Revenue Cycle Management Consultation
Healthcare is constantly changing. Mergers and acquisitions continue to peak high. Regulatory updates have changed the way organizations operate. Reimbursement has declined.
So, the move towards value-based care has become more apparent, and new technology has opened doors that many never thought possible. As these changes continue to develop, organizations are facing challenge of optimizing operations, maximizing revenue, and increasing their Performance. Multiple factors play a key role in the decisions that carve the future of an organization, and any incorrect steps along the way could create operational issues which would be hard to overcome. There is never a incorrect time to ensure that all parameters have been taken into
consideration before taking vital decisions.
With revenue cycle management experience, Pro RCM Solutions has the insight and process expertise to help identify and overcome areas of concern or difficulties, while providing the necessary data and insights to help make educated or good decisions. Our consulting experts will review your revenue cycle operations from scheduling through final patient payment, identifying potential revenue loss, while providing insightful and detailed business analytics that visualize the exact areas for improvement. From there, we identify technology resource that can be introduced into your daily operations, maximizing processes to increase productivity and drive revenue in an effective and efficient manner.
Whether your organization is trying to streamline operations or acquire and expand, Pro RCM Solutions is the right choice to help you achieve extraordinary outputs.
revenue cycle
revenue cycle
Patient Access Management
Rendering high-quality care means much more than just treating a patient. Ensuring that a patient can access the care they need, when they need it, faster and efficiently is an important part of the patient’s satisfaction. Our patient access management solutions provide the necessary tools that ensure the patient information is accurate and readily available at the time of visit so that you can focus on what matters most.
Eligibility and Benefit Verification
Patient’s eligibility and benefits can change at any moment. Lack of follow-up with insurances before seeing a patient could lead to an increase in claim denials and a significant revenue loss. Maintaining an effective and accurate verification process is essential to maintain a healthy revenue cycle. Our eligibility and benefit verification specialists regularly follow up with the insurances to ensure that patient information is up-to-date and accurate at the time of the visit.
We Verify a Wide Range of Information as below:
- Policy effective dates and coverage details
- Individual patient eligibilities
- Patient’s Plan
- Covered benefits
- Non-covered benefits or procedures
- Co-pay
- Deductible
- Co-insurance
- Claims electronic payer ID and mailing address.
- Referrals and pre-authorization requirements
- Pre-existing condition
- Maximum benefits
- Lifetime maximum
- Other related information
Our verification process checks procedure or CPT-specific coverage and benefits along with all out-of-pocket costs. So that patients are aware of what is due prior to their visit. This process provides on-time patient payments and prevents unnecessary back-end collections, effectively increasing patient satisfaction and maximizing revenue.
Referral and Authorization Management
When evaluating a healthcare organization, one of the greatest contributors to revenue loss is the failure to obtain a referral or authorization before performing a procedure. Every service or procedures need not require a referral or pre-authorization! But if a referral or pre-authorization is required and if not obtained, reimbursement for the procedure is at risk. While some insurance carriers may allow a retro authorization or referral, but most do not.
As daily tasks begin to build up, this part of the revenue cycle process is often over-looked, resulting in costly consequences. Utilizing our referral and pre-authorization services confirms that the patient is approved for the planned service or procedure prior to service, ensuring that the first stage of the revenue cycle is completed appropriately. Doing as such, assures the rest of the claims process up for success.
Provider Credentialing and Enrolments
Provider credentialing is the detailed process of getting a physician or provider affiliated with payers. Which is a crucial step in the revenue cycle. This process allows the provider to see patients within the participation or network and get reimbursed for performed services. Due to plan constraints or restrictions, patient may not be able to see a provider if they are not enrolled with the insurance. Our credentialing team works hand in hand with the insurance carriers to ensure that all documents based on payers are received timely, processed, and approved for the provider to begin seeing patients or render services.
The process behind provider credentialing and enrolment requires constant follow-up and attention in detail. Inaccurate information or a lack of follow-up will delay the process and cause issues with revenue and collections. Pro RCM Solutions understands the importance of credentialing and enrolment and works to ensure that all steps are handled effectively and efficiently. So that the physician can start doing what they do best! Which is seeing patients😊
From the start, our team of experts work to submit all the necessary documents that are required to credential the provider with the insurance, hospital, or medical group and obtain all privileges required to render services. From there, we work to ensure that all providers are linked to the payers, all documentation and contracts are loaded properly to ensure accurate and prompt reimbursement.
Provider credentialing and enrolment is a time-consuming and redundant process as the application is reviewed and analyzed by multiple people along the way. Pro RCM Solutions will diligently follow up with the necessary entities until all information has been approved and the provider can begin performing procedures or services. Delegating this task to subject matter experts allows you to free up resources and focus on core business functions which will optimize your internal operations.
Edit Resolution/Claim Submission
At Pro RCM Solutions, our claims edit resolution and claims experts drive the electronic claims submission process to ensure payment of healthcare claims. We leverage our insurance connections to ensure that all medical claims are submitted promptly and accurately. We automate remittance (ERA enrolment), EFT enrolments and management of claims data to improve payment rate, cash flow and account receivables or reimbursement.
Our technology-driven approach interfaces with the various insurances to submit huge amount of claims and claim status update electronically. This improves operational workflow by notifying our payment posting and accounts receivables team, which claims have been successfully processed and which requires immediate action or follow-up.
Our Services Allows Health Organizations to:
- Ensures clean claim submissions for both primary and secondary health insurance claims.
- Submit workers compensation and auto insurance or carriers claims with all pertinent information.
- Identify and correct incomplete or incorrect claims.
- Ensures smooth integration and validation with your patient accounting system.
- Identify and locate missing attachments or medical records necessary for claims adjudication.
- Reduce first pass claim denials
- Improve workflow automation.
- Optimize collections by reducing denials or delayed payments
We provide advanced tool and processes that identify, resolve, and prevent insurance denials by categorizing the claims respectively and reporting our findings into actionable results. Our workflow optimization tools help streamline the claims process will ultimately put healthcare organizations in a position to improve key operational and financial performance metrics that drive productivity and revenue.
Payment Posting and Reconciliation
Healthcare providers experience long account receivable cycles that delay revenue, unstable cash flow, fatigue billing teams and frustrate financial management. These elements are further segregated by accurate and inaccurate claims denials. This process can be significantly improved through Pro RCM Solutions’ accounts receivable (A/R) and claim denial management services. Our team deploys a systematic and resolvable approach that ensures accurate reimbursement of claims.
A/R management is a vital function that ensures unpaid or unprocessed claims for physicians, ambulatory surgery centres, and hospitals are addressed in a timely and efficient manner. Taking a strategist, analytical approach to accounts receivable management is a decisively swift way to achieve significant, tangible and accurate returns or output.
Our Payment Posting Service Include:
- Verification of payment according to contractual obligations or insurance contract.
- Verification of incorrect claim denials.
- Immediate actions are taken to rectify incorrectly processed insurance payments.
- Identification and verification of trends that affect large numbers of claims to rectify payer issues.
- Accurate and error-free payment posting.
Accounts Receivable and Denial Management
Healthcare providers experience long receivables cycles that delay revenue, destabilize cash flow, fatigue billing teams and frustrate financial management. These elements are further compounded by accurate and inaccurate claims denials.
This process can be significantly improved through Pro RCM Solutions’s accounts receivable (A/R) and claim denial management services. Our team deploys a systematic and meticulous approach that ensures accurate reimbursement of claims.
A/R management is a vital function that ensures unpaid or unprocessed claims for physicians, ambulatory surgery centers, and hospitals are addressed in a timely and efficient manner. Taking a strategic, analytical approach to accounts receivable management is a decisively swift way to achieve significant, tangible, and accurate returns.
Our Accounts Receivable and Denial Management Services:
- Utilize automation and process improvement to avoid an inflation of A/R.
- Employ workflow optimization tools.
- Use a focused approach toward account resolution & collections to minimize unnecessary follow-up.
- Utilize key performance indicators to identify operational nuances that can be used to streamline revenue cycle operations, minimize denials, and increase revenue.
- Provide timely follow-up and resubmission of claims to avoid timely filing limit scenarios.
Credit Balance Review
Revenue cycle credit balance review includes the identification and resolution of any credit balances that may have occurred during a revenue billing cycle. Credit balance review is necessary and regulated by law and helps to clean up unnecessary open accounts on your A/R. If accounts receivable reports have unresolved or open credit balances, it results in miscalculated revenue reports and pulls necessary resources off important tasks to correct the issue. Additionally, failing to reimburse overpayments could potentially result in a fine or as multiple fines could result in serious financial non-compliance issues. These issues can be avoided by optimizing your revenue cycle and performing a thorough credit balance review by Pro RCM Solutions.
Our automated processes alligned with our seasoned revenue cycle experts ensure that every payment, credit, and adjustment is checked systematically across the entire A/R. Whether it’s a coding error, patient estimation error, incorrect billing, or payment duplication, our team will identify the source of the issue and make the corrections necessary to close out the account and even pre-cautionary measures will be taken to avoid that in future.
Pro RCM Solution’s credit balance review services ensure regulatory compliance while protecting revenue and streamlining operational workflow.
Insurance Underpayment Recovery Services
Healthcare providers lose revenue annually that gets written off as contractual adjustments when third-party payers underpay according to the contractually allowed amount. Pro RCM Solutions identifies and corrects underpayments, incorrect adjustments, and zero payments from third-party payers, helping providers improve their bottom line and increase patient satisfaction levels.
Pro RCM Solutions utilizes a holistic approach to identify underpayments from a billing and coding reimbursement perspective.
Our Insurance Underpayment Recovery Services:
- Analyse payment reports to identify instances of insurance underpayments.
- Compare remittances to the fee schedule and managed care contracts.
- Work directly with the payers to validate the findings and arrive at the corrective course of action.
- Provides trend analysis and works with payers towards account resolution.
- Identify the root cause of claims payment errors leading to underpayments and make the necessary actions.
Advisory and Consulting Services
“>With narrow margins and a constantly evolving regulatory landscape, healthcare systems, physician practices and hospitals are expected to provide optimal services amidst increasing financial pressures. Revenue cycle issues, clinical errors, and negative contracting language impact not only the operational workflow of a healthcare organization but could cripple the organization financially. One misstep at the beginning of the scheduling process could negatively impact the claim throughout the entire billing process. As these issues begin to pile, a lack of resources necessary to make corrections will begin to have an impact on finance in negative manner.
Pro RCM Solutions possesses a deep knowledge of best practices in revenue cycle management, clinical review and provider education. We utilize this expertise to deliver high-quality and cost-effective solutions for our clients. After a thorough review of your current processes, our advisory and consulting experts will identify operational mistakes or lag that are negatively impacting your bottom line and offer solutions along with technology to increase workflow and productivity.
We offer comprehensive advisory and consulting services that help you identify opportunities and provide custom solutions to develop a clear culture of accountability to assure optimal revenue performance:
- Process improvement.
- Automation
- Provider education
- Technology consultation.
- Risk contracts consultation.
- Chart retrieval.
- Quality measures consultation.
- Coding audits
- Clinical documentation improvement
Committed in providing practical solutions, we help reduce operational costs, increase cash flow, and improve patient satisfaction. Through a blended model of technical expertise and operational business workflows, we help you to achieve transformational and sustainable results.
Resource Utilization and Management
Pro RCM Solutions provide additional resources for organizations lacking the resources which are necessary to complete daily tasks or recover from an operational lag. Armed with a deep understanding of healthcare processes and a team of highly skilled and driven revenue cycle experts, we can step in and instantly provide value to an organization struggling to maintain it’s current workload.
With years of industry experience, our team of coders, billers, and analysts are constantly reviewing and getting updated to industry challenges to provide the greatest impact to the clients whom we service.
At Pro RCM Solutions, we help organizations optimize their RCM processes by acting as an extension for their current team, allowing scalability and the ability to handle numerous tasks that might have been neglected. Our team will analyse your internal processes and then devise an optimal workflow to achieve efficient and accurate results in an effective manner.
Our analysts will also assist with setting up performance metrics or KPI to refine processes and utilize technology-enabled solutions to streamline workflow and maximize revenue.
Boot Camp Training
Pro RCM Solutions offers coding boot camp training services to healthcare organizations across the globe. We employ highly qualified instructors with years of industry experience that facilitate customizable and thorough learning programs for our clients and their employees. Our boot camps are structured to include regulatory and compliance education to ensure that the highest level of standard is taken care.
Our Boot Camp Training Empowers Employees to:
- Understand and apply coding rules and principles appropriately.
- Navigate and understand the coding manuals.
- Develop fundamental coding skills for different medical specialties or requirements.
- Learn accurate code assignments as per the latest coding guidelines to stay updated.
- Understand revenue cycle processes to identify, correct and implement necessary changes in a proper manner.
Our fast-paced, highly detailed boot camps impart coding concepts and principles that ensure the participants are adept in the various medical terminologies and are ready to take the next step in their careers or endeavours.
Refresher Training
Pro RCM Solution’s refresher training for medical coding and billing is tailored to equip healthcare professionals who want to refine their skills and optimize their performance or output. We provide custom refresher training programs for healthcare organizations and their employees. When boot camp training does not yield the expected outcome, our refresher training program can help cover the gap in the learning process. We have seasoned and certified trainers who can provide a quick touch-up on all the critical aspects of medical coding and billing or dig deeper to identify underlying issues. We understand that refresher training may just focus on certain topics rather than the entire course. To this end, our training programs enable candidates to take customizable courses that prepare them for medical coding in hospitals and physician offices.
Starting with the basics of medical coding, we quickly cover everything from regulations and compliance to audits and then explain how all of this impacts the revenue cycle. Our highly proficient and experienced instructors provide guidance, the latest regulatory updates, and use of learning tools to achieve the desired outcome. By customizing our refresher training programs to meet your specific requirements, we strive to provide effective training for all the staff within your organization.
Process Management Techniques
Healthcare process management techniques are a pragmatic approach to improving performance. At Pro RCM Solutions, we help healthcare leaders continuously refine and advance their processes to reduce costs, improve patient care and enhance the overall patient experience. We help set parameters that measure your performance by implementing custom process management techniques. This will ultimately help to systematically plan, organize, and execute various tasks that maximize efficiency and achieve your desired goals in an effective manner.
Our Process Management Support Services Include:
- Quality improvement with a focus on fixing critical processes.
- Utilizing data to optimize healthcare process management.
- Streamlining critical processes and adopting new processes or technology to enhance productivity.
- Decreasing implementation time through time-effective training and onboarding.
- Eliminating barriers and enhancing workflows to create desired outcomes.
Our process management experts utilize your data and observe your processes to present you with a verifiable analysis that will increase workflow and efficiency and ultimately impact your outcomes.
