RCM Scope of Services
Front End: Charge Capture, Claims Submission, EDI Management
We integrate our billing system with multiple EMRs and intelligent claim scrubbers to automate more of the charge capture process. Our robust front-end submission system helps us increasingly identify claims that will deny so they can be corrected before they are submitted.
Middle: Claim Status, Payment Posting, Denials Classification
Our automation applied to the middle of the revenue cycle increases accuracy, speeds the time to payment, and accelerates getting denials appealed and paid.
Back End: Payer AR Management, Denials, Resubmissions, Appeals
We are early adopters of machine learning to predict denials. We automate much of the transaction work so our staff can work on claims not paid correctly the first time. This leads to superior collection results.
Patient Responsibility: Statements, Patient Calls, Payment Plans
We send patient statements, balance reminders, field in-bound calls in our US-based call centers, administer patient payment plans, and manage the integration with various emerging mobile patient payment technologies.
Reporting and Analysis: Standard and Custom RCM Reports, Insights about the Business
Our business intelligence and analytics capabilities allow our clients to have great visibility to RCM performance and extract real actionable insights about their business from the data that flows through the revenue cycle.
Compliance: RCM and Coding Compliance, Data and System Security
We take our responsibility to help ensure our clients’ compliance with various healthcare regulations seriously. Likewise, we protect our clients’ data in multiple ways that an individual practice could never afford if managing their systems in-house.
Technology Management: Hosting, Application Interfaces, Data Exchange
There are an increasing number of complex technologies that must come together to enable a high performing revenue cycle. We have extensive IT skills to manage and optimize these disparate systems for our clients.
Our standard reporting is organized around four primary areas in order to give our clients a fully rounded view of their revenue cycle and their business.
These measures show collections performance against projected cash flow. The expected collections are determined by a sophisticated algorithm that incorporates specifics of the claim, payer allowable amounts, and historical payments.
2. Billing Operations
The metrics assess the performance of key aspects of the billing process from start to finish as claims and AR move toward full resolution.
These measures of upstream production volumes provide insight into the services performed by providers – by provider type, location, visit type, coding, and RVUs.
The data help our clients understand how their work was actually compensated, providing multiple views of the reimbursement analysis – by payer, provider, procedure and visit types.
In addition to our standard reporting, our Business Intelligence team provides deep and sophisticated custom analysis to support our client’s specific business questions.
RCM White Papers
RCM Best Practices
Enter your name and email below to download a checklist that outlines priority RCM performance measures and the critical success factors that distinguish superior performers.RCM Best Practice Checklist
The Big Question
Enter your name and email below to download a whitepaper that addresses the number one question when it comes to the revenue cycle: How are we paid compared to how we should be getting paid?The Big Question