

🔹 Documentation Review

• Verify completeness and accuracy of supporting documents
• Ensure all documents meet payer-specific requirements
• Coordinate with intake, QA, and clinicians to obtain missing items

🔹 Status Tracking & Follow-Up

• Monitor the status of all submitted authorizations
• Follow up with payers to avoid delays or missed visits
• Update EMR and notify staff upon approval or denial

🔹 Denial Management

• Analyze reasons for denial and resubmit with corrections
• Prepare appeal packets when necessary
• Track appeal outcomes and update documentation

🔹 Communication & Coordination

• Liaise with case managers, payers, and referral source. 
• Notify scheduling and field staff of approved visits
• Maintain clear logs and status reports for agency leadership

🔹 Compliance & Timeliness

• Ensure all authorizations are obtained before visits when required
• Meet all payer deadlines to prevent service disruptions
• Stay current with evolving payer rules and documentation needs

🔹 Visit Scheduling

•  Schedule SOC, ROC, recert, and routine visits based on physician orders 
• Coordinate with nurses, therapists, and aides based on availability and coverage area
• Prioritize urgent cases, including hospital/SNF discharges and high-acuity referrals

🔹 Frequency & Order Compliance

• Schedule visits according to ordered frequency and disciplines
• Adjust schedules as needed for order changes, resumption of care, or missed visits
• Communicate with QA and authorizations to verify approved services

🔹 Staff Coordination

• Match patients with appropriate field staff based on geography, availability, and specialty
• Maintain communication with clinicians for confirmations or updates
• Notify intake and clinical managers of any scheduling barriers

🔹 EMR & Calendar Management

• Enter scheduled visits into agency EMR/calendar
• Update visit notes and status based on staff communication
• Ensure timely scheduling to support billing and documentation flow

🔹 Missed Visit Tracking

• Document and report missed visit 
• Coordinate rescheduling per agency policy and payer guidelines 
• Identify patterns or staffing concerns that may impact compliance

🔹 Communication & Support

• Provide real-time updates to intake, QA, and field staff
• Act as liaison between clinicians and office team for visit coordination
• Ensure proactive communication to reduce delays and patient dissatisfaction

🔹 Order Tracking

• Monitor all outstanding orders including SOC, ROC, recertifications, supplemental, and discharge
• Maintain organized logs for pending and completed orders
• Follow up on unsigned or missing physician orders

🔹 Order Preparation & Submission

• Prepare physician orders with accurate patient and visit details
• Ensure alignment with the Plan of Care and EMR documentation
• Send orders to physicians via fax, portal, or secure email

🔹 Signature Retrieval

• Track order return status and follow up regularly for timely signatures
• Escalate delays to agency leadership if needed
• Ensure signed orders are returned within required timeframes to maintain compliance

🔹 Order Corrections & Revisions

• Review returned orders for errors or missing information
• Coordinate with clinicians to make necessary corrections or updates
• Resend corrected orders promptly for re-signature

🔹 EMR Documentation

• Upload signed orders into the agency EMR
• Link orders to the appropriate patient record and service episode
• Maintain audit-ready documentation for surveys and billing

🔹 Compliance & Coordination

• Ensure all orders meet payer, CMS, and agency documentation standards
• Collaborate with intake, QA, and billing teams for order accuracy
• Support timely billing by reducing delays in order completion
   

🔹Policy & Procedure Support

• Assist with developing, reviewing, and updating      agency policies
• Ensure alignment with current CMS and state-specific      regulations
• Provide templates for operational workflows and      clinical compliance

🔹Survey Readiness & Audit Support

• Prepare agencies for state, CMS, and payer audits
• Conduct internal chart audits and documentation      reviews
• Identify and help resolve compliance risks before      surveys

🔹QAPI Assistance

• Support agencies in developing and maintaining      Quality Assurance & Performance Improvement programs
• Monitor trends and provide action plans for      improvement
• Track patient care outcomes and identify areas for      clinical education

🔹Administrative Support

• Maintain organized logs for referrals, orders,      authorizations, and visits
• Manage communication with physicians, payers, and      referral sources
• Provide general clerical support to ease agency      workload

🔹Compliance Monitoring

• Track OASIS submission timeliness, signed orders, and      missed visits
• Ensure documentation is complete, compliant, and      billing-ready
• Stay current with industry changes and regulatory      updates

🔹Staff Coordination & Communication

• Support scheduling, intake, and billing teams with      compliance-related documentation
• Coordinate clinician training reminders and document      tracking
• Maintain clear internal communication for operational      transparency