Coding, Compliance & Revenue Cycle Services

Pinnacle offers revenue cycle solutions for providers, hospitals, health systems, academic medical centers, and health plans. Our medical coding team consists of a diverse variety of healthcare professionals who hold a wide range of certifications through AAPC and AHIMA. All staff and support resources are located within the United States (“onshore”).

Vendor Quality Solutions

Pinnacle can assist with Evaluation and Management and specialty specific coding on an as needed or long-term basis. We can cover your internal staff during leaves of absences, heavy volumes or backlog or to cover while you are filling open positions.

  • Coding & Revenue Cycle resource interim staff is available.
  • Per Chart and hourly pricing options are available and dependent on the client needs.

Revenue Cycle Assessments, Claims Edits & Denial Management

Pinnacle can assist with coding related edits and denials due to low staffing levels or high volumes to allow the organization time to find the right candidate to cover a vacant position. Temporary assistance is available where backlogs or high volumes need resolution so client staff may keep up with current workflow.

  • All staff are experience with Medicare, Medicaid and Commercial insurance local and government payment policies and regulations.
  • Detailed analysis of coding denial trends to determine best approach to remediate errors.

Compliance Coding & Billing Reviews / Education

Pinnacle’s experienced resources are vetted and verified their quality and productivity meets our standard in their performance of both simple and highly focused complex specialty reviews for various settings for Professional Fee Services both surgical and Evaluation and Management services. Assistance with coding and documentation reviews to support client’s compliance and internal audit work plans. Outsourced audit assistance models and/or any specific reviews and audit requests are available.

Pinnacle structures each audit / review with the client’s specific goals and objectives in mind.

  • Follow-up training and education, customized to the attendees and worthy of attendee’s TIME to realize improvement quickly and efficiently leveraging value of the time spent.
  • Review client documentation templates and provide feedback on documentation improvement.

Revenue Cycle Management

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If you are considering outsourcing your RCM or are considering outsourcing your billing, are having difficulty finding and retaining qualified staff, or considering an outsourced option, Pinnacle Healthcare Revenue Solutions (PHRS) will exceed your expectations.  We provide consistent and predictable performance that is  necessary to plan your cash flow and focus on caring for your patients.

PHRS is the recognized expert in nephrology and interventional nephrology coding. Our team can improve your in-house operation through:

  • Full workflow review
  • Patient intake process to reduce avoidable denials
  • Assess work queue design for accounts receivable follow up
  • Benchmark performance
  • Benchmark staffing levels
  • Establish key performance indicators (KPI’s)
  • Establish dashboards of performance

Our partnership with you is what sets PHRS apart from other RCM companies. PHRS is not just a billing service.  We use processes we have developed to drive success in revenue cycle and deliver outstanding financial results. These processes are critical success factors in our solution.

Hierarchical Condition Category (HCC) Coding

Pinnacle utilizes AAPC, AHIMA, and NAMAS certified professionals who are well-versed in all aspects of Risk Adjustment. Our certified professionals have decades of auditing, coding, revenue cycle, and practice management experience.  Pinnacle can assist with various HCC risk adjustment models including CMS-HCC, HHS-HCC, ACA, PACE, ESRD, State Medicaid, and RXHCC.

Pinnacle’s HCC Coding service line offers health plans, facilities, and providers the ability to improve performance measures by providing the following services:

  • HCC Coding, Audit, and Validation Services for yearly HCC Sweeps
  • Retrospective chart audit services
  • Expert medical record review and code assignment from all settings
  • Examination of pertinent medical evidence including adherence to all CMS and official coding guidelines
  • Data analytics and performance metrics consulting
  • Risk score validation and improvement strategies
  • Improve coding skills through continuing education “CEUs”