The healthcare Revenue cycle management (RCM) is the financial process that facilities to manage the administrative and clinical functions associated with claims processing, payment, and revenue generation. The process encompasses the identification, management, and collection of patient service revenue. It is the financial process, utilizing medical billing software, which facilities to track of patient care episodes from registration and appointment scheduling to the final payment of a balance. Here is what’s involved in the revenue cycle:
Preregistration: Collecting preregistration information, such as insurance coverage, before a patient arrives for inpatient or outpatient procedures.
Registration: Collecting subsequent patient information during registration to establish a medical record number and meet various regulatory, financial, and clinical requirements.
Patient collections: Determining patient balances and collecting payments.
Charge capture: Rendering medical services into billable charges.
Coding: Properly coding diagnoses and procedures.
Claim submission: Submitting claims of billable fees to insurance companies.
Utilization review: Examining the necessity of medical services.
Remittance processing: Applying or rejecting payments through remittance processing.
Third-party follow-up: Collecting payments from third-party insurers.
PhysicianRCM is an RCM & Billing Services Company with a dedicated team of skilled professionals with a blend of experience & expertise ensuring clean claims submission to be paid through the first submission for faster reimbursement and minimum denials/rejections. We are always available via email / Call for your help in day-to-day billing & to provide real-time support to answer your questions and concerns.
Eligibility Verification Services
We believe that precise eligibility verification directly impacts the reimbursements, minimizes the Denials / Rejections, help to submit clean claims & to increase upfront collections. Insurance Coverage Benefits Verification is a vital element of avoiding insurance claim denials & increased profitability. We ensure prompt & precise eligibility verification that provides a detailed view of the patient’s coverage, and primary/secondary payer’s details, including member ID, group ID, coverage period, co-pay, deductible, co-insurance out-of-network benefits, & payment obligation.
Claim Processing & Submission
Claim Creation is one of the key areas of the Revenue Cycle & we have excellent skills in handling Charge Entry & Claims Submission on various billing software for multiple specialties. To avoid revenue leakage we need to address common billing errors like nonspecific coding; missing information; timely filling; incorrect patient identifiers; duplicate claims; up-coding & unbundling; and not supporting medical necessity. The clean claim submission minimizes the denials which boosts Practice profitability & Cash flow and it helps in decreasing the medical office outlays.
Payment Posting is one of the most vital steps in the RCM process & precise posting represents overall billing proficiency and sorts out reasons for low influxes if any. We ensure error-free posting of Payments & Adjustments. We deal with denials, overpayment, and recoupment/refunds with proper documentation. Denial posting helps in resolving the reason for denial and prevents future claims from getting denied for the same reason. Our posters & denials analytical staff review down coded payments, contractual adjustments, and contracted fee schedules while posting EOB/ERA Payments.
Denials & Appeals Management
Our experts track every unpaid claim to rectify denials & get faster reimbursements. We believe that minimizing denials boosts your Practice’s profitability & Cash flow. An effective Tracking & Prevention approach enables us to identify the denials for corrective action & resubmission. Our staff performs regular Follow Up on resubmitted claims to make sure that appeals should be successful to optimize your payment cycle.
Accounts Receivable (AR) / Follow-Up
Accounts Receivable directly impact the cash flow, therefore, we design internal controls to manage A/R follow-up and put them in place to recover the funds. Our A/R Follow process ensures timely payments & quick settlement of Aged & unpaid claims. We constantly follow up on accounts Aging 20+ Days with insurance companies (via web portals, fax, IVR & Calls) to increase Revenue Collection & reduce Accounts Aging.
Adaptive Software Strategy
We work with any PM / EHR system & our services are not bound to any particular software or technology. The Billing Software helps in streamlining processes as it includes claim creation, filing & scrubbing, integrated clearinghouse, and denial management tools. It helps Medical billers & coders to process the patient treatment information into numerical codes (ICD-10 & CPT codes) which describe the medical services rendered for claim filing & reimbursement
At PhysicianRCM, We know our job as an RCM & Billing Services Company, if you are looking for ways to improve, we will likely have the best ideas. In the changing environment of Healthcare regulations & technology, the Practices need an innovative partner for Medical billing Services who can help in improving clinical & financial workflows, increasing Profitability, & reducing practice operational expenses. We are the trusted HIPAA-Compliant Company & provide Billing services to healthcare providers of all sizes.
Who We Serve
- Small & Large Practices
- Solo Physicians (MD, DO, PA, NP)
- Independent Medical Practice Groups
- Physician Groups
- Medical Clinics
- Behavioral Health / Psychiatry
- Chiropractors / Chiropractic
- Internal medicine physicians / Internal medicine
- Chronic care management (CCM) & Remote patient monitoring (RPM)
- Nursing Home / Skilled Nursing Facility
- Family Practice / Primary Care
- Urgent Care
- Community Health
- Physical Therapy
- Pain Management
- Preventive Care