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The following page explains how Apex RCM Services ("Apex RCM", "we", "us", or "our") establishes service level standards for the healthcare practices and organizations that we partner with. This document outlines what our service level agreements cover, as well as how we establish performance metrics, provide reporting on those metrics, and continuously seek ways to enhance our service delivery.
The specific services, targets, and remedies provided to each customer are documented within the customer's signed service agreement. This information is meant as an overview of general information and should not be construed as a binding agreement. In the event there is a discrepancy between this information and a signed agreement, the signed agreement will govern.
What This Covers
Service levels can apply to any of the services that a client uses from us. Examples include:
- Revenue cycle management and medical billing
- Practice management and auxiliary services
- Healthcare consultancy
- Quality management systems (QMS) and Lean Six Sigma
- Business intelligence (BI) reporting
How Targets Are Set
Each of the practices that we serve has a unique set of circumstances. Because of this, we will never use the same formula to determine what each practice can achieve. Prior to beginning our work together, we discuss the type of practice you have, the payer mix you use, how many claims you process, and where you currently stand in terms of performance. We then develop reasonable expectations for achievement with you. Once these expectations are established, they are documented in your Service Agreement. If your practice evolves in the future, we can adjust those expectations accordingly.
What We Measure
Depending on your services, the measures we agree with you may include:
- Claim Submission: How quickly completed charges are submitted to payers.
- Clean Claims: The share of claims accepted on first submission.
- Denial Management: How quickly denials are worked and how many are resolved.
- Payment Posting: How quickly payments and adjustments are posted.
- Accounts Receivable: How old are your unpaid invoices, and how long does it take you to get paid?
- Reporting: How often your performance reports are delivered.
Reporting and Reviews
At all times, you can determine how effectively your revenue cycle is operating. We provide regular reports on agreed-upon indicators based upon the time frame specified in your service agreement. During these reviews with you, we examine what has been successful, what has failed, and what steps we plan to take going forward.
Support and Communication
Client-specific contacts are listed within each client's documentation. Day-to-day communication is performed using channels agreed upon by the client and yourself. Your service agreement will outline how fast you should expect responses to your inquiries, and who you can reach out to if an issue requires escalation.
When a Target Is Missed
If a target has not been met by a measurement, then we find the reason why, report our findings to you, and agree on how to take action to rectify the situation. The service credit or other forms of remediation will be as specified in your signed Service Agreement.
What We Need From You
The outcome of many of the things we do for you will rely upon information that only your practice can give us. We have agreed upon service level agreements that are dependent on your providing timely and accurate billing information, documentation, access to systems, and answers to questions we ask you. Additionally, there are potential delays due to the actions of payers, clearinghouses, government agencies, etc., which are beyond our ability to reasonably control, and could potentially impact the outcomes we produce for you.
Changes to This Page
We may update this page from time to time. This page is updated each time a change is made. Updating this page does not change the terms of a signed service agreement.
Contact Us
To determine which level of service applies to your practice, please go to the Contact Us page.
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