In partnering with physicians, PEARL will customize our services to build a solution specific to the needs of each center. Our flexible business models allow physicians to focus on patient care while we ensure the business and operational efficiency of their practice.
We recognize that no two centers are exactly like - this one is yours. From site selection to first day of operation, we manage the entire development process while ensuring the build fits the physician’s needs.
PEARL provides capital
Architecture/Construction
Medicare certification & accreditation
Equipment
Vendors
Licensure
The success of a center depends on consistent, high-quality services both within and outside the center. The journey begins and ends with the patient which requires effective processes and communication.
Workflow
Marketing
Human Resources
Quality reports
Registration forms
Drawing upon experience across 200+ centers, we implement operational best practices in each of our centers. Staff plays a critical role in success, but it is only one piece of the puzzle. We understand the details and leave no gaps.
Credentialing
Finance & Accounting
Scheduling
Inventory Management
Policies & procedures
Staffing
We are experts in outpatient cardio-vascular revenue cycle management. We dedicate a specialized billing team to each center to ensure timely payment for all services.
Billing, Coding, Collections
Denial Management
Payor contracts
Data Analytics
Registration forms
Payor Contract Procurement
Payor Contract Negotiation
Our billers are not generalist revenue cycle professionals. Each team is specifically experienced in cardio-vascular outpatient coding, billing, and collecting. We closely follow each bill until payment is received and analyze collection data monthly to ensure consistent, high-level performance.
PEARL provides dedicated coding, billing, and collection resources for each of its centers. These resources address any denials or claims needing further information and will stay in constant communication with your office for an efficient and reliable workflow.
PEARL will be your advocate in collections and will ensure full support for appeals on denied/rejected claims. Our team will also implement processes where denials can be reduced.
PEARL’s billing team will coordinate with front office personnel regarding any authorizations. Our team can identify patient insurance plans and confirm payment amounts.
PEARL’s biller ensures all payer contracts are reviewed at time of renewal and maintain the facility information for these payers.
PEARL will review any updates on Medicare codes throughout the year and keep your office informed of changes that are relevant.
PEARL will submit insurance applications and assist with negotiating contracted rates with each insurance body.
Because PEARL’s RCM services go beyond just medical billing, PEARL utilizes its in-house resources to evaluate each facility’s reimbursement profile and opportunities for growth. We will analyze healthcare trends and your current business profile to provide guidance that can support your practice’s growth.
The ASC and Physician’s Office have quality reporting guidelines administered by CMS to avoid payment penalties to their annual payment rates. PEARL’s RCM model will assist in the implementation of these two programs. Our team will review monthly measures with your office to avoid receiving a failed score.
PEARL will never bill out the claims until the op notes are complete. Based on a particular visit or op note, the team will evaluate the patient history to match the diagnosis codes pertaining to their treatment. Additionally, all approved diagnoses for appropriate procedures will be communicated.
PEARL’s biller will run monthly analytics reports that provide insights and trends on collections, accounts receivable and denials. These will be shared with your office in monthly meetings to ensure transparency.
Whether to open an OBL, ASC, or OBL/ASC hybrid depends on multiple variables including, the procedures planned to be performed in the center, what is permissible under the state regulations for the location, the specialties and number of physicians involved, etc.
OBLs typically take 2-5 months while ASCs typically take 12-24 months.
Every center is different. We would welcome learning more about your needs and determining a budget that is specific to your practice.
Opening and managing an OBL or ASC requires a significant investment and a tremendous amount of work. This venture is far more demanding than running a clinic. Our business was founded on the premise that focusing on core clinical vs. non-clinical competencies reduces risk and enhances the probability and scale of success.
For an OBL, a physician is typically able to add a site of service to his/her PC and keep the contracts already in place. The reimbursement rates for procedures, however, may require significant negotiation to make the center viable. An ASC will require new contracts and negotiations with all commercial payors.