RCM Revenue Cycle Management and Practice Billing Coding Consultants

Service locations we proudly serve.

Medical Offices

Single and Multi-specialty Medical and Surgical Groups

Hospitals

Small, Medium to Large Institutions & Hospitals

Facilities

ASC, FQHC, RHC, Nursing Homes, Rehab, Hospice and Diagnostic Centers

Our company's culture, ethics and our values sets us apart from all other company. We care for our Clients' patients ultimate outcome of care, that their services or surgeries getting approved or getting paid will be the least they have to worry. We make sure our physicians can focus more on the highest patient quality care. And we will take care of everything from the front desk to the back-end ~ Rafael T. Pescasio, Chief Operations and Finance Officer

Maximized Reimbursement.

Focused Patient Quality Care.

Reduced Patients Complaints.

Increased Patients Satisfaction.

STAY COMPLIANT.

READ WHAT OUR CLIENTS SAY ABOUT US

Our Mission is to Serve the Medical Practice Industry with Integrity, with our Unlimited Knowledge and Expertise

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

Reduce patients complaints and increase patients satisfaction.

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OUR EXPERTISE

Healthcare Operations Consulting Company

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 3 to 6 years of reviewing your coding and documentation

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

SPECIALTY Expertise

Interventional Pain Management
Orthopedic and Spine Surgery
Anesthesiology
MRI and All Radiological Orders
Bariatric Surgery
Hospitals Cases
Nursing Homes and Hospice Facilities
Motor Vehicle Cases
Workers Compensation Cases

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

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 Prior Authorization
Obtaining Peri Operative Orders
Financial Counseling

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 Submission
Claims Follow up
Patient Statements
Remittance Processing

READ OUR BLOG

We strive, so you can thrive and GROW more!

We have an incredible 99% Retention Rate!

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Compliance

We take it very seriously.

Standards
Practices
Laws
Risks
Audits
Regulations
Strategy
Policy
Control
Requirements

15+ 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

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We are 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

40% Experts in Surgical Prior Authorization & Patients Access
55% Experts in Full Revenue Cycle Management
5% Experts in Coding and Documentation Audit/Compliance Review

Ms. Pinky Maniri - Pescasio, MSc, BSc, CRCR, CSPPM

Founder | Lead Consultant | Physician Advocate

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

Meet Our Operations and Management Team

Mr. Ralph Pescasio, Sr., MSc

Co-Founder | CFO | COO
30+ years in Renal and Hemodialysis Facility Technical Operations

Miss Sandy, BSN

Director of Operations for Medical Practice Offices

Miss Sandy is a Nurse with years of experience in Prior Authorization and Utilization Management

Miss Kristine

Director of Credentialing and Contracting

Mr. Jai Maniri, BSc Engineering

Director of IT Engineering and Technical Support

Miss Jeanne Dearley, MSN, BSN, RN

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

Miss Alyson

Senior Director of Operations

Miss Maya

Director of Marketing and Business Development

Mr. Adam Anschel

Consultant for Ancillary Products and Services

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