Revenue Cycle Management
Services
Revenue cycle management is the process used by healthcare systems in the United States to track the revenue from patients, from their initial appointment or encounter with the healthcare system to their final payment of the balance.
- Eligibility verification and Prior-Authorization
- Coding, Charge Entry and Validation
- Claims filing
- Payment Posting
- A/R Management
- Denial Management
- Patient Collection
- Customized Reporting
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Eligibility verification and Prior-Authorization
8 % of claims submitted are rejected because of eligibility problems
This is an essential step to avoid Coverage-related Claim Denials, such as:
- Outdated information about patient`s Payer Coverage;
- Incorrect insurance related information or patient demographics;
- Lack of Pre-certification / Pre-authorization or referral.
We offer a one-stop solution for complete real-time eligibility verification to stop the bleeding caused by:
- Claim rejections due to patient eligibility errors;
- Denials due to billing the wrong payer;
- Staff expenses for verification and collection;
- Payer reimbursement issues.
Coding, Charge Entry and Validation
Charge entry is one of the key areas in medical billing as the charges entered will determine the reimbursements for physician’s service. Errors in data entry and charge capture can cost as much as 7% of the annual revenue.
90 % of claim denials are preventable. Accurate Claim Validation services are essential to reduce denials and generate more revenue for the practice.
Account Receivables & Denial Management
Study shows that practices with a high percentage (20% and more) of KPI “Account Receivable greater than 90 days” is a critical indicator that practice is loosing money.
Accurate A/R Insurances follow-ups will ensure that:
- Any denials are omitted;
- Follow ups are performed as per practice protocol;
- Days in A/R are 90 days and less.
90 % of denied claims are preventable.
American Academy of Family Physicians survey shows that it is a frequent occurrence accounting for between 5-10 %.
A healthy denial management process helps to:
- Scale down the number of denials;
- Prevent resolvable denials from happening in the future;
- Speed up cash flow in the practice.
Patient Billing and Collection Services
As per recent studies, half of the healthcare consumers are frustrated with their provider’s patient billing and collections processes.
In 2019 34 % of consumer`s bills went to collection agencies:
- 24% didn`t realize the bill was owed
- 13 % said they never received the bill
Only 40% of outstanding balances were collected.
A healthy established Patient Billing and Collection process helps to:
- Smooth patient billing process;
- Increase patient payment collection rates;
- No to turn patients away.