Revenue Cycle Management (RCM) is a financial process in handling billing, revenue collection and payment processing for medical services rendered to the patient. It utilizes medical billing software in tracking patient care activities from patient registration until the claim is fully settled.
Revenue cycle management (RCM) is the financial process, involving patient care episodes from registration, appointment scheduling, and claim processing to the final payment of a balance. In the modern days, RCM process is implemented efficiently by using software. Front office is the foundation for the entire revenue cycle management process across all functional areas any error leads to financial loss. Thus, we provide capacity building to our clients.
Our RCM system is integrated with Practice Management Systems and HIS/EHR/EMR for bills with diagnoses and services rendered as well as proper International Classification of Diseases-10 (ICD-10) and Current Procedural Terminology (CPT) codes.
Enhance hospital net revenue.
Diminish Rejection Rates.
Select Revenue Opportunities.
Revenue Data Reconciliation with Finance team.
Pre-Registration
Registration
Consultation
Coding and pre-Authorization
Billing/Charge Capture
Collection of Patient Contribution (Deductible)
Medical Service utilization/Claims review
Claims documentation.
Remittance Processing (Denial management)
Payment collection
Pre-certification
Pre-authorization
Patient Demographics
Insurance Registration
Insurance Verification
Coordination of Benefits
Medical Service utilization/Claims review
Obtaining Referrals
Coding (ICD, CPT, HCPCS, CCI Edits, Modifiers)
Coding Audits
Charge Entry
Batch Submission Formatting
835 File Processing
Review & Correct System Edits
Review & Correct Clearing House Edits
Review & Correct Payer Edits
Claim Resubmission w/ Payer-Requested Documentation
837 File Processing
Payment Batch Creation
Cash Log Balancing
Primary Payment Posting
Secondary Payment Posting
Self-Pay Payment Posting
Zero Payment Posting
Monthly Statistical & Financial Reporting
Un-Adjudicated Claims Follow-Up
Not-On-File Claim Resubmission
Denials Management & Clarification
Coordination of Benefits
Appeals Management
Underpayment Appeals
Secondary & Tertiary Appeals
Unadjudicated Claims Calls
Medical Record Submission
Master File Maintenance
Third-Party Payer Contracting
Finance & Accounting
Compliance Hotline Monitoring
Clinical Trials
Data Management
Specialized Reports
OoN Claim Negotiating
Payer Contract Negotiations
Audit Reviews
Practice Management
Expert Witness in Legal Cases
Payment Plan Creation
Re-call reminders
Appointment Reminders
Pre-Collection Processing