Revenue Cycle Management

Enabling Provider and ACO with deeper understanding of their revenue cycles through a comprehensive and integrated suite of solutions.

 

providers_credentials

Provider Credentialing

Review and validation of the professional qualifications of physicians to help them register with payers

VRCM – Value Proposition To Providers

  • Expertise in Medicare / Medicaid applications, managed care assistance, evaluating and negotiating reimbursement proposals, quarterly re-attestation and other key services

Pre-Certification

Process of confirming eligibility prior to inpatient admissions for selected procedures and services

VRCM – Value Proposition To Providers

  • Eliminates the risk for the providers by avoiding non-covered services
  • Assures the providers for getting paid for the selected services

verification

Eligibility Verification

Detailed review of claims to verify it’s eligibility before proceeding for further documentation and processing claims through appropriate channels

VRCM – Value Proposition To Providers

  • Timely identification of ineligible claims helps providers by directly billing patients and hence improving cash collection timelines

coding_billing

Medical Coding And Billing

Verification and validation of the transcripts for completeness and quality

Coding of relevant diagnosis and the procedures as per ICD -9 / ICD-10 standards

VRCM – Value Proposition To Providers

  • Accurate coding determines the amount of reimbursement for patients covered by Medicaid, Medicare and other insurance programs
  • Timely processing of coded bills ensures continued cash realization for the client

cash_posting

Charge Entry And Cash Posting

Process claims and demographics entered in providers billing system and quickly forward to insurance companies for timely payment

VRCM – Value Proposition To Providers

  • Experienced billing professionals ensure that claims are sent to payers on-time and with fewer errors resulting in faster payments for providers
  • Domain expertise in practice management and medical billing softwares

chart_view

A/R Analysis And Denial Management

Follow up with insurance companies to track claim status

Analyze reason for denial and undertake corrective measures including resubmissions, appeals etc

VRCM – Value Proposition To Providers

  • Aggressive follow up and accurate A/R analysis helps improve operational cash flow and increase collection ratio by reducing bad debts and write offs
  • Helps providers to concentrate on care management by managing their revenue risk