Revenue Cycle Management & Healthcare Services

Patient Financial Lifecycle Management:

Patient Registration and Enrollment: Collecting accurate patient demographic and insurance information upon their first point of contact with the healthcare system. This foundational step sets the stage for an efficient revenue cycle.

Eligibility Benefits and Verification: Verifying patient insurance coverage, determining benefits eligibility before services are rendered. This process includes confirming coverage limits, co-pay amounts, and deductibles, thereby reducing the likelihood of claim denials due to coverage issues.

Preauthorization Process: Obtaining prior authorization for certain medical procedures and medications as required by insurance providers. This process involves submitting clinical information to justify the necessity of the services and ensuring they are approved for coverage.

Billing and Claims Management:

Medical Coding and Billing: Translating medical records into standardized coding for billing purposes is vital. Accurate coding ensures that claims precisely reflect the services provided and comply with payer requirements, minimizing the risk of claim denials.

Charge Capture and Entry: Ensuring all services provided are meticulously captured and accurately recorded in the billing system is imperative. This meticulousness prevents lost revenue attributable to missing or inaccurately documented services.

Claim Submission: Submitting medical claims to insurance providers requires meticulous attention to accuracy and adherence to payer-specific billing guidelines to expedite reimbursement processes and avoid delays.

Revenue Assurance and Recovery

Payment Posting and Reconciliation: Applying payments and adjustments to patient accounts, ensuring accurate accounting of what has been paid and what is still owed.

Insurance Follow-up and Denials Management: Actively managing unpaid claims and denials, including investigating, resubmitting, and appealing as necessary to secure payment.

Patient Billing and Collections: Handling patient responsibility portions of the bill, including invoicing and collections. This also involves patient communication and negotiation of payment plans when needed.

Regulatory Compliance and Financial Oversight

Compliance Management: Ensuring adherence to all relevant healthcare regulations, including HIPAA, to avoid legal and financial penalties.

Revenue Integrity Auditing: Auditing processes and accounts to ensure billing accuracy and revenue integrity, identifying and rectifying any discrepancies.

Financial Reporting and Analysis: Providing detailed financial reports and analyses, helping healthcare providers understand their financial performance and identify opportunities for improvement.

Contract and Credentialing Services

Contract Management and Analysis: Overseeing payer contracts, ensuring terms are adhered to, and negotiating beneficial terms for future contracts.

Credentialing Services: Facilitating the process of provider credentialing with insurance companies, ensuring that providers are recognized and authorized to receive payment from payers.

Patient Financial Counseling: Assisting patients with understanding their financial obligations, insurance coverage, and available assistance programs.

Operational Efficiency and Support

Technology Solutions for RCM: Implementing and managing technological solutions that automate and streamline various aspects of the RCM process, enhancing overall efficiency.

Training and Education: Educating staff on the latest RCM practices, changes in billing standards, and regulatory compliance to maintain high-quality service.

Customer Service Support: Offering dedicated support for patient inquiries related to billing and insurance, enhancing their overall experience and satisfaction.

RCM Process Optimization: Continually analyzing and refining RCM processes, adapting to industry changes to optimize revenue and efficiency.