Considered the most critical part of any RCM cycle, we ensure that patients truly have the coverage needed for any procedure. Our verification process eliminates eligibility-related denials and increases revenue by at least 7%.
We increase clients’ revenue by 10-20% by ensuring maximized reimbursements without over-coding. We maintain a 95% success rate on first-attempt HCFA and UB clearinghouse claims with worker’s compensation and No Fault availability.
Following up with Accounts Receivables ensures a timely turnaround of any rejections or denials that may happen to a claim. We maximize the resources allocated to AR follow-ups to ensure that claims are resubmitted in a timely manner.
Our team is equipped to overturn various types of denials, including medical necessity, maximum benefits exhausted, additional documents required, coding-related, patient-benefit related, prior authorization issues, or EDI issues. We work diligently to get denials overturned in a timely manner.
Working closely with the AR team, our Appeals & Medical Necessity team has both preset and customizable appeal templates for each type of denial. A timely submission has a huge impact on overturning complicated denials efficiently.
We ensure your Explanation of Benefits and Electronic Remittance Advice are posted and reconciled daily to ensure accurate EOD statements for your staff to review.
We handle everything related to patient statements, including taking calls from patients directly and sending out reminders via your preferred method of communication. We understand that successfully collecting patient balances is essential to your business.
We’ll share weekly reports to uphold transparency. We organize monthly REM sessions with all of our clients to ensure that everyone’s on the same page for the upcoming roadmap.
Automated medical billing systems can optimize billing by minimizing the time and resources necessary to submit claims and obtain remuneration.
Utilizing automated medical billing systems can decrease the incidence of errors in claims submissions, enhancing the precision of claims and reducing the probability of payment refusals or postponements.
Medical billing systems can enhance healthcare providers’ financial performance by mitigating the incidence of denied or delayed claims, thereby increasing revenue.
Implementing automated medical billing systems facilitates the adherence of healthcare providers to industry regulations, such as HIPAA, through the accurate and timely submission of claims.
Implementing medical billing systems can offer healthcare providers instantaneous access to financial information, facilitating the monitoring of revenue streams and enabling informed decision-making concerning their economic trajectory.
Automated medical billing systems can streamline patient payment procedures, thereby minimizing the possibility of perplexity and vexation while enhancing their overall engagement with the healthcare service provider.
Revenue Cycle Management (RCM) refers to the process of managing a healthcare provider’s financial transactions, from patient registration to final payment. It involves optimizing the entire revenue cycle to improve cash flow, reduce medical billing errors, enhance clean claims rate and ensure compliance with regulations.
The RCM process includes patient registration, eligibility verification, charge capture, medical coding, billing, claims submissions and collections. It is a complex process that requires collaboration between clinical and administrative staff.
Effective Revenue Cycle Management can help accelerate revenue, reduce costs, and improve patient satisfaction. It is also essential for maintaining compliance with government regulations, such as HIPAA and the Affordable Care Act.
Medical billing is the process of generating and submitting healthcare claims to insurance companies or other payers to receive payment for services provided to patients.
This involves translating healthcare services into standardized codes, submitting claims, and following up to ensure timely and accurate payment.
Effective medical billing is essential for the financial health of healthcare providers and allows them to continue providing quality care.
Denial management is the process of identifying and addressing denied healthcare claims.
Denials can occur due to incorrect coding, missing documentation, or delays. The goal is to resolve issues and recover revenue through corrections or appeals.
Effective denial management improves financial stability by reducing losses and increasing claim success rates.
Pre-authorization is a process where insurance companies determine if a medical service, procedure, or medication is covered before it is provided.
It ensures that services are medically necessary and meet coverage criteria.
A medical coder is a professional who assigns codes (ICD-10, CPT) to diagnoses and procedures.
These codes are used for billing, insurance claims, and record keeping.
Prior authorizations can take from a few days to several weeks depending on complexity and insurance provider.
Submitting complete documentation helps speed up the process.
ICD-10 is a standardized system used to code diseases, symptoms, and procedures.
It helps ensure accurate billing and documentation.
Outsourcing provides:
