Prisco / Services
Services built around the life of a claim.
Six service lines covering the revenue cycle from the front desk to the final payment. Specialties and scope are agreed with you during discovery.
End-to-end revenue cycle
From the first eligibility check to final resolution of the account, we keep every stage visible and every handoff clean.
How we measure it. First-pass acceptance, days in A/R and net collection rate.
What is included
- Eligibility and benefit verification
- Charge capture and charge review
- Coding and documentation review
- Claim scrubbing and submission
- Payment posting and A/R follow-up
Denial management
We treat each denial as information. Appeals recover what is owed; root-cause work stops the same denial from returning.
How we measure it. Preventable-denial rate, overturn rate and recovered value.
What is included
- Denial categorization and root-cause analysis
- Appeal preparation with supporting documentation
- Payer trend reporting
- Prevention loops back to coding and front-end teams
Medical coding
Every claim is built from what the record supports. Certified coders select the codes, and an independent reviewer checks them before submission.
How we measure it. Accuracy from sampled audits, read alongside productivity.
What is included
- ICD-10-CM, CPT and HCPCS Level II code selection
- E/M levelling, modifiers and NCCI edits
- Professional and facility coding
- Provider queries and documentation gaps
Production and quality assurance
Quality is a separate function, not a final glance. Independent auditors sample the work, classify variances and return clear feedback.
How we measure it. Accuracy trends and time to correct.
What is included
- Sampling audits and error classification
- Coaching notes and calibration with your auditors
- Weekly or monthly scorecards
- Review of an existing team’s work on request
Ambulatory services
Professional-fee coding and billing support for clinics, physician groups and outpatient departments, with denial prevention at the source.
How we measure it. Clean-claim performance and turnaround.
What is included
- Professional-fee coding and charge capture
- Claim follow-up and rejection handling
- Documentation feedback for providers
EMS and ambulance billing
Ambulance claims depend on documentation. We make sure medical necessity, service level and mileage are supported before a claim goes out.
How we measure it. Documentation completeness and first-pass acceptance.
What is included
- Medical necessity and service-level review
- Ambulance HCPCS codes and mileage
- Payer-specific rules and denial follow-up