RCM
Revenue Cycle Management
Appointment Scheduling
This involves scheduling patient appointments, either over the phone or online, based on the provider's availability and the patient's needs. The goal is to ensure that patients are seen in a timely manner, while also maximizing the provider's schedule to optimize revenue.
Eligibility & Benefits verification
Before providing any services, it's important to verify a patient's insurance coverage and benefits to determine their financial responsibility. This includes checking their deductible, copay, coinsurance, and coverage limits.
Provider credentialing
Providers need to be credentialed with insurance companies and government programs to be able to provide services and receive payment. This involves completing an application, providing documentation, and undergoing a review process.
Authorization
Some services require pre-authorization from insurance companies to be covered. This involves submitting documentation and receiving approval before providing the service.
Medical coding and billing
This involves translating a patient's diagnosis and treatment into codes that insurance companies and government programs use to determine payment. Billing involves submitting claims for payment and following up on any denials or issues.
Claims submission
After services are provided and codes are assigned, claims need to be submitted to insurance companies and government programs for payment. This involves providing documentation and following specific submission guidelines.
Payment posting
Once payment is received, it needs to be accurately recorded in the provider's system to ensure that patient balances are up to date and accurate. This involves posting payments and reconciling any discrepancies.
Denial management
Denials can occur for a variety of reasons, such as coding errors, eligibility issues, or missing documentation. Denial management involves identifying the reason for the denial, appealing when necessary, and resolving the issue to receive payment.
AR follow-up
Accounts receivable (AR) follow-up involves tracking outstanding balances and following up with patients and insurance companies to collect payment. This can involve sending statements, making phone calls, and negotiating payment plans.
Reporting
Reporting involves generating and analyzing data to help providers make informed decisions about their revenue cycle. This can include tracking metrics such as denial rates, days in AR, and payment per encounter.
Why you should use our services?
Our medical solutions services are designed to meet the diverse needs of patients and healthcare providers. We offer a wide range of services, including preventative care, diagnosis and treatment of illnesses and injuries, and ongoing support for patients with chronic conditions.
Medical equipment and supply provision.
Medication management and counseling.
Clinical research and trials.
Medical education and training for healthcare providers.
Health information and data management.