Scope Of RCM

Scope Of RCM

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.

Steps in RCM


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

Image

Scheduling


Pre-certification

Pre-authorization

Registration


Patient Demographics

Insurance Registration

Insurance Verification

Coordination of Benefits

Medical Service utilization/Claims review

Obtaining Referrals

Charge Entry


Coding (ICD, CPT, HCPCS, CCI Edits, Modifiers)

Coding Audits

Charge Entry

Claims Submission


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

Payment Posting


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

A/R Follow-Up


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

Miscellaneous Services


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

Patient Statements


Payment Plan Creation

Re-call reminders

Appointment Reminders

Pre-Collection Processing