Revenue Cycle Management
Revenue Cycle Management (RCM)for Medical Billing involves various scopes of the process to be handled by billing and coding departments, which means each claim is handled and worked on by different members of the billing team causing risk of Claim errors if not handled efficiently through each scope of services leading to a delayed or denied claim. Therefore quality checks at each scope of services are crucial to curb issues down the line. Always remember getting a claim reimbursed at first submission is easier than working on appeals for denial which usually takes longer and more AR Follow-ups
There are several areas to be looked into when evaluating Qualitative measures for Revenue Cycle Management, listed below are a few that can help.
Insurance Eligibility and Benefit Verification
Most of the claim denials are due to incorrect insurance or coverage details. This can certainly be reduced by Verifying Insurance Eligibility and coverage details prior to the patient encounter with the provider. Verifying the below details can help identify missed or improper coverage details and also apprehend the coverage updates and changes.
- Patient Demographic details
- List of benefits as per patients plan
- Plan effective and termination dates
- Co-pay, deductibles and Co-Insurance
- Primary and Secondary Insurance coverage
- Code level benefit
- Maximum coverage limits for a particular procedure
Coding Audits
Coding is the most laborious and complex process due to which coding errors may seem to be inevitable. Regular coding audits to highlight repeated errors, lapses in following coding guidelines and client-specific protocols will help the coder achieve accuracy improving the overall health of the Coding Process.
Analyze your AR Days
Analyzing delayed and denied claims with constant follow-ups is mandatory to ensure claims are paid within 30 days to achieve maximized collection and to prevent claims in extended days or more than 60 AR days. As we all know the more days in AR, the fewer chances of getting paid.
Charged Amount Vs Paid Amount
It is equally important to know what percentage of claims are paid as per the charged amount or per the fee schedule. Low paid claims can pile up to a great amount of revenue loss, analyzing and appealing with the payer until the claims are fully settled is essential for successful Revenue Cycle Management.
Percentage of Write-off
When analyzing your paid claims, tracking how much you had to write off helps understand the loopholes where your revenue is flowing out. If you are paid less than your contracted amount which leads to a majority of your write-offs, you should be working towards potential methods to recover them or curb them in future claims.
Paid Vs Denial Percentage
It is of paramount importance to examine your paid and denied claim percentage on a weekly or monthly basis. This allows you to capture the areas that affect the quality of your revenue cycle management and implement corrective measures.
Physician Credentialing
Ensuring your physicians are credentialed and their credentialing is renewed on time is an effective way to improve overall Revenue Cycle Management. For an insurance company to process your claims, it is important that your physicians are credentialed. If the rendering physician credentialing is not valid, claims will be denied outright. Keeping a tab on re-credentialing dates can help avoid last-minute hassle causing revenue loss.
Outsourcing your RCM Services to Offshore Medical Billing Company
Offshore outsourcing has been long-established and adopted as the best choice for Revenue Cycle Management. Outsourcing your revenue cycle process to an offshore-based medical billing company will help tackle almost all the issues listed above with their expertise and experienced team working for various clients handling the services. A well-established Medical Billing Company has the resource to meet all your RCM requirements listed below:
- Maximized cleaner Claim submission
- Adept AR follow up skills to ensure claims are paid within 30 AR days
- In-depth audit process on each scope of services and on areas need special attention
- Monthly Reports with variance in Paid vs. Denied Claims
- Denial Management and AR Follow up
- Proficient in Credentialing and Re-credentialing
About e-care
e-care is one of the leading Medical Billing Companies providing complete Revenue Cycle Management Services for more than 2 decades. With more than 100+ clients across various states in US and being a multi-specialty billing company, e-care can provide dedicated and focused billing services to all our clients. To know more about our ASC billing expertise log on to www.ecareindia.com