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Demo & Patient registration

Patient demographic and registration details are core data for any Clinics or hospitals. It is very important to make sure correct details are entered and same is invoiced/billed insurance post encounter.

Eligibility & Benefits verification

It is vital part of RMC. To reduce the denial rate and increase the collection, provider make sure Eligibility and benefit is thoroughly verified before providing services.

Preauthorization

There are many services that requires prior authorization before providing the services. Exceptions are emergency and some low modality services. This is very TAT driven and should be handled properly. If provider is missed to take preauthorization timely will be loss of revenue.

Medical Coding

Currently HCPCS (CPT and DX) are coded with ICD(10th revision). Correct coding is necessary to avoid coding/bundle/Incidental/medical necessity related denials. We have CPC certified coders who are expert in Medical coding.

Charge entry

Charge Entry staff should be aware of entering correct code, charge amount and other important information on claims billing to avoid the denial in future.

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Billing & claims submission

Once demo, Coding and Charge entry is done and Incvoice/Claim is created. It must be billed to Insurance for payment. Claims should be submitted in timely manner to avoid timely filing denial that leads to revenue loss for provider.

Rejection

Clearing house and system scrub should be reviewed properly to make sure that claims are billed with correct information on EDI 837 and Claims form. Lesser the rejection higher the Clean claim ratio leads to better cash flow.

Denial/AR management

Denial management and AR is vital part of RCM cycle. Failing to adequately work on denials and AR will lead to loss of revenue. this not only impact the denial and outstanding AR but might affect the future billing of same scenarios.

Credit balance

Higher the credit balance bad for AR health of an account. Should be below industry benchmark, this can be maintained with proper review of credit balance. This includes system is updated with right fee schedule and payment posting error is negligible.

Credentialing & Provider Enrollment

Credentialing is the process where Providers need to be reviewed by evaluating their qualifications and practice history. Where Enrollment is process of requesting participation with Insurance network as provider.

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360-779-2228

Demo & Patient registration

Demo & Patient registration

Eligibility & Benefits verification

Eligibility & Benefits verification

Preauthorization

Preauthorization

Medical Coding

Medical Coding

Charge entry

Charge entry

Billing & claims submission

Billing & claims submission

Rejection

Rejection

Denial/AR management

Denial/AR management

Credit balance

Credit balance

Credentialing & Provider Enrollment

Credentialing & Provider Enrollment

FAQ

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Services

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