For more than a decade, Pert has been offering a complete ‘peace of mind’ service in Revenue Cycle Management in usa for numerous valued medical practices. We ensure efficient Revenue cycle management & medical billing and coding services in usa, to save your time and overhead costs in a well-organized manner.
PERT Revenue Cycle Management has been associated with US Healthcare from 1997 and since 2007, we have been successfully offering comprehensive medical billing and coding-Revenue cycle management services in usa to various medical facilities spread across several states. We have been successfully functioning in services revolving around EMR and Medical Transcription, medical billing and coding-Revenue cycle management in usa. In medical billing and coding-Revenue cycle management services, the primary value proposition for our esteemed clients has been reducing payroll costs and optimizing resources which we have helped realize by assuring impeccable accuracy and swift turn-around-times. As a competitive service provider, we always strive to offer highly competitive rates to our clients for our medical billing and coding-Revenue cycle management services in usa utilizing the best contemporary processes and tools in the business.
Our endeavor for highly accurate services is driven largely by diligent work that is done in the field of data analysis and management by defining, measuring, monitoring, analyzing, correcting and controlling.
Revenue Cycle Management Services
Revenue Cycle Management (RCM) Services are a set of processes and strategies used by healthcare providers to manage their financial activities, from patient registration to claims processing and payment collection.
Continue to Bill In-House or Engage Pert's Revenue Cycle Management & Coding Services
In times Revenue cycle Management is a process used in the healthcare industry to manage the financial aspects of patient care, from registration to payment.
13 steps of revenue cycle management are as follows:
1). Pre-registration:
Collecting patient information before the appointment, verifying insurance eligibility and benefits, and providing an estimate of the patient's financial responsibility.
2). Registration:
Gathering patient demographic and insurance information, verifying patient identity, and obtaining necessary signatures and consents.
3). Scheduling:
Scheduling appointments and verifying that the provider is in-network with the patient's insurance plan.
4). Insurance Verification:
Verifying insurance coverage and obtaining any required authorizations or referrals.
5). Charge Capture:
Capturing charges for services provided to patients and ensuring that all charges are accurate and complete.
6). Medical Coding:
Assigning medical codes to diagnoses and procedures performed during the patient's visit.
7). Claims Submission
Submitting claims to insurance companies and government payers for reimbursement.
8). Claim Tracking:
Tracking claims to ensure they are processed in a timely manner and following up on any denials or rejections.
9). Accounts Receivable Management
Managing outstanding accounts receivable and following up on unpaid claims or patient balances.
10). Payment Posting
Posting payments received from insurance companies and patients to the appropriate patient accounts.
11). Denial Management:
Managing claim denials and identifying trends to improve billing processes and reduce future denials.
12). Patient Collections:
Collecting outstanding patient balances and developing payment plans as necessary.
13). Reporting and Analysis:
Analyzing revenue cycle performance metrics and identifying opportunities for improvement.
Best Practices @ Denial Management & Medical Billing and Coding Services
Denial Management in Medical Billing refers to the process of identifying, analyzing, and addressing claim denials from insurance companies or other payers in United States. When denial management in a healthcare provider submits a claim for reimbursement, it may be denied for various reasons, such as incorrect coding, missing information, eligibility issues, or failure to meet medical necessity criteria.
Effective denial management is crucial for healthcare providers to optimize revenue, minimize financial losses, and ensure timely reimbursement. Here are some steps involved in the denial management process :
1). Denial Identification:
The first step is to identify denied claims through regular monitoring of remittance advice or Explanation of Benefits (EOB) received from insurance companies. Denials can be categorized as hard denials (claims that cannot be reprocessed) or soft denials (claims that can be corrected and resubmitted).
2). Denial Analysis:
Once denials are identified, it is essential to analyze the reasons for the denials. Common reasons include coding errors, missing or invalid patient information, pre-authorization requirements not met, bundling or unbundling issues, and non-covered services. Thoroughly reviewing denial codes and payer policies can help determine the root causes.
3). Corrective Action:
After identifying the reasons for denials, corrective actions should be taken. This may involve updating or correcting claim information, obtaining necessary documentation, resubmitting the claim with appropriate modifiers or codes, or appealing the denial if it was incorrect or unjustified.
4). Denial Tracking and Reporting:
Keeping track of denied claims is essential to monitor trends, identify recurring issues, and measure the effectiveness of the healthcare denial management process. Utilizing denial management software or systems can streamline this process and provide insightful reports for analysis.
5). Staff Education and Training:
Continuous education and training of the billing and coding staff are crucial to reducing coding errors and improving claim accuracy. Staying up-to-date with coding guidelines, payer policies, and industry changes can minimize denials.
6). Payer Communication:
Establishing effective communication channels with payers can help clarify denial reasons, understand specific requirements, and resolve issues promptly. This may involve contacting the payer's customer service or provider relations department for clarification or further information.
7). Process Improvement:
Regularly reviewing denial trends and patterns can help identify areas for process improvement. Implementing changes such as updating coding practices, improving documentation, or streamlining pre-authorization procedures can reduce denials in the long run.
It's worth noting that denial management can be complex and time-consuming, particularly for larger healthcare organizations. Many providers choose to outsource denial management services to specialized billing companies or utilize dedicated denial management software to streamline the process and improve overall efficiency.
Our team is highly self-motivated to benefit from all the opportunities afforded by our dynamic operations to stay ahead of the curve on all important aspects like:
- Medical terminology
- Medical Coverage Plans
- Types of Insurance Policies
- Medical Coding
- Changes/Updates in Claim Forms
- Medical and Surgical Procedures, etc.
Our team also has got added skills of Word Processing, Spreadsheets, and Presentation Skills that helps in creating reports and documentation for management.
Revenue Cycle
- Insurance verification for benefits and eligibility
- Demographic Entry
- Charge Entry
- Payment Posting
- Coding Review Audits
- Account Receivable Payer Follow-Up
- Legacy/Old Accounts Receivables and Follow-Up
- Denial Management and Processing
- Reconciliation
- Management Reporting
Medical Coding
- Medical Coding Audits
- Facility/Non Facility RVU’s
- ICD-9 Coding based on AMA and CMS Guidelines
- Hospital/In-patient Coding
- ASC’s – Ambulatory Surgical Centers Coding
- CPT, APC, DRG’s and HCPC’s Coding across various specialties
The Pert Advantage:
- Identify and collect in areas where you are losing your money
- End-to-end solutions for the Healthcare Industry
- Complete Billing and Patient Cycle Management
- Faster Turn-Around Times
- HIPAA Compliant
- Highly talented and trained skill sets available as a workforce
- Patient Registration and input of Patient Demographic Information
- Complete verification of Eligibility and Benefits done to reduce any denials that may result due to benefits not covered for the patient based on the specialization of the provider
- Charges entered with an accuracy of above 99.9%
- All the payments and charges posted and claims billed out within 24 hours (business days)
- Real time posting of payments from ERA’s upon receipt from insurance companies
- Reconciliation of all the deposit slips done on a daily basis
- Audit of the charges, payments, and demographics and regular verification
- AR aging followup done to keep the AR less than 20% in 90+ days with close track on the claims continually until receipt of the payments
- Denial Management
- Coding done by experienced and qualified coders to achieve reduction in denials and enhanced revenue generation
- Patient statements scrutinized closely with only the valid ones forwarded to the patients as per the client’s instructions on frequency of such communication
- Month end reporting on the number of charges and payments received
- Reconciliation of all the unbilled charges with respect to the arrived patients done weekly to identify the missing super bills
- Help you go paperless concentrate more on patient care.
Medical Coding services
As the first step of the charge entry process, medical coding requires spot-on accuracy. We train our medical coders in quick, accurate and reliable processing of records and periodically ensure review, retraining and orientation towards the latest best practices. We also believe that it is of utmost importance for us to ensure that we work with updated resources and tools at all times including but not limited to latest books or softwares for the procedure and diagnosis coding based on AMA guidelines We ensure timely feedbacks on coding changes, documentation updates, and periodic reporting in line with every client’s dynamic requirements. This helps our team to match steps with the best in the industry in so far as impeccable service delivery is concerned. We also keep a close eye on the government regulations to ensure dynamic real-time alignment with the segment’s best practices. We have a proficient and skilled workforce that is well versed with various medical coding formats inclusive of ICD-9 coding, CPT coding, and HCPCS coding. They are medical reimbursement experts aiding in quick and hassle free reimbursements up to the complete satisfaction of the medical staff as well as the patients as per the laid out standard operating procedures.
Charge Entry
Our team practices strict adherence with HIPAA regulations and AHIMA rules with utmost attention to details to ensure correct and timely reimbursement from the providers for the valuable services rendered through great hard work of our physician clients. Our team makes sure to have the charges entered within 48 hours of receiving the work. All the claims are entered adhering to the respective insurance’s billing guidelines. This ensures clean claims are sent to the insurance companies at the first go and the reimbursement is faster. We have done this since 2007 ensuring clean claims, minimal denials, 99.9% accuracy, full compliance with prevailing regulations, and consistent track record with negligible risk of errors.
Payment Posting
Our Payment positing team is aware of multiple insurances and how they process their claims. They are knowledgeable and understand the various terms used by insurance companies to indicate the payment details on an Explanation of Benefits (EOB)
Demographic Entry
Patient Registration form or the intake form has the details of the patient’s demographic information. All that information is entered the same day the data is received to ensure speedier charge posting.
Accounts Receivable Services
Cash flow management holds a high degree of importance in the professional, efficient, and economically viable operations of any modern medical practice, small or large. Towards that end Pert Promises of managing the cash and revenue flows most efficiently decisively gets our valued clients ahead of the competition. We do this by helping practices effectively manage their cash and revenue flow, by reducing the accounts receivable days and helping increase profitability through increase in the collection ratio. Pert benefits from one of the best teams of AR followup professionals who can quickly identify patient accounts requiring follow up and take appropriate measures to collect unpaid and/or underpaid claims.
Our Services in Account Receivable include:
- AR analyses
- Insurance followup
- Patient payment followup
We also provide timely information on:
- Payer punctuality
- Aging analysis, procedure code analysis, insurance analysis, cash collection analysis, under payment analysis, and expected collection report
- Charges, payments and adjustments
---- The bottom-line for us is to help improve operational cash flow
by reducing bad debt and write-offs ----
Insurance Verification
Industry-wide experience shows that close to 75% of all healthcare claim denials are because of ineligibility of the patients for services billed to the insurer by the providers often because his or her policy stands terminated or modified on the day of service provided. Our role is to help dramatically reduce the accounts receivable cycle and increase revenue by significantly reducing the impact of ineligibilities and increasing the number of "clean" claims - claims that are complete and are for patients who are eligible for the benefits being claimed. This helps remedy numerous downstream issues, i.e., delayed payments, repeat work, decreased patient satisfaction, increased errors, and loss-inducing nonpayment.
Eligibility Verification, in effect, helps achieve the following benefits:
- Improved AR Cycles (reduced AR Days)
- Higher number of clean claims
- Greater cash collections and reduced write-offs and denials
Insurance Eligibility and Benefits Verification Services include:
- Receive Schedules from the Hospital via EDI, email or fax
- Coverage verification on all Primary and Secondary Payers (as applicable)
- Responses and phone calls to Payers.
- Contact with patient for information, as required
- Provide the client with the results which include eligibility and benefits information such as member ID, group ID, start dates and coverage end, co-pay information, benefits ( as per doctors specialization and procedures done) etc.
Related Services (optional)
- Obtain Pre-Authorization Number
- Obtain referral from PCP
- Enter/update Patient demographics
- Inform client if there is an issue with coverage or Authorization
Eligibility verification defines who can render what care and under what circumstances. As such, ensuring that patients are eligible for services before care is rendered reduces rework of claims and alerts providers and patients to their options.
Medical Biller: Skills & Responsibilities
- Navigate through various insurance rules and regulations to reduce A/R days.
- Understand the nuances of various types of insurance carriers along with their claim requirements.
- Provide successful follow-up efforts for A/R including the appeals process for denied claims.
- Practice best practices for insurance and patient collections while maintaining excellent public relations.
- Reduce risks by understanding Fair Debt collection practices, professional courtesy regulations, clean claims and timely filing guidelines, Refund requirements, and other regulations.
- Use data and reports as indicators for potential improvement areas.
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