Healthcare Revenue Cycle Management (RCM)
is the financial process that healthcare organizations use to track patient care episodes, from initial appointment scheduling and registration through final payment. RCM encompasses the entire lifecycle of patient financial transactions, including verifying insurance eligibility, managing claims, coding, billing, collecting payments, and following up on denied claims. This process ensures timely payment for services provided and minimizes revenue loss by optimizing each step of the financial journey. Effective RCM is crucial for healthcare providers to maintain financial health, streamline operations, and enhance patient satisfaction.
REVENUE CYCLE MANAGEMENT (RCM) OUTSOURCING
We offer end to end RCM solutions for clients in the US, UAE, and Australia, improving billing accuracy and revenue recovery. Our Services include
Front-End Revenue Cycle
- Patient Scheduling & Appointment Management: Efficient scheduling to reduce no-shows and optimize time.
- Eligibility Verification: Ensure accurate billing through verified insurance coverage.
- Prior Authorization: Seamlessly manage authorizations for services.
- Patient Registration/Demographics: Capture accurate data for timely claims submission.
- Pre-collections & Patient Calling: Effective communication for payment options and balances.
- Scheduling & Inbound Calls: Match patients with the right facilities and doctors.
Mid-Revenue Cycle Services
- Charge Entry & Audit: Accurate charge processing and audits for proper billing.
- Medical Coding Services: Certified medical coders ensure correct billing codes.
- Revenue Integrity: Regular audits to prevent revenue loss.
- Clinical Documentation Improvement: Enhance documentation for accurate coding and reduced denials.
Back-End Revenue Cycle Services
- Remittance Processing: Timely and accurate payment posting.
- Accounts Receivable & Denial Management: Maximize collections and minimize denials.
- Credit Balance Management: Handle refunds efficiently.
The values we live by
Improved AR Days: AR Days (Days Outstanding) maintained below 35 days
a) AR Days are a measure of how long it takes your practice to collect the outstanding bills from the payer.
b) The average range for AR days is 30 days to 70 days, although anything over 50 days could be indicative of financial trouble for your practice.
Denial Rates Reduction with No Recursive Denials: Denial Rates are reduced to less than 4%
By doing proper root cause analysis, we will be able to bring down your denial rate to less than 4% and also, we ensure to eradicate any recursive denial.
Net Collection Ratio
a) Access data global consistently improves the financial health of our clients by driving their Net Collection Ratio (NCR) to 95% and above.
b) By reducing denials and ensuring timely follow-ups and appeals, we maximize the amount collected on claims, reflecting the true revenue potential for healthcare providers.
c) Our focus on improving NCR helps ensure that clients capture nearly all the revenue they’re entitled to, optimizing their cash flow and overall financial performance
Real-Time Quarterly Revenue Forecasting
a) We meticulously analyze payment patterns, trends, and the liquidation rate of outstanding balances to provide accurate payment forecasting for the upcoming quarter.
b) Our forecasting process considers all unexpected events that may impact payments and is continuously updated in real-time.
c) This allows us to identify fluctuations early and implement strategies to ensure consistent revenue flow, minimizing the risk of any unexpected drops
Targeting & Tracking all Claims
a) We prioritize all claims, starting with high-dollar values while ensuring timely filing for insurances with shorter submission and appeal limits.
b) This guarantees that no filing deadlines are missed. Simultaneously, our expert analysts give equal focus to aging claims, specifically targeting those over 90 days.
c) By running parallel operations, we expedite the resolution of these older claims, ensuring they are processed and cashed out as quickly as possible
First Pass Ratio
a) we meticulously validate each claim before submission, ensuring that all necessary documentation, coding, and compliance requirements are met.
b) This rigorous process helps us achieve a first-pass resolution rate of 95% and above, where claims are paid upon the first submission without the need for corrections or appeals.
c) By minimizing denials, we accelerate revenue collection for healthcare providers, streamlining their operations and improving financial outcomes.
AI Technology
a) Achieve unmatched transparency and oversight to gauge productivity and resolve issues.
b) Our internal workflow management system allows seamless collaboration between teams by providing real-time reports and status updates.
Clean Claims Rate
The claims will be thoroughly checked for CCI edits before filing that ensures clearing house rejection, thereby, increasing the clean claims rate to 95% and above.
A Holistic Approach
The revenue cycle can run like a well-oiled machine. The right holistic approach allows for the identification and correction of errors in the revenue cycle that create a backlog of accounts receivables, essentially fixing the problem before it starts.