Celtic Consulting

Billing & Denials Consulting Services

Celtic Consulting will put appropriate programs into place to ensure maximum efficiency regarding billing and denials. Accuracy in MDS billing safeguard the facility against errors and denials resulting from their departments.

Billing Consulting Services

Billing Training: Training of all billing office staff, including specific areas which comprise: billable services and supplies, correct completion of UB-04, HIPPS, occurrence, status and revenue codes, bill types, and HCPCS and CPT codes and modifiers.

Billing Audits: Celtic Consulting will audit a sample of claims in an effort to identify potential errors and areas of risk, including claims processing errors. Based our findings, we will assist in the development of a solution for more effective and accurate billing systems; including improvement of Interdisciplinary team communication to assure accurate reimbursement for services provided.

Monthly Claims Review: Celtic Consulting can provide a pre-billing review, to assist in submission of ‘clean’ claims. Triple Check system, development, implementation and ongoing evaluation of process. Training for MDS rehab and billing staff, along with Interdisciplinary team to improve communication, efficiency and accuracy of claims submitted.

Management of Denied and/or Appealed Claims

Medicare A, Medicare B Billing & Collections: Celtic Consulting can assist your organization with submission of timely billing and collections related to Medicare Part A and Part B, improve outstanding receivables decreasing aging, allowing for improved financial outcomes.

Additional Development Request & Billing Assistance: Celtic Consulting will provide on-site and off-site expertise to your organization and auditors in resolving any audit concerns for achieving optimal resolution. 

Denials Consulting Services

Initial Medical Record Reviews:To ensure all supportive documentation is readily available and clearly identified for the reviewing entity.

Appeal Level Reviews: Onsite and offsite medical record review, contact with MAC, insurance providers, and other entities on provider’s behalf, assistance with all levels of appeal including Administrative Law Judge hearings and Medicare Appeals Council documentation preparation.

Litigation Reviews: Celtic Consulting will work with attorneys and can provide expert witnesses in depositions and whistleblower cases.

Denials Tracking System & Management Program: Celtic Consulting will work to assist facilities in developing tracking systems for appeals and denials including electronic appeals submission software setup and training. Celtic Consulting will supplement your organization’s processes to avoid financial implications related to missed/late responses and follow up. Your organization will know the current status of all denied or appealed claims. Management Program includes a customized Denial Management Resource Manual for the facility.

Medical Record Management: Celtic Consulting can provide management of the organizations work flow processes, EHR/EMR assistance, policy and procedure development, compliance auditing, and training and education for employees.