Specialized Care Settings

Tailored Revenue Cycle Solutions Built for Your Clinical Setting

Every healthcare setting operates under distinct billing rules, payer guidelines, and patient intake demands. Nova Arc replaces generic one-size-fits-all billing with specialized workflows and certified teams designed specifically for your clinical care environment.

Care Setting 01

Urgent Care Centers

+48% Point-of-Service Collections

Setting-Specific RCM Challenges

Urgent care clinics face intense pressures from high-volume same-day coding turnaround and self-pay collection leakage, compounded by inconsistent payer handling of S9083 global billing versus fee-for-service E/M codes.

  • Rapid Walk-In Registration: High patient velocity leads to frequent typos, invalid policy numbers, and secondary insurance omissions.
  • Complex S-Code Adjudication: Payer inconsistencies regarding S9083 global billing versus fee-for-service E/M codes cause frequent denials.
  • Self-Pay Revenue Leakage: Patients departing without settling copayments or deductibles, creating expensive bad-debt collection cycles.

How Nova Arc Solves It

Nova Arc combines same-day E/M chart coding and automated modifier -25 scrubbing with sub-second eligibility verification and card-on-file capture to prevent billing delays and eliminate walkout self-pay leakage.

  • Sub-3-Second Eligibility Checks: Automated EDI 270/271 queries instantly confirm active coverage and exact copay amounts upon scan.
  • Tokenized Card-on-File POS Workflows: Collects copays and secures pre-authorized credit cards for remaining balances, lifting collections by 48%.
  • Automated E/M Modifier -25 Scrubbing: Protects legitimate minor procedures (sutures, splinting, X-ray interpretations) from unbundling rejections.
  • Same-Day EDI Dispatch: Accelerates cash turnaround, depositing commercial carrier payments in under 12 days.
99.4%
Clean claim rate across multi-site urgent care clinic networks.
Inquire About Urgent Care Billing
Care Setting 02

Ambulatory Surgery Centers (ASCs)

Zero Implant Carve-Out Leakage

Setting-Specific RCM Challenges

Surgery centers face severe financial risk from implant and device pass-through coding complexity, missing vendor invoice carve-outs, and high-dollar claim denials driven by multiple procedure unbundling.

  • Implant & Hardware Invoice Carve-Outs: Failure to attach manufacturer invoices or comply with specific payer markup rules results in zero implant payment.
  • Dual-Track Facility vs. Professional Discrepancies: Disconnects between the ASC facility claim (UB-04) and surgeon professional bill (CMS-1500) trigger audits.
  • Pre-Surgical Prior-Auth Stalls: Delayed carrier authorizations force procedure rescheduling, idling expensive operating rooms.

How Nova Arc Solves It

Nova Arc deploys CASCC-certified surgical coders who digitally link vendor invoices to electronic 837I claims and run automated Multiple Procedure Discount (MPD) audits to recover full implant carve-out dollars and eliminate high-dollar claim denials.

  • Automated Implant Carve-Out Matching: Digitally links vendor invoice PDFs to electronic 837I claims, complying with carrier-specific markup schedules.
  • Specialty Surgical Pods (CASCC Certified): AAPC certified coders specialized in orthopedics, ophthalmology, pain management, and gastroenterology.
  • 72-Hour Pre-Op Prior-Auth Guarantee: Proactive authorization team confirms surgical clearance 72 hours ahead of scheduled OR time.
  • Multiple Procedure Discount (MPD) Audits: Sequences CPT codes precisely to optimize primary and secondary surgical reimbursements.
< 28 Days
Average days in A/R for high-complexity multi-specialty surgery centers.
Inquire About ASC Billing
Care Setting 03

Physical, Occupational Therapy & Rehab

100% 8-Minute Rule Compliance

Setting-Specific RCM Challenges

Physical therapy and rehab practices face steep revenue hurdles around CMS therapy cap tracking with mandatory KX modifier thresholds, ongoing authorization renewals before visit exhaustion, and unit-math errors under the 8-minute rule.

  • CMS 8-Minute Rule Calculation Errors: Inaccurate unit allocation across timed CPT codes (97110 therapeutic exercise, 97140 manual therapy) triggers clawbacks.
  • Authorized Visit Exhaustion: Treating patients beyond approved insurance visit allowances results in uncollectible retroactive denial write-offs.
  • Unsigned Plan of Care (POC) Recertifications: Failing to secure referring physician signatures within 30 days causes technical Medicare claim rejections.

How Nova Arc Solves It

Nova Arc automates 8-minute rule calculations and deploys a proactive visit countdown radar that flags therapy caps and triggers timely KX modifier attachments and re-authorizations before care is disrupted.

  • Automated 8-Minute Rule Verification: Mathematical pre-bill validation ensures total treatment time matches billed CPT units exactly.
  • Proactive Visit Countdown Radar: Alerts clinical coordinators when a patient has 2 authorized visits remaining, prompting timely re-auth requests.
  • Medicare KX Modifier & Cap Automation: Applies KX modifiers automatically upon reaching annual statutory therapy thresholds with audit-proof documentation.
  • Physician POC Tracking & E-Fax Escalation: Tracks plan-of-care signature turnaround, triggering automatic physician reminders before 30-day deadlines.
< 0.8%
Denial rate across outpatient physical, occupational, and speech therapy clinics.
Inquire About Therapy Billing
Care Setting 04

Behavioral Health & Substance Use

99.2% Parity Claim Acceptance

Setting-Specific RCM Challenges

Behavioral health providers face unique revenue vulnerabilities around session-limit authorizations, complex mental health parity law billing nuances, and disjointed third-party carve-out payer clearinghouses.

  • Third-Party Behavioral Carve-Out Gateways: Commercial medical plans frequently route mental health claims to third-party clearinghouse IDs (e.g. Optum, Beacon, Magellan), causing incorrect clearinghouse rejections.
  • Psychotherapy Add-On Coding Complexity: Complex duration rules for add-on psychotherapy codes (+90833, +90836, +90838) billed alongside medical E/M evaluations.
  • Telehealth Place of Service (POS) Rule Shifts: Constant shifts between POS 02 (telehealth outside patient home) and POS 10 (patient home) causing carrier denials.

How Nova Arc Solves It

Nova Arc automatically identifies behavioral carve-out payer gateways during pre-registration and enforces clinician license-aware billing rules to track authorized session intervals and maintain full parity compliance.

  • Automated Carve-Out Payer Routing: Identifies underlying mental health clearinghouse routing codes automatically from patient 270 eligibility checks.
  • E/M & Psychotherapy Combination Scrubbing: Validates clinical time documentation to ensure compliant pairing of psychiatric evaluations and therapy sessions.
  • Telehealth POS 02/10 & Modifier Validation: Auto-applies modifiers (-95, -GT) based on specific state Medicaid and commercial telehealth policies.
  • Sensitive Patient Financial Advocacy: Compassionate, discrete digital patient billing statements with confidential payment plan setups.
99.2%
Parity claim acceptance rate for outpatient and residential mental health centers.
Inquire About Behavioral Health Billing

See How Nova Arc Tailors RCM for Your Facility

Schedule a personalized consultation with a dedicated revenue cycle architect specialized in your clinical care setting, and receive a complimentary 90-day denial audit.

Schedule a Discovery Call Call (800) 555-NOVA