Health & Wellness

GHOA currently holds URAC accreditation for Case Management and maintains established best practices consistent with the standards for the Case Management Society of America (CMSA), both which are the industry gold standards.

GHOA has multiple types of Case Management programs that are designed for specific clinical situations based on type of injury, severity of injury, chronicity of claim, and other issues to be addressed by the involvement of the Nurse Case Managers. The provided Case Management programs include:

Field Case Management

Telephonic Case Management

First Step Early Identification/Intervention Program^SM

Next Step Medical Advisory Program^SM

Catastrophic Case Management

Chronic Pain Case Management

One Time Evaluation/Task

Liability Review

Life Care Planning

Discharge Planning

Medical Billing 

GHOA’s comprehensive approach to Case Management services has delivered documented results that surpass expectations. This approach brings proactive solutions to new and developing issues by discovering trends in the client’s data. All case management data is collected and documented in our proprietary case management system. GHOA creates and implements customized solutions to accommodate the individual needs of each client. 

Each nurse case manager engages in communication with the Injured Worker, physician, employer and the claims examiner. Our Multicultural & Multilingual Nurses are able to work with any patient or professional. An assessment is completed initially to determine the most cost effective action plan. In collaboration with all parties involved the nurse case manager plan of action is devised to strategically address the barriers of the claim. The overall goal is to assist the Injured Worker in reaching maximum medical improvement and early Return-To-Work in the most cost effective manner. 

GHOA provides medical case managers who are licensed Registered Nurses (RN), with many holding a masters or bachelors degrees in nursing. Most are Certified in Case Management (CCM) or holding designation of Certified Disability Management Specialists (CMDS), Certified Occupational Health Nurse (COHN) or other additional certification in related fields and clinical specialists. GHOA provides all case management services nationwide. 

According to a recent Congressional study, over 18% of all medical claims are rejected due to improper claim procedures. It is also estimated that only 15% of physician practices submit HIPAA compliant claim forms, resulting in delayed reimbursement and/or rejected claims. Our goal is to free the practitioner from the daily billing and reimbursement hassles that plague so many providers in today’s overburdened healthcare environment. GHOA provides total account management and has a vested interest in making sure the physician receives maximum reimbursement. By using state of the art Medical Practice Management software and remaining current on all state and federal mandates, as well as ever changing insurance requirements, GHOA is uniquely positioned to provide you and your patients the experienced and knowledgeable billing services required in today’s healthcare industry.

SERVICES

Electronic Claim Submission
Medicare
Medi-cal
HMO-PPO
Private Insurance
Workers Comp
Collections
Reports
Process all Charges and Payments, Deposits to Bank
Prepare and Mail Patient Statements
Respond to Patient Inquires Regarding Account Status
Compare Third-Party Payments to Physician Profile
Compare Physician Profile to Prevailing Rates
Review and Implement Proper Code Use to Assume Maximum Third Party Reimbursement, Including CPT and Blue Shield Analysis
Certified Coder on Staff