Patient Scheduling and Appointment:We will helps you manage patient appointments, ensuring timely scheduling and reducing no-shows and cancelation.
Eligibility benefit check and Insurance verification:We verify patient insurance coverage, eligibility, and benefits, enhances patient satisfaction, accelerates payments,ensuring accurate billing and reducing claim denials.
Prior Authorization:We verify prior authorization to ensure the requested care is medically necessary and meets the insurance plan’s coverage guidelines with verification of prior authorization, ensuring approvals are obtained for required services.
Patient Registration/Patient Demographics:We manage patient registration and patient demographic data, ensuring accurate billing claims, effective patient care, patient communicationand timely claims submission.
Charge Entry:We manage charge entry, ensure accurate documentation, verify insurance information, secures reimbursement and ensuring accurate billing and timely claims submission.
Charge entry audit:Carry out regular audits of this process to discover mistakes and inefficiencies. This can assist you in identifying areas for development and ensuring that your practice is making the most of its income potential.
Coding Services:Coders translate diagnoses, treatments, and procedures into standardized codes required by insurance providers, facilitating accurate claim submissions, ensuring timely reimbursements and reducing claim denials.
Coding Audit:Our ai set up and experts perform coding audits to identify and rectify coding errors, ensuring timely reimbursements and reducing claim denials.
Clinical Documentation Improvement:We review and enhance patient medical records for accuracy, completeness, and clarity to ensure appropriate coding, accurate reimbursement, reduce claim denials, and ensure compliance with regulations.
Claims submission:We manage process of submitting claims to the insurance company through clearinghouse EDI and sending claims through proper format to initiate payment processing, Faster reimbursements, Reduced administrative burden, Improved accuracy. We submitting claims via multiple clearing house such as waystar, office ally, availity, change healthcare, trizetto provider solutions, kareo (tebra), advancedMD, athenahealth, ClaimMD.
Payment Posting:We process and post patient payments, ERA, EOB by tracking all services that are being provided to patients, coordinate and reconciliation patient payments for secondary insurance, patient balance, adjustment and write off.
Reconcile payments with ERAs/EOBs: Reconciling the incoming checks, credit card payments, and electronic fund transfers with the statements from payers is imperative to safeguard that all funds have been received. Funds could have been misrouted, or checks lost.
Accounts Receivable Management: Our expert team works and manage accounts receivable to ensuring timely follow-up and collections. Accounts receivable (AR) is a critical component of healthcare revenue cycle management (RCM) that represents the outstanding payments owed to a healthcare provider. It includes charges, payments, adjustments, and denials, all of which impact the financial health of the organization. Understanding and effectively managing accounts receivable is essential for optimizing revenue streams and maintaining a sustainable healthcare practice.
Denial Management:Our expert team Identify the root cause of denials which is vital for effective AR management and our experienced team analyse the reason for denials and immediately re-submit the clean claim, we take action on every claim denials and appeal if needed, ensuring maximum reimbursement and reducing denial which effect revenue.
Appeals management: Process of sending appeals is very crucial for RCM, we appeal payers to review their decision against the denial of the claim and process the claim towards payment. We are ensuring maximum reimbursement after submission of appeal on any denials to avoid affecting to revenue.
Patient calling and billing:When payments remain outstanding, collection processes are initiated to obtain the owed amount, following up with patients in a structured manner.
Patient Statement:Billing statements are generated and sent to patients, detailing their account charges, payments, and any remaining balance due.
Provider credentialing and enrollment Services:Our team manages collecting data, primary source verification, application submission, tracking approval of application, contracting with insurance, re-credentialing, individual Provider Linking to Group and Group Enrolment.
Our ai rcm billing expert can automate eligibility verification, data entry, claim submissions, speeding up approvals, reducing delays. Improved accuracy, proactive denial management, predictive insights, faster revenue cycle, ensure adherence to regulations like HIPAA by extracting and verifying patient information.
