healthcare revenue cycle services

Revenue Cycle services

While IT systems have a great potential to improve the efficiency of the revenue cycle, due to the subjective complexity, there is always human involvement required. Billers and AR specialists need to ensure that claims sent out are correct, get paid and get reconciled in the billing systems. Many a times follow-ups are necessary with payers and payments need to be posted to ensure that the ledgers are balanced.

If you have been leading a team of billers and AR specialists managing claims, payments, AR, Denials etc. you would relate to the complexities that specialties and settings of operation introduce in the revenue cycle. Below are a few things that we think might be of significance for you.

Understanding of
patient charts
Familiarity with
ICD10 coding
Expertize in
837/35, 270/71, COB etc.
Experience with
AR collection from payers
Knowledge of
payment posting, ledgers etc.
Data
analytics

Things we can do for you

The biggest concern providers and billing organizations have today is to get the right money in at the right time. With experience, billing departments acquire the knowhow of how to bill in order to get the maximum reimbursements without risking penalties. As the number of qualified billers dips in the US, its cumbersome to train the new staff on this to minimize revenue loss. With experienced people who have had exposure to various care settings, we can help you get your money in within the specific window of time. If your RCM cycle is broken, we can help you fix it by

With MCO transition, shift from FFS to VBC, Chronic care management and many other contextual changes, getting the right reimbursements quickly has become trickier. While the claim process is mostly electronic (barring a few exceptions), what goes into the claims is paramount. We shorten your revenue cycle and improve your cash flow by

  • Creating and sending electronic claims to Medicare, Medicaid and private payers
  • Ensuring the eligibilities before the claims go out, to minimize the rejections
  • Handling the COBs with secondary and tertiary payers
  • Ensuring enrolments (which are vital at the time of MCO transition) to ensure payments

While getting the payments in time is vital, its equally important to balance the books. We automate the posting processes to minimize the time and effort spent in tallying charges and payments. The intent is to give all the stakeholders as current a picture as possible by

  • Posting payments into your billing system
  • Handling adjustments, write-offs, overpayments etc.
  • Managing the outstanding claim queue

Given the complexity of healthcare settings’ context of operation, variety of plans, changing regulations among many other things, rejections and denials aren’t a surprise to anyone working in the billing department on the providers end. Though it’s a reality, one needs to make sure that the money that the providers are entitled to, reaches them. We make that possible through people who know their ways to accelerate settlements by

  • Tracking, Reporting and following-up on aging claims
  • Calling up the payers to seek detailed reasons for rejections/denials
  • Building a case for the providers to get paid for the right amount
  • Giving you a clear picture of your money by leveraging self-service reports

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