Revenue Cycle Management Services

Our team excels in managing patient appointments, guaranteeing prompt scheduling, and minimizing missed appointments. It involves gathering contact information, demographic data, insurance details, and the purpose of the visit.

Before and after scheduling appointments, we utilize the information collected to confirm eligibility and pre-authorization. Our team uses appointment billing information to contact insurers and secure post-authorization in emergencies.

We convert clinical diagnoses, procedures, and medical services into numerical values, which is essential for both patient care and payment of services in the revenue cycle. Our coding process applies to both healthcare facilities and physicians, and it typically utilizes ICD-10 codes.

Our team creates bills for service reimbursement, accurately submitting provider-performed procedures to insurance carriers. This critical step guarantees error-free healthcare claim submissions to insurance companies and third-party payers for both facilities and physician groups.

Steps in the Charge Entry Process:

• Receipt of documents
• Recording the patient demographic information
• Workflow automation
• Review of imported charges
• Statistical Quality Control
• Adherence to pre-defined provider-specific rules
• Review of any pending or held documents
• Charge Audit Services

Our team conducts claims check and resolves errors by meticulously reviewing charges and codes to verify their precise capture and posting. We perform a quality check on claims to ensure they are error-free before submission.

We engage in claims submission and insurance billing, which includes preparing and submitting claims either to an electronic clearinghouse or directly to payers. We prioritize immediate error resolution and collaboration, guided by the clearinghouse confirmation report, to maximize the chances of a successful claim and a seamless payment process.

We receive details of point-of-service payments made by patients, which can include cash, check, or credit card payments for co-pays, deductibles, or services not covered by insurance. Our team carefully examines this information and reconciles it with each patient's account.

We handle large volumes of Electronic Remittance Advices (ERAs) from payers and process them in batches by importing them into the client's practice management system. During each batch processing, we address exceptions that arise and verify the batch totals for accuracy.

We receive scanned Explanation of Benefits (EOBs), which are securely accessed either through FTPs or the Electronic Health Record (EHR) system. We then process these EOB batches in accordance with our established protocols for adjustments, write-offs, and transferring balances to secondary insurance companies or patients.

We decode and record denial codes from payers, taking actions like re-billing, balance transfers, write-offs, or reprocessing as needed.

We track and address healthcare claim status, including calling insurers to resolve unpaid or denied claims. Effective A/R management is crucial for smooth healthcare operations, as denied claims affect cash flow. To appeal denials, we gather necessary documents like appeal letters and supporting documentation.

We bill patients for deductibles, co-pays, and co-insurance according to their insurance policy terms. Patient statements are sent every 30 days, followed by phone calls. If there's no response after the third statement, it's handed over to a collection agency. Provider decisions are then based on this status, potentially including write-offs.