Revenue Cycle Management

Front Desk

Helping providers as virtual assistance by receiving the calls starts with greeting the patients, understanding the reason of call and give appropriate resolutions. Also, it includes some of the additional activities like taking the time of appointment, collection of payment co-ordinating with scheduling team, etc.

Scheduling

Once the front desk takes the appointment this team verifies co-ordinates with the Front Desk, Authorizations and Verification department and check the patient schedule it allotted to given time and also eligibility and verification criteria has been met and text to the patient for the confirmation of the appointment.

Eligibility Verifications

Helping providers to check the eligible CPT and Dx for the particular patient’s insurance or the plan which helps in reducing the resubmission of the claims for the basic denials related to demographics, procedure coverage, co-ordination benefits, plan participation, etc. Leading to improved patient satisfaction and improving medical billing.

Authorizations

Authorization in medical billing refers to the process wherein the payer authorizes to cover the prescribed services before the services are rendered. This is also termed as pre-authorization or prior authorization services. This Also ensures the surety of payments while billing the procedure.

Medical Billing

Entering the CPT and Dx in the providers EMR either through super-bills or the electronic entries with modifiers and sequence of the submissions. Also, the activities of claim submission through payer(s) with correct plan coding e.g., if a patient has United Health Care and Medicare Advantage plan it should be correctly to that payer ID. Either it should be UHC, UMR, AARP/Supplement else accordingly. Payer ID configuration, dealing with clearing house, EDI Set up help, Modifier check, etc are the other subsidiaries activities involved in billing process.

Accounts Receivable and Claims Reconciliation

This includes the following on the claims denied from the insurance for some reason like coordination of benefits, primary allows more than secondary, modifier inconsistent with the CPT, CPT billed as non-billable, etc. Here out team analyse the reason of denial and resubmit the claim after rectifying the errors.

This also helps as reduction in denials for the future submission and increased revenue experience to the provider. We strive on clean claim ratio percentage on higher side as we target above 90% for the one-shot payment. Additionally, we review the LCD, LRMP guidelines of the insurances in order to be in sync with the changes.

Credentialing

We take care of in-networking process for an individual provider or group of provider or practice. Also includes partial credentialing to fully credentialed provider as some time when applying to the initial credentialing the insurance may enrol the provider in some of the plans only but later it requires the fully credentialed provider in order to enjoy all the benefits, we do cater those services. Expediting the credentialing services by regular follow up as the follow up play an vital role in order to get in time result.

Reports Management

Preparing of the monthly reports like CPT’s, Dx, Modifier, Revenue, etc as required or demanded by the clients in order to check the work flow and movement of the process. As after reviewing those, we can determine the changes needed or where upscaling of the process is required.

IT and administration

Our team currently working on Kinnser for HH services apart from that for scheduling and front desk management have knowledge from Athena, IMS, ECW, etc.

Dual Screen desktop’s for efficient productivity and ease of production.

Company has leased lines backed up with 5G WIFI connections and lastly failure of both can be backed by 5G hotspots in order to avoid any failure and max efforts to give uninterrupted services.

24x7 in person IT expertise support as well for prompt resolutions