Tech Edge with
Human Expertise
- Revenue Cycle Management
- Consulting
- Health Information Management
- Information Technology
+
Clients
Served
K+
Practitioners
Supported
M+
Coding Cases
Completed
K+
Billing Cases
Addressed
Our Edge:
We believe in harnessing the strategic combination of human expertise and technology to drive innovation and excellence in healthcare consulting. With over 30+ years of experience, we have honed skills in Revenue Cycle Management, Health Information Management, Medical Coding and Billing, and Information Technology Services. Our comprehensive services and solutions are focused to meet your unique needs.
Our experience and expertise spans globally ensuring timely and efficient delivery of our services and support. While we improve your revenue cycle, bring efficiency in operations, reduce costs, and provide value, we always infuse technology with human expertise. Our solutions are designed to achieve the best possible outcomes, financially and operationally.
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Experience innovation through the combination of Human Expertise and Technology
Patient Access Services
Patient Access Services processes in healthcare revenue management
Patient Access Services
- Patient Scheduling
- Patient Registration
- Appointment Reminders
- Eligibility Verification
- Benefits Verification
- Authorization and Referrals
- Patient Access Interim Management
Mid-Cycle Services
mid-revenue cycle processes in healthcare revenue management
Mid-Cycle Services
- Medical Coding and Abstracting
- Medical Coding Auditing
- Charge Validation/Correction
- Health Record Analysis
- Clinical Documentation Improvement (CDI) Staffing
- Clinical Documentation Improvement (CDI) Auditing
- Cancer Abstracting and Registry Reporting
- Quality Indicators Abstracting and Reporting
- MPI Integrity and/or Clean-up
- Charge Description Master (CDM) Reviews & Updates
- Education
- H.I.M Interim Management
Extended Business
Office Services
extended business office services processes in healthcare revenue management
Extended Business
Office Services
- Claim Submission
- Error Correction
- EDI Management
- Claims Processing
- ERA/EFT Processing
- Payment Posting
- Claim Status Check
- Denial Analysis
- Appeals and Resolution
Patient Access Services
Download BrochureServices:
- Phone calls
- Mobile Apps
- In-Person visits
- Online patient portals
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
Patient Scheduling
Patient Scheduling offers efficient management of healthcare appointments, optimizing resources and reducing wait times. Streamlining the scheduling system boosts patient satisfaction and maximizes physicians' time.
Services:
- Patient demographics
- Insurance details
- Medical history
- Emergency contacts
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
Patient Registration
Patient Registration is the first step in the medical billing process, involving the patient data collection of accurate personal and insurance details. Proper registration ensures seamless billing, minimizing claim denials, and reducing delays in payment.
Services:
- 270/271
- Eligibility
- Coverage limits
- Out of pocket expenses
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
- Real time Eligibility
- Payer portals
- Insurance calls
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
Eligibility and Benefits Verification
Eligibility and Benefits Verification involves confirming a patient's health insurance coverage and benefits, ensuring that services provided are covered and minimizing claim rejections. Accurate verification leads to timely payment collections and reduces billing errors.
Services:
- 278
- Pre-certification
- Peer to Peer discussion
- Prior approvals
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
- Fax
- Payer portals
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
Prior Authorizations and Referrals
Prior Authorizations and Referrals are essential for expensive procedures or medically necessary medications and are covered by insurance. By obtaining pre-authorization, healthcare providers avoid costly claim denials and reduce administrative burdens.
Mid-Cycle Services
Download BrochureServices:
- CDI Management Interim Contract Staffing
- CDI Specialists Interim Contract Staffing
- CDI Audits
Key Features:
- Competitive Pricing
- Onsite or Remote Support
- Vetted CDI Professionals
- Ability to Quickly Scale
- Comprehensive Reports
- Competitive Pricing – Domestic, Offshore, or Hybrid
Patient Types:
- Inpatient
- Ambulatory Surgery Coding
- Emergency Department Coding
- All Outpatient Coding
Settings:
- Acute Care
- Critical Access
- Ambulatory Surgical Centers
- Medical Practices
Components:
- Physician Documentation
- Physician Assistant Documentation
- Nurse Practitioner Documentation
Clinical Documentation Improvement (CDI) Services
We offer expert CDI services, ensuring your organization benefits from onsite or remote support from vetted CDI professionals. Our ability to quickly scale staffing and provide comprehensive CDI management and practitioner documentation audits enhances your revenue cycle while ensuring compliance and improved patient care.
Services:
- Full or Partial Outsourced Coding Services
- Interim Coding Services
- On-Call Coding Services
- Backlog Coding Services
Key Features:
- ICD-10-CM, ICD-10-PCS, CPT/HCPCS
- MS-DRGs, APR-DRGs, AP-DRGs, APCs. HCCs
- Competitive Pricing – Domestic, Offshore, or Hybrid
- Ongoing Support
- 2 Week Implementation
- < 24Hour Turn-around
- Up to 7 Days Per Week of Service
- U.S. Holiday Coverage
- Embedded Quality Assurance
- Monthly Value Reports
Patient Types:
- Inpatient
- Ambulatory Surgery
- Emergency Department
- Ancillary Department
- Clinic
- All Outpatient
Settings:
- Acute Care Hospitals
- Critical Access
- Long Term Care
- Outpatient Settings
Components:
- Facility Component
- Professional Component
Medical Coding Services
We believe in delivering top-tier medical coding services with domestic, offshore, or hybrid models, ensuring tailored solutions for your organization. With rapid implementation in just two weeks, we offer 24-hour turnaround times and comprehensive coverage, including U.S. holiday support and embedded quality assurance, enabling efficient coding across all patient types and settings.
Services:
3 Prong Approach -
- Coding
- Validation and Correction of Charges
- Documentation Review and Feedback
Key Features:
- Bringing CDM-driven Codes/Charges Together with the Coder-assigned Codes
- Correction of OCE/NCCI Edits Prior to Accounts going Through the Scrubber
- Includes Recommendations for Documentation Improvement
- Services Provided by Certified Coders Trained in Revenue Integrity
- Summary and Detailed Reports
- Mitigation of Denials
- Competitive Pricing – Domestic, Offshore, or Hybrid
Patient Types:
- All Outpatient
- Ambulatory Care Patients
- Inpatient
Settings:
- Hospitals
- Ambulatory Surgical Centers (ASCs)
- Physician Practices
- Specialty Clinics
- Emergency Departments (EDs)
Components:
- Facility Component
Comprehensive Outpatient Revenue Integrity Services (CORIS)
Our CORIS Service assist healthcare providers with proper compliance, keeping revenue integrity, and preventing costly errors. By applying this optional charge code validation service, facilities can safeguard their financial health and improve claim outcomes with precision coding.
Services:
- Coding Audits
- DRG Validation
- Documentation Reviews
- Charge Validation
Key Features:
- Pre-Bill/Concurrent Audits
- Retrospective Audits
- Includes Revenue Opportunities and Compliance Recommendations
- Customizable Audit Scope
- Frequency Options (Daily, Weekly, Monthly, Quarterly, Annually)
- Summary and Executive Reports
- Comprehensive and Detailed Reports
- Trending Reports
- By Coder
- By Practitioner
- By Code Type
- By Error Category
- Competitive Pricing – Domestic, Offshore, or Hybrid
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgery Patients
- Emergency Department (ED) Patients
- Long-Term Care Residents
Applicable Settings:
- Hospitals
- Ambulatory Surgical Centers (ASCs)
- Physician Practices
- Long-Term Care Facilities
- Emergency Departments (EDs)
Components:
- Facility Component
- Physician Component
Data Quality Service
Maintaining accurate and compliant medical coding is key to proper reimbursement and less denials. With our Data Quality Service, healthcare providers can improve coding accuracy, identify areas in need of improvement, and assess the completeness of clinical documentation.
Services:
- Coding Education for Coders
- Documentation Education for Practitioners
- Compliance Education
- HIPAA Education
- Annual IPPS/OPPS Updates
Key Features:
- Tailored Training Programs
- Continuing Education Credits (CEUs)
- Live or Recorded Webinars
- Online Training (Onsite Available)
- In Line with Industry Standards
- Hands-On Learning Modules
- Certification Prep
- Ongoing Support
- Competitive Pricing – Domestic, Offshore, or Hybrid
Patient Types:
- Inpatient
- Outpatient
Applicable Settings:
- Hospitals
- Ambulatory Surgical Centers (ASCs)
- Physician Practices
- Specialty Clinics
- Emergency Departments (EDs)
Components:
- Facility Component
- Physician Component
Education Services
Our Education Services help to equip your team with the knowledge they need to navigate the complexities of healthcare and stay up to date with regulatory standards.
Services:
- Mentoring of New Coders
- Mentoring of Coders Moving to a New Patient Type
- Mentoring of Seasoned Coders on Another Coding System
Key Features:
- ICD-10-CM, ICD-10-PCS, CPT/HCPCS
- Pre-Bill Support
- Use of Real Coded Medical Records
- Includes Instructional Lessons, if Needed
- Feedback to Coding Leaders
- Personalized/One-on-One Mentoring
- Customized Mentoring
- Continuous Skill Development
- Competitive Pricing – Domestic, Offshore, or Hybrid
Patient Types:
- Inpatient
- Outpatient
- Emergency Department (ED) Patients
- Ambulatory Surgery Patients
- Long-Term Care Residents
Applicable Settings:
- Hospitals
- Ambulatory Surgical Centers (ASCs)
- Physician Practices
- Long-Term Care Facilities
- Specialty Clinics
Components:
- Facility Component
- Physician Component
Coder Mentoring Service
Building a team of proficient coders is paramount to the success of your healthcare organization. This hands-on approach improves coder’s skills and contributes to the overall quality of your coding operations.
Services:
- Comprehensive Edit Review
- Coding Error Correction
- Fast Claims Resubmission
- Clean-up of Outpatient Exception Report
- Consulting Services
Key Features:
- Expedites Claims Submission
- Compliance Assurance
- Customizable Solutions
- Competitive Pricing – Domestic, Offshore, or Hybrid
Patient Types:
- Inpatient
- Outpatient
- Emergency Department (ED) Patients
- Ambulatory Surgery Patients
Applicable Settings:
- Hospitals
- Ambulatory Surgical Centers (ASCs)
- Physician Practices
- Specialty Clinics
- Emergency Departments (EDs)
Components:
- Facility Component
Edit Reconciliation Service
Choosing our Edit Reconciliation Service, healthcare providers can address their edits timely and completely to decrease the days in A/R, decrease the time and cost handling a claim multiple times, enable quicker claim turnaround. This leads to faster and more accurate reimbursement and a smooth and efficient revenue cycle.
Services:
- Health Information Management (H.I.M.) Interim Management and Staffing
- Patient Financial Services Interim Management and Staffing
- Business Office Interim Management and Staffing
- Patient Access Interim Management and Staffing
- Revenue Cycle Leadership Interim Management
Key Features:
- Interim (Short Term or Long-Term)
- Flexible Engagements
- Vetted Professionals
- Competitive Pricing
- Expert Leadership
- Process Optimization
- Compliance Oversight
- Training and Development
- Competitive Pricing – Domestic
Patient Types:
- Inpatients
- Outpatients
- Emergency Department (ED) Patients
- Ambulatory Surgery Patients
Applicable Settings:
- Hospitals
- Ambulatory Surgical Centers (ASCs)
- Physician Practices
- Specialty Clinics
- Long-Term Care Facilities
Components:
- Facility Component
- Physician Component
Interim Management and Staffing
Our Interim Management and Staffing Service provides healthcare organizations with expert leadership and staff needed for continuity during times of transition. With experienced H.I.M. and Revenue Cycle professionals, we enable your organization to staff accordingly and never be left with a vacant position, especially in a leadership role.
Services:
- Operational Assessments
- Health Record Analysis
- MPI Clean-ups
- DNFB Management/Clean-up
- Release of Information (ROI) Support
- Consulting
Key Features:
- Quick Implementation
- Scalable Solutions
- Customizable Service Packages
- Data Security
- Ongoing Support
- Competitive Pricing – Domestic
Patient Types:
- Inpatients
- Outpatients
- Emergency Department (ED) Patients
- Ambulatory Surgery Patients
Applicable Settings:
- Hospitals
- Ambulatory Surgical Centers (ASCs)
- Physician Practices
- Specialty Clinics
- Long-Term Care Facilities
Other H.I.M. Services
Pena4 delivers tailored solutions increasing operational efficiency and ensuring compliance, backed by a team of experts committed to optimizing your health information management processes.
Business Office Services
Download BrochureServices:
- CMS 1500
- UB04
- EDI
- EHR
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
Claim Submission
We initiate the revenue cycle by creating and submitting clean claims to ensure faster reimbursement, minimizing lag caused by errors or incomplete information.
Services:
- CMS 1500
- UB04
- EDI
- EHR
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
- Clean claims
- Claims scrubbing
- Claim Edits
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
Error Correction
Our team identifies and corrects any inaccuracies or discrepancies in the claims submitted, preventing unnecessary rejections and payor denials.
Services:
- CMS 1500
- UB04
- EDI
- EHR
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
- clean claims
- Electronic and paper claims
- Claim rejections
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
EDI Management
By managing electronic data interchange (EDI) transactions, we ensure seamless communication between payers and providers, expediting claim processing and improving accuracy.
Services:
- CMS 1500
- UB04
- EDI
- EHR
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
- 837I
- 837P
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
Claims Processing
Each claim is reviewed and processed meticulously to ensure compliance with payer regulations and guidelines, reducing the chances of underpayment and denials.
Services:
- CMS 1500
- UB04
- EDI
- EHR
- ERA
- Payment reconciliation
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
- 835
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
ERA/EFT Processing
We efficiently handle Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) transactions across payors, ensuring timely and accurate payment postings.
Services:
- CMS 1500
- UB04
- EDI
- EHR
- Payment reconciliation
- EOB
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
- EOB
- Denial posting
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
Payment Posting
Our team accurately posts payments to patient accounts, reconciling any discrepancies in the bank deposits and ensuring that your financial records are up to date.
Services:
- CMS 1500
- UB04
- EDI
- EHR
- 276/277
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
- IVR
- Payer portals
- Insurance calls
- Clearing house
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
Claim Status Check
Continuous monitoring of claim statuses ensures that any issues are promptly identified and resolved, accelerating cash flow, and minimizing revenue delays.
Services:
- CMS 1500
- UB04
- EDI
- EHR
- 835
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
- CARC codes
- RARC codes
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
Denial Analysis
We thoroughly analyze claim denials across payor mix and patient types to identify trends, correct issues, and implement strategies to prevent future denials, improving overall revenue recovery.
Services:
- CMS 1500
- UB04
- EDI
- EHR
Key Features:
- Flexible Pricing
- Seasoned Medical billers
- Swift transition
- Exceptional Quality
- Quick turnaround
- Corrected claims
- Reconsiderations
- Appeals
- Payer portals
- Certified mails
- Fax
Patient Types:
- Inpatient
- Outpatient
- Ambulatory Surgical Center
- Emergency
- Urgent care
- Ancillary
Components:
- Physician
- Facility
Appeals and Resolution
Our seasoned staff handle the appeals process, working to overturn denials and recover lost revenue. We provide clear documentation and proactive communication with payers to achieve the best possible outcomes.
Medical Coder Learning and Assessment ToolCentral Learning
A web-based Medical Coder Learning and Assessment application utilizing real-life medical records, code rationales, and answer keys.
View Details
Watch Video
Medical Coding Auditing ToolGURU Auditor
A cloud-based one-stop solution for medical coding audits for various patient, types, settings and code sets.
View DetailsWatch Video
Who we serve
We partner with healthcare organizations globally to increase efficiency in operations, economize costs, and improve outcomes. Our extensive health information management and revenue cycle services extend to:
- Healthcare Systems
- Acute Care Hospitals
- Critical Access Hospitals
- Rehabilitation Hospitals
- Urgent Care and Ambulatory Surgical Centers
- Medical Practices
- Medical Insurance Companies
- Revenue Cycle Management Companies
- Health Information Management Universities
Clients
Partners
Tools and Technology
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This is one of very few vendor relationships I have experienced in my 35 years as an HIM where I truly feel like we are partners with the same goal in mind-quality health information.
Cindy Penner
The Ottawa Hospital
I have had experience with other offshore coding services, and the quality from the Pena4 coders is excellent.
Craig Chase
Catholic Health Services
Very responsive team, expert knowledge, and easy to work with.
John Samuels
Better Health Advisors
Always on point with Turn Around Time requirements.
Lordy Josama
One Brooklyn Health System
Great long-term relationship, able and willing to meet our needs. Great customer service, great support, great outcomes!
Ray Cosner
Mt. Sinai Health System
It has been such a pleasure to work with Pena4 and their team. They have highly educated coders and I do not need to be involved in their internal processes, they know how to get the job done and with great quality.
Bonnie DiAntonio
RWJ Barnabas South
Pena4 continues to deliver high-quality services to our Team. We look forward to maintaining our strong partnership with the Pena4 Team.
Jade Johnson
Mount Sinai Hospital MSH/MSQ
Thank the management team, Arnab, Navin, Caroline, and the entire support team for their continued support and dedication to BronxCare Health Systems.
Valerie Oselmo
BronxCare Health System
Pena4 staff was helpful and accommodating to our professor and students' needs.
Dasantila Sherifi
Rutgers University
Implementation is a 2-way street and Pena4 keeps up its end. They provide great service with involved and attentive operations leaders.
Craig Chase
Catholic Health Services
Love the Team! Deb, Bernie, and Shelley are extremely knowledgeable, friendly, and especially pleasant to work with!
Sonia Shiels
Joseph Brant Hospital
We hired HIMonCall to assist with coding to meet our mandated fiscal year deadlines. We were able to meet this deadline successfully with the help of these contract coders and the work was delivered on time, as promised.
Monique Rasmussen
Providence Health Care
Locations
India
Pena4 first initiated their presence in India back in 2004, branching out from its origin in the USA.
U.S.A.
The growth from USA spread across in more than 4 different locations with great adaptability.
Canada
Venturing into a new horizon, Pena4 spread its wings in Canada with Health Information Management Services.
Puerto Rico
Since 2000, Pena4 is the primary health information management and revenue cycle in Puerto Rico.