We offer a comprehensive Revenue Cycle Management (RCM) solution, spanning from establishing clear house processes to optimizing patient collection. Utilizing the SWOT analysis tool and leveraging historical data, we meticulously assess your medical practice or billing company. Our aim is to ensure that you receive the highest possible reimbursement, providing a strategic approach to maximize financial returns.
Patient demographics and charges are gathered either directly from the practice or through our comprehensive practice management and EHR system. Our dedicated Coding and Billing team meticulously reviews all bills, employing our practice management claim scrubbing process for accuracy before submission. Claims are then electronically submitted to insurance companies, while for workers' comp and auto insurance claims, we prefer the traditional method of sending paper claims via mailing addresses or direct fax. To ensure a streamlined billing process and prevent any backlog, we generate a Billing Log known as the CICO (Patients Check-In and Check-Out) report. This report serves as a weekly overview, allowing us to promptly address any billing-related queries and concerns. By sending this report regularly to the Provider's office, we facilitate a collaborative review process. Providers can identify any overlooked patient bills or unprocessed claims, rectifying issues promptly to maximize monthly revenue and minimize any potential TFL (Time for Lock) issues. This proactive approach not only ensures timely billing but also contributes to revenue optimization and operational efficiency.
We routinely monitor Clearing House rejections on a daily basis, addressing and resolving the rejected claims promptly. This ongoing effort contributes significantly to our Continuous Claims Resolution (CCR).
We receive payments through Electronic Remittance Advice (ERA) or Explanation of Benefits (EOB) from provider offices. Subsequently, we diligently post these payments onto outstanding claims, meticulously documenting the process in our payment received and payment posted log sheets. Additionally, we generate denial claim sheets, prioritizing the resolution of pending claims to ensure efficient handling by our Accounts Receivable (A/R) team.
Unpaid claim reports for accounts receivable are generated and reviewed on a daily basis. Our focus is on addressing all pending claims that exceed 30 days from the billing date. Utilizing a report organized by the first bill date ensures comprehensive attention to claims that necessitate action. Our approach strictly adheres to the Standard CCR Process, guiding the resolution of all claims through systematic follow-up until final resolution is achieved.
We regularly dispatch Pending from Provider reports to either Provider offices or Medical Billing Companies. These reports comprise pending claims requiring assistance from the Provider office to proceed with the necessary steps.
We consistently dispatch patient statements in accordance with providers' instructions. Our proactive approach involves diligent follow-ups with patients regarding any outstanding balances with their respective provider offices. By facilitating communication and cooperation between patients and provider offices, we strive to expedite resolutions and ensure a swift resolution for both parties.