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Revenue Cycle Management

We improve your revenue cycle with our expert service.

Effective Healthcare Revenue Cycle Management Systems

We Help Organize Your Medical Billing Systems So You Can Maintain Profitability And Focus On Providing Superior Care

Achieve Healthcare’s Triple Aim

The healthcare revenue cycle encompasses the entire life of a patient from the moment they make an appointment for medical services to when all claims and payments have been made. Medical providers use healthcare revenue cycle management (RCM) to develop a process that helps organizations get paid the full amount for services as quickly as possible. However, the life of a patient’s account is not as straightforward as it seems.

We can help you establish a successful RCM program for your hospital or clinic to help achieve healthcare’s triple aim:

  • Improve the health of patient populations
  • Create a better care experience for patients
  • Reduce the cost of care

Get in touch with us today to schedule a free consultation to see how we can help your organization maintain financial stability.

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Outsource Your Medical Billing Solutions to Us

Healthcare revenue cycle systems are unique because bills and claims are usually processed over a long period of time. Claims go back and forth between payers and providers for months until all issues have been resolved. Patients also do not always have the funds available to immediately pay medical bills causing further delays. We can help speed up this process by:

  • Automating duties like appointment and payment reminders and reaching out to insurers regarding claim denials
  • Providing insights on why a claim was denied
  • Issuing employee prompts to enter information to save on claim revisions and gain insights on why claims might be denied
  • Ensuring proper reimbursement for Medicare patients
  • Determining a patient’s insurance status and copay requirements
  • Potentially include error detection to assist in correcting and tracking unpaid claims
  • Opportunities to review revenue shortfalls

How It Works

Step 1: Pre-Registration

Employees create patient accounts that detail medical histories and insurance coverage. Getting the most accurate information initially provides the groundwork by which claims can be billed and collected in the most efficient and effective way possible.

Step 2: Claim Submission

Once a patient has been seen, we work with you to create a claim submission that identifies the nature of the treatments received and the proper ICD-10 code. These codes signify how much an entity is reimbursed for highly specific treatments.

Step 3: Remittance Processing

After a claim has been created, it is sent to the private or government payer for reimbursement. This involves payment posting, statement processing, collections, and handling claims denials. Once an insurance company evaluates the claim, healthcare organizations are usually reimbursed for their services depending on the patient’s coverage and payer contracts.

 

Please note that claims can be denied for various reasons like improper coding, missing items in the patient chart, or incomplete patient accounts. We can help to make sure this doesn’t happen. For anything that is not covered by insurance billing, healthcare organizations must notify and collect payments directly from the patient.

Ready to Stop Losing Money?

The revenue cycle touches every aspect of a healthcare organization’s clinical and financial operations making successful management of the revenue cycle vital to its health. We can help you navigate the constantly evolving healthcare landscape. Get in touch with us today to get started.

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Revenue Cycle Management Offerings

Eligibility and benefits verification. Charge entry Medical coding. Payment posting. Electronic remittance posting. Submission of paper and electronic claims. Manage clearinghouse and payer rejections.

Denial review and management. Insurance and patient follow-up. The appeal of all denied or underpaid claims. Return mail processing. Daily/Monthly close. Fee schedule review and analysis.

Secondary insurance billing. Patient statement processing and mailing. Patient pre-collections processes. Credit balance reconciliation. Accounts Receivable analysis and management. Policy development. Denial review and management. Insurance and patient follow-up and collections. The appeal of all denied or underpaid claims. Return mail processing.

Provider enrollment and contracting. Customized management reports. Old accounts receivable clean-up.

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