RCM is the process of identifying, collecting, and managing the practice's revenue from payers based on the services provided. A successful RCM process is essential for a healthcare practice to maintain financial viability and continue to provide quality care for its patients.it s included the below key areas: -
Our expert team will review the denial and will engage an effective communication with the stakeholders.
Our goal of a prospective audit is to catch any billing or coding errors before the claim is submitted.
Retrospective audits involve reviewing claims that have already been submitted in the terms of either paid, denied, or pending lead to:
Our team facilitate the accurate representation of a patient’s clinical status that translates into coded data. Coded data is then translated into quality reporting, physician report cards, reimbursement, public health data, disease tracking and trending, and medical research.
Case mix index is a measure used to reflect the diversity, complexity, and severity of patient illnesses treated at a given hospital or other healthcare facility. Higher case mix index values indicate that a hospital has treated a greater number of complexes, resource-intensive patients, and the hospital will be reimbursed at a higher rate.
Key performance indicators (KPIs) are quantifiable measurements that demonstrate the effectiveness of an individual, department, or organization in achieving key goals. Clearly defining goals and tracking meaningful KPIs can provide valuable evidence to show that internal audit’s activities are supporting the business’s strategic objectives.
Our expertise team will negotiate payer contract for your tangible and intangible services upon identifying the true value. Our professional team who can advise you on the proper pricing model for your respective payer contracts.
Reconciliationis a key step in closing the revenue cycle, our experienced finance and reconciliation expertise teamare tasked with auditing and financially reconciling all records to be presented to the payer for a final closure of accounts. Reconciliation process will start following the Submission and Resubmission.
Rule engines help us to identify processing level errors like eligibility, medical necessity, excluded ICD, Insurance guidelines the details will regularly updated with set of algorithms,empowering your practice to monitor patterns of abuse and uncover suspicious claims, which when left undetected, could hurt a practice’s business.
Review on the current system and process and giving proper advise for ana enhancement which will effectively impact on:
We offer greater transparency, efficiency and accuracy in the management and reporting of revenue cycle data.