RCM – Revenue Cycle Management

Complete Revenue Cycle Management Service for
Healthcare Institutions

RCM Benefits & Verification Eligibility

Benefits & Verification Eligibility

For any Revenue Cycle Management Healthcare cycle, BEV is the most crucial part. We are into the assurance that your patient’s plan holds coverage for the procedure to be followed by you. This will be eliminating all eligibility related denials and enhances revenue by at least 7 – 10%.

RCM Coding & Submission

Coding & Submission

Scrutiny of claims is done to maximize reimbursements without over-coding which implies one of the ways of our typically boosting client’s revenue by 10% – 20%. We are into the maintenance of a nearly 100% success rate on the first attempt of HCFA and UB clearinghouse claims with WC (workers compensation) and NF (No-Fault) present as well. Our AAPC and AHIMA certified coders always tend to be ahead of all the latest updates of coding.

RCM AR Follow Up

AR Follow Up

We all have the awareness that claims are bound to be denied by insurances. Therefore, the most crucial aspect of any billing workflow is AR follow-up. The timely run is ensured by Accounts Receivables follow-ups around rejections and denials. Here at CredablePro, we ensure the allocation of maximum resources to the AR follow-up team such that there is a timely follow up of a high number of submitted claims to enable quick action and re-working of the denials.

RCM Denial Management

Denial Management

We are into ensuring that there are minimum denials of your AR. We have experts who can overturn all types of denials extensively, right from medical necessity denials, maximum benefits exhausted, the requirement of additional documents, related denials coding, patient benefit related denials, issues of prior authorization, EDI issues, our adept team resolves and gets the denials overturned with timely, effective, affirmative follow up and extensive appeals.

revenue cycle management

Appeals/Medical Necessity

We have a separate team dealing with appeals and reconsiderations, working closely with the AR team. For each type of denial, our team has both pre-set and customizable appeal formats. Extensive appeals that comprise the timely submitted right information are bound to have an enormous impact on effectively overturning the most complicated denials.

EOB/ERA Posting

EOB/ERA Posting

We assure all your EOB’s (Explanation of benefits) and ERA’s (Electronic Remittance Advice) are regularly posted and reconciles towards making sure of the accurate end of day statement for your staff to review and access average revenue growth. We comprise a two-tier quality system in place to make sure all postings go through a level 1 and level 2 check before the generation of the final reconciliation report.

rcm revenue cycle management

Patient Statements

It is a must to collect patient balances after insurance and co-payments that are among the largest of owed buckets. What is needed to help is available with us that will ensure you in getting every dollar from every patient. All patient statements are handled as well as we take calls from patients who even have statement questions. Side by side we make polite calls to remind patients of their balances with the usage of all modes of communication including emails, fax, texts, etc.

revenue cycle management healthcare

Revenue Enhancement Meets

Our billing workflow is kept highly transparent with our clients. Workflow logins of the billing teams are shared for outright transparency with the client. There is weekly sharing of all the reports. Monthly REM sessions are organized with the client ensuring that we lay out a clear road map, passing overall ageing and revenue reports, showing the client exactly what we have planned to set up their collections, therefore, revenue growth and assessment in the coming quarter.

Simplifications of Prior Authorizations

The complicated process of prior authorization approval and derivation is simplified by the enablement of healthcare providers to diminish prior authorization related workload and denials while improving cash collections with our specialized workflow management of prior authorization. This is inclusive of managing the prior authorization checks, submissions, logic, and document storage, resulting in increased revenue using the diminishment of preventable denials. It is a simplified process!

Streamlining Your Workflow

Your Payor Mix is thoroughly scrutinized and all the prior authorization requests to payors and codes are altogether tracked. We work with your internal staff and physicians to ensure we are getting prior authorization for every single claim before the procedure is performed. In most cases, we have a retro auth facility available, so our team is always ahead of prior auth checks with the payors, ensuring we either apply for prior auth right up-front before the procedure happens or apply for the retro auth within the stipulated time frame. In short, we have a 68% reduction in time spent per account.

Prevention of Denials

There is a revenue increase using the prevention of prior-authorization denials. Insurance specific criteria are incorporated for the improvement of your prosperity. Our effective prior auth workflow management system guarantees an 8-10% reduction in denials and smoothens out the AR workflow for the enhancement of the collections graph. The result is: we enable a 10-12% increase in the revenue.

Quicker Turn Around

All your cases are routed to the right benefits manager for a faster turnaround time in the acquisition of the pre-authorization approval. We have in-depth experience working with the payors prior authorization departments that come in handy in this workflow. In our pre-auth directory, we include pre-set formats and payor specific forms. This results in time accumulation as well as the quickening of the claim processing time. Therefore the overall collections are improved, as a consequence, there is a 25% faster time to decision.

Are You in the Possession of BackLogs or Aged AR?

Aged AR or Stuck AR is the demon that is being battled by every practice, laboratory or healthcare institution submitting insurance claims. These have reference to the insurance denials, rejections and other missing info related claims, which you are unable to do much about, subject to either being staffed shortly, your billing company not putting in enough efforts or resources or just because you have too much on your plate administration wise, that the billing & aged AR took a back seat.

This implies that you have lost money. This money could have been collected and grown your bottom line.

For just achieving that, we have a much-simplified solution. First of all, don’t fire your biller or your billing team. There is no need to make any changes in the software and to hire us; you don’t have to pay any additional cost. You just have to hand over the aged AR to us and allow us to collect on those un-worked denials and rejections. We get paid when you get paid on that lost or old AR. How simple it is!

A Brief about Our Backlog Recovery and Aging Experts

We have a team of over 150 expert billers that has 15 years of RCM expertise and over 500 practices across the nation. We were taught everything we wanted to find out regarding the most important facet of RCM – Denial Management.

Every time we took on a practice’s billing, we made sure we set a target to bring down the denial percentage by a good 15-18% in the initial quarter and proud to say, we haven’t failed to achieve it even once. That is genuinely what evolved our credentialing & enrollment arm because you cannot diminish a practice’s denials unless you are up to handling their credentials.

Preparations by Our Aged AR Experts

  • Assessment of your whole AR for the last 3 years
  • Preparation of Analysis on what the collectable metric is
  • Presentation of a quarterly collection plan based on buckets
  • Allocation of knowledgeable AR resources to the project
  • The establishment of communication flow up with the practice
  • Setting a monthly progress reporting system with the client.

Actions by Our Aged AR Experts

  • Aggressive follow up of AR on old aged claims
  • Identification of denial causes and classifying buckets
  • Strategizing & prioritization of workflow & timelines
  • Aggressive and assertive submission of appeals
  • Identification of patient owed balances and planning retrieval
  • Closely vocation with the credentialing team
  • Closely vocation with the enrollment team – ERA, EDI related issues
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