RCM Revenue Cycle Management and Practice Billing Coding Consultants

Who We Are.

We are a National Leader in Patients Access, Surgical Prior Authorization and Utilization Management, Medical Surgical Scribes, Revenue Cycle Management and Coding, Documentation Review Audits. The facilities we serve are in the Medical Offices, Ambulatory Surgery Centers and Hospitals. We have a 98% SUCCESS Rate with a fast turn-around time.
We are also your Experts in Injury Claims utilization and revenue cycle management. In-and-out of Network Providers. Guaranteed you can increase patients' satisfaction, excellent outcome, and best quality care.
The Technology infrastructure and HIPAA Compliance that we have in our organization is 100% compliant with the Government's HIPAA Security, Laws, Rules and Regulations.
We have a huge team of Clinical Nurses, Operations Specialists and top-calibre Medical Practice Consultants in the industry. We have been around for more than 20 years! Happily located in the State of New Jersey and serving 50 U.S. States!

READ OUR CLIENTS' PRAISES HERE.

Who We Serve.

Medical Practice Offices

Single and Multi-specialty Medical and Surgical Groups

Ambulatory Surgery Centers

Out-of-Network ASC? Revenue Cycle Management for an Out of Network ASCs is our cup of tea! Nearly 20 years in the ASC space!

Hospitals and Facilities

Small, Medium to Large Institutions & Hospitals & Federal Qualified Health Centers (FQHC)

What We Do.

You can smile again!

You can focus more on Patient Quality Care

Our team can help you build a better and efficient workflow. Maximize your reimbursement, faster payment turn-around time with less less errors!

Our Medical Scribes Got Your Back! Relax.

Our Medical Scribes can do all the extra work you need to do with documentation so you can free up a little bit and breathe. Our Medical Scribes are Nurses with a minimum Baccalaureate Degree in Nursing and with 5 years bedside experience. Charting is just the easiest thing for them to do because they have been doing it years!

Patients Satisfaction. Better Outcome.

We are a team of clinical nurses whose core value is EMPATHY. We are care for your patients. Our Patients Access Services are incomparable to none. Our Surgical Prior Authorization Team is committed to help all your patients that needs the surgery the soonest possible time. We have 98% Approval Rate and fastest turnaround time in the industry today!

Read Our BLOG

Our Blog Posts constantly rank on Google because of the valuable contents that we put out on the internet that serves the Medical and Hospital Industry.

Go Check it out!
CLICK HERE!

READ WHAT OUR CLIENTS SAY ABOUT US

Our Mission is to Serve the Medical Practice Industry with our outmost integrity, wealth of knowledge and years of expertise.

We consistently have exceeded our Clients' Goals with their
Outcome and Result!

OUR EXPERTISE

Prior Authorization Process

Coordination of surgical orders management
Prior-to-insurance eligibility and coverage verification
Utilization and medical policy review
Medical necessity evaluation and screening
Financial clearance process

Medical Documentation/ Encounter Scribes

All Medical Specialty we can easily do!
Our Medical Scribes are 100% Nurses with bed-side work experience
Strong Clinical Background
Strong Critical Thinking Skills
Strong Documentation and Charting Encounter Skills

Patients Access 

Patients Registry and Initial Demographic Entry
Patients Scheduling and Confirming Appointments
Coordination of prior-to-encounter orders management
Prior-to-encounter insurance verification
Obtaining Referral
Obtaining Peri Operative Orders
Financial Counseling
Post-Surgery Pain Score/Scale Follow Up
Calling patients regarding their lab and diagnostic reports

Full Revenue Cycle Management

98% of the time your claims can get paid
Cash flow increase up to 35% in 90 days
Accounts Receivables Management
Denial Management
Charge Capture
Utilization Review
Codes Scrubbing
Claims Follow up
Patient Statements

SPECIALTY Expertise

Hospitals & Facilities
Interventional Pain Management
Orthopedic and Spine Surgery
Anesthesiology
MRI and All Radiological Orders
Bariatric Surgery
General Surgery
Ambulatory Surgery Centers
Motor Vehicle Cases
- Letter of Protection (LOP)
- Attorney's Lien
Workers Compensation Cases

Insurance Credentialing and Contracting
Payers Contract Fees Negotiations
Developing Compliance Program for your Organization
Developing Best Practices on Policies and Procedures

Coding and Documentation Audit Review

Our goal is to provide our clients the confidence that their billing and coding practices are following best practices and eliminates the risk of inadvertently committing fraud and being fined up to triple the damages.

Ensuring that the Provider understands how to maximize reimbursement while they remain compliant and following the documentation and coding guidelines;
We perform a thorough review of at least 12 charts per rendering provider by means of an audit in which the provider documentation is evaluated for completeness, accuracy and compliance of coding and the proper level of evaluation and management coding

E/M & Surgical Coding Education and Training

To optimize the provider’s understanding of medical coding and reporting the proper level of E/M and appropriate Surgical Coding as specified by the coding guidelines;
To optimize the provider’s understanding of the Utilization and Reimbursement guidelines and policies
We help you understand bundling/unbundling guidelines and the proper reporting of Modifiers and HCPCS Codes

We can go back 2 to 3 years of reviewing your coding and documentations.

We have an incredible 99% Retention Rate!

READ WHAT OUR CLIENTS SAY ABOUT US

Compliance

We take it very seriously.

Standards
Practices
Laws
Risks
Audits
Regulations
Strategy
Policy
Control
Requirements

Revenue Cycle Management Company in New Jersey

20+ Years of Well-Kept Promise

You can trust a Team of Highly Skilled and Knowledgeable Medical Coders, Billers, Utilization Analysts and Project Management Consultants serving in the Medical Practice Industry, Hospitals and Facilities
Reduce patients complaints and increase patients satisfaction
You have 100% in-control of your data

We are just different in the Medical Practice and Hospital Industry

CALL US FOR A FREE ASSESSMENT

Your Benefits.

First and foremost is PEACE OF MIND (which the ROI is incredible!)

No new employees hiring
No employee benefits and vacation time
Increased Providers Confidence
Increased Patients Satisfaction
Increased Surgical Procedures Approval
Increased Cash Flow
Decreased Denials
Decreased waiting time for patients getting the procedures
Focused Full Time Employee Hours Allocation
Guaranteed more COST-EFFECTIVE
Guaranteed faster reimbursement payments' turnaround time
Guaranteed Maximized Profitability
Compliant.

Don't just take our word... read what our clients have to say.

READ OUR BLOG

Who we are as a Team.

We always take pride with our clients' patients outcome.

Educational Background

89% Nurses (BSN)
5% Information Technologists (BSc)
4% Business Management (BSc)

Years of Work Experience

75% with 5+ years
20% with 12+ years
5% with 15+ years

Job Roles

75% Experts in Surgical Prior Authorization & Patients Access and Documentation/Coding Audit Compliance Review
25% Experts in Full Revenue Cycle Management

MS. PINKY MANIRI-PESCASIO, MSc, BSc, CRCR, CSPPM

Chief Executive Officer, President & Founder

Backed by her 26 long years experience, you will be amazed on how much she knows about the Healthcare and Medical Practice Industry. Ms. Pinky Maniri-Pescasio is a renowned and highly educated Professional Medical Practice Consultant, a sought-after National Speaker on Physician Billing, Coding and Reimbursement. A well-respected Revenue Cycle Management Expert and Compliance Expert. She was a University a Professor in her Past Life and you can feel and learn how passionate of a teacher she is. She has always believe, that every Medical Provider MUST get paid for their rendered services based on Medical Necessity. There is no reason for unnecessary claims denial and rejection. It is just knowing the Clinical, Utilization, Documentation and Reimbursement Guidelines and Policies.
She blogs all about the Medical Practice Industry. Visit her BLOG here.
Physician Advocate | Reimbursement National Speaker | Practice Consultant
Certified Specialist in Practice Management
Certified Specialist in Revenue Cycle Management
Certified Specialist in Managed Care

Our Founder's Professional Affiliations & Industry Commitment

Gohealthcare Practice Consultants HFMA Business Partner Member 2022

Meet Our Amazing Team!

Administration and Operations Management Team

Mr. Ralph Pescasio, Sr., MSc

CFO / COO
30+ years in Renal and Hemodialysis Facility Technical Operations

RCM Pain Management Billing and Prior Authorization Services - GoHealthcare Practice Solutions

Mr. Patrick Pescasio

Director of Human Resources and Talent Acquisition

Mr. Patrick has years of experience in HR Management and Talent Acquisition. He oversees all stages of candidate experience (including application, interviews and communication).

Miss Kristine Williams

Executive Office Administrator

Mr. Jai Maniri, BSc Engineering

Director of IT Engineering and Technical Support

Miss Jeanne Dearley, MSN, BSN, RN

Senior Vice President of Business Development
and Utilization Clinical Review Team
30+ years experience as Clinical Instructor and as an OR Charge Nurse

Miss Maya Dal

Director of Credentialing and Contracting Services

Mr. Adam Anschel

Consultant for Ancillary Products and Services

Miss Monique Buenaventura

Business Development and Client Relations Manager

Chronic Care Management Services and the New Changes for 2017 CMS Medicare recognizes the Chronic Care Management (CCM) as a critical component of primary care services that contributes to better health and care for individuals. So in 2015, Medicare began paying separately under the Medicare Physician Fee Schedule for CCM services furnished to Medicare patients with multiple chronic conditions.

Chronic Care
Management Billing

2019 New CPT Codes Medicare Payments for Virtual Services Remote Monitoring Interprofessional Consultation In the Final Rule, CMS noted “[i]n recent years, we have sought to recognize significant changes in healthcare practice, especially innovations in the active management and ongoing care of chronically ill patients. . . .” However, CMS’ efforts to promote these innovations have been limited by its interpretation of the statutory restrictions on Medicare reimbursement for telehealth services.

Medicare Guideline on Virtual Services

(1) Incorrect demographic information (insurance ID , date of birth, even the gender!) Always scan a copy of your patient's primary and secondary insurance card. Make sure to get a copy of their new card (if there is a change) (2) Patient's non-coverage or terminated coverage at the time of service may also be the reason of denial. That is why, it is very important that you check on your patient's benefits and eligibility before seeing the patient (unfortunately, I have seen practices who does not check benefits and eligibility on their patients so they end up being not paid for the service they have rendered for the patient