Our revenue cycle management (RCM) services for hospitals and physician practices will help you attain your fiscal goals, despite the rising complexity of payer contracts, challenges associated with high deductibles, and mergers and acquisitions that disrupt system platform strategies. We provide RCM services for today's market, so you can enjoy benefits such as:
Improved workflow efficiency
Timely verification and processing of account information
Reliable coding accuracy
Increased charge capture
Lower compliance risks with accurate coding
Improved timeliness and accuracy of charge postings
Less time from patient encounter or discharge to final bill
Lower claim denial rate
Reduced accounts receivable days
Less bad debt and charity write-offs
Reduced costs to collect
Accelerated cash flow and margin growth
A disproportionate 50% of claim denials result from front-end issues, such as missing or incorrect patient information. Our front-end RCM audit services begin with a review of patient demographics to help your organization troubleshoot patient intake processes.
Prevent revenue loss with early detection of insurance eligibility issues. We'll show you how to front-load the payment process with eligibility verification that includes maximum allowable visits, pre-authorization requirements, patient financial responsibility, and secondary insurance coverage.
Avoid denials and reimbursement delays based on credentialing, re-credentialing, or re-validation errors. Our RCM specialists will validate your physician and nonphysician practitioner credentials to ensure all have been accurately completed.
We'll help you boost your point of service cash collection rate with copay collection innovations. You'll also reduce the cost of patient balance follow-up by eliminating or shorten patient billing cycles.
Percent of patient schedule occupied is an important KPI with direct impact on revenue and organizational growth. We review your patient communication forms and policies to help you maximize your #1 resource — time.
Does your provider documentation reflect the complete picture of your patients' care? Our RCM specialists will ensure your medical charts support your reporting. We'll also review documentation for opportunities to capture the full extent of your case mix index, E/M levels, and risk adjustment scores.
Claims not meeting medical necessity and payer compliance requirements lead to denied payment. Our RCM specialists will identify missed revenue opportunities and resolve root causes likely to invite external audits and paybacks.
Successfully working claim edits will save your organization the cost of working denials. Our claim edit audits examine worked edits to validate or correct how they were handled. And when edits are denied, we review with billing staff and teach the medical biller how to appeal.
We provide claim edit services to support coding and billing staff during system conversions or to address backlogs post-conversion. We'll scrub procedure and diagnosis codes against NCCI and payer-specific edits to ensure claims receive prompt and optimal pay.
To safeguard against liabilities that include paybacks, allegations of fraud under the FCA, being placed on pre-payment review, and exclusions from program participation, we review your high-cost procedure claims to ensure utilization rates are on par with your peers.
Delayed claims mean delayed pay, yet charge lag commonly extends accounts receivable cycles by 10%. We'll decrease your days outstanding by troubleshooting inefficiencies responsible for both charge lag and claims lag.
Our charge capture reviews confirm that charges and receipts aren't missed when reconciling patient charges across the care continuum. In addition to addressing breakdowns in the charge capture process, we identify opportunities for process improvements.
Our charge description master (CDM) maintenance can potentially save your organization thousands of dollars. We'll review your CDM and upkeep processes to ensure current data facilitates financial forecasting and equitable pay.
Payment Management From patient statements to payment posting and distribution, we work with you to streamline processes and track claims to determine where problems originate and prevent problems from recurring.
Self-Pay Collections Boost your net collection rate and reduce collection cycles. We analyze your current revenue cycle operations and focus on strategies to lessen self-pay receivables, as well as bad debt and write-offs.
We are a leading healthcare RCM service provider, leveraging decades of experience to help provider organizations — from hospitals, health systems, and physician practices to long-term care facilities, ASCs, and home health agencies.
From patient statements to payment posting and distribution, we work with you to streamline processes and track claims to determine where problems originate and prevent problems from recurring.
Our RCM auditing, consulting, training, and business services are customizable and scalable.
Our certified revenue consultants collaborate with your staff to provide data insights, recommendations, and training to improve key performance indicators.
We know every dollar counts, which is why we're committed to helping you collect, find, recover, and retain more. Our RCM specialists will pinpoint exactly where you're losing money and show you how to turn it around.