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Revenue Cycle Management

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Revenue Cycle Management (RCM)!

Revenue cycle management (RCM) is a process that manages claims processing, payment, and revenue generation. It entails using technology to keep track of the claims process at every point of its life, so the healthcare provider doing the billing can follow the process, address any issues, and allow a steady stream of revenue

The process includes keeping track of claims in the system, making sure payments are collected, and address denied claims, which can cause up to 90% of missed revenue opportunity.

RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly code claims using ICD-10. Time management and efficiency play pivotal roles in RCM, and a physician’s or hospital’s choice of an EMR will largely center on how their RCM is implemented.

Services:

  • Fax documentation

    This is the preliminary step. The fax contains information about insurance, prescription, sleep study report, and other clinical records of patients received from the doctor's office. Using these records, we will confirm whether it is a purchase of a new machine or replacement machine/supplies for the existing/new patient, and move it to the respective CSR to proceed further for verification
  • Eligibility and Benefits Check

    Insurance Verification is a process where we call the insurance company to check for patient's demographics, individual and family deductibles, policy termination date and coverage limit to determine whether the patient is eligible for machine/supplies
  • Pre Auth/Pre cert

    Pre-cert is obtained from the insurance company based on the patient's usage of the machine. This process will ease the submission of claims and guarantees payment without any further delay
  • MCR CL Supplies / Setup

    Medicare Checklist is an internal company requirement which makes it mandatory that each user assist patients with orders to complete insurance verification, and verify patient medical documentation that meets Medicare criteria.
  • AR Follow - up

    Analyzing the Claims and checking the status of payments on a systematic manner with the insurance companies, and if any claim is denied, probing for the exact reason and resubmitting it on time for payment.
  • Sorting / Filing

    All the records like insurance, prescription, sleep study report and other clinical records received from doctor's office are filled in the respective folder for future reference. If it is for a new patient new folders are created with all demographic details
  • Shipping Ticket/order entry

    Once insurance is verified, based on the insurance eligibility and patient's request, Shipping ticket is created for the eligible machine and supplies.
  • Billing

    It is the process of generating an invoice for the machine and supplies that patient's bought from the DME. The billing will be sent to both the patient and the insurance
  • Payment posting

    Reconciliation of statement based on the payment received from the insurance company, and forwarding to the follow-up team for claims that were not received
  • Adjustment Projects

    A Process of adjusting the payments which will not be recovered from the insurance.
  • Medical Records

    Calling patients or doctor’s office to get the missing medical document for approval of shipping supplies.
  • Sales Order Tech

    Calling Pulmonologists or Sleep Center for CPAP Referrals. By providing patient education and PAP set-up services, our service enables us to receive fair market compensation
  • Note card

    A Process of sending HAND WRITTEN cards like Thank you note, no supply/order, late shipment/delay, etc

BENEFITS OF PARTNERING WITH US

  • Zero set up cost

  • Improve cash flow cycle

  • Saving more than 60% on operating costs

  • Quick support ensuring faster turnaround time

  • Experienced personnel will handle your revenue cycle management

  • Continual follow up of your bills and records for better revenue collection.

  • HIPAA compliant proven processes for high performance revenue cycles.

  • State-of-the-art software and technologies for a highly productive functioning of your revenue cycle management

  • Risk-free business support services ensured by stringent information security policies and practices