Entire Revenue Cycle Management

Verification of Benefits/Precert

  • Eligibility Verification and Precertification process
  • Obtaining Preauth/Precert for procedures
  • Verifying PCP referral for the patient
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Coding of the medical services
  • Detail analysis of all medical records
  • Coding the procedures and diagnosis as per the industry standard guidelines
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    Demographics/Charge Entry
  • Auditing and updating the demographics with the benefit notes.
  • Entering of Charges
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Transmission of Claims
  • Transmission of electronic claims
  • Transmission of paper claims
  • Fixing the rejections of both clearinghouse/carrier
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    Cash Posting
  • Enrollment of ERA’s
  • Downloading of the ERA’s everyday from the respective insurance websites.
  • Posting of insurance/patient payments.
  • Applying deductibles appropriately
  • Reconciling the unapplied/overpayments and sending refunds to the client on a weekly manner
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Fee Schedule Review
  • Comparison of the allowed amounts/fee schedule for each procedure by Carrier
  • Segregating the low paid claims and sending to the AR for follow-up
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Follow-up of the Insurance AR
  • Closure of all correspondence/denials accounts within 48 hours.
  • Effective follow up on all claims every month
  • Review of AR every week by bucket to monitor the performance of insurances in each bucket
  • Review of denials every week to identify any major issues affecting the collection.
  • Escalation of issues and updates to the client on a timely manner
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Follow-up of the Patient AR
  • Generation of the patient statements and dispatching as per client protocol
  • Follow up on patient balances
  • Dedicated analysis in segregating patient balances into collection and bad debt
  • Sending Instruction of moving accounts to the collection agency every month
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Credentialing/Participation
  • Building and tracking database on provider participations.
  • Enrolling providers to all faster modes of revenue generation
  • Analysis on the participation benefits and providing the suggestions to the provider.
  • Sending mails to the client on domain updates/ client specific updates.
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Target Analysis
  • Plan specific Targeting of the collections every month
  • Weekly analysis of target performance and identifying collecton issues
  • Providing the target shortfall analysis at the end of every month (if applicable)
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Client Relationship
  • Sending daily updates to the client about charge and cash
  • Scheduling and conducting weekly teleconferences with the client
  • Performance feedback from the client at the end of every month.
  • Scheduling teleconferences (as per client convenience) for discussing of the client issues.
  • Sending Month end reports to the client with a detailed presentation of each and every process
  • Sending Practice Management Reports
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