Billing and Revenue Cycle Management (RCM) Services
On-Site medical Management Services, Revenue Cycle management and or billing services include a wide range of services that provide detailed information to the practice manager regarding the status of all claims from billing to patient collections.
Bill Review (Coding, Claims Processing, Reimbursement, Statements, Ins and Patient AR’s, DAR):
- Charting and Documentation
- Coding and use of modifiers
- Procedures coding
- Claims processing
- Average revenue per patient (by payor)
- Remittance/Payment posting/variance report
- Returned claims (25 rejections/denials)
- Insurance and Patient AR’s (0-30,30-60,60-90, 90-120, 121+) (compared to national averages)
- Patient Demographics by zip code (defining your primary, secondary, and tertiary market areas)
- Insurance demographics by payor (BCBS, UHC, Aetna, CASH patients, all others) (% of payor population in your primary and secondary service areas)
- Contractual reimbursement rates by payor (BCBS, UHC, Aetna, CASH patients, all others)
- Number of Audit requested received yearly by payer
- Dollars recouped by payer year over year for the last 2 years by payer (identifying coding or services delivery areas that are changing, or not getting paid)
What makes us unique
Our ability to successfully work with our doctors in all areas of the billing and revenue cycle management process makes us an invaluable asset.
Key points we address for a productive workflow:
- Insurance enrollment and CAQH maintenance.
- Progress notes, documentation instructions for proper E&M level & procedures as well as maximize billing.
- Our workflow eliminates the use of paper superbills when using an EMR system, saving time, money & our environment.
- Make recommendations on setting up coding and billing processes as well as maintenance of electronic transactions for faster payment and minimized paperwork — less work to get your money faster.
- We help you get paid, by processing monthly patient statements and coordinate with provider elected collection agency, if patient responsibility billing remains unpaid.
- Monthly reporting showing practice activity, payments from the patient, insurance, and aging of accounts help you keep an eye on what is essential.
Proper set-up with all insurance carriers is a must:
- We understand that being In or Out of Network makes a difference in how the practice financially performs.
- On-Site keeps all credentialing information up-to-date and centrally located in the CAQH system. This process provides accurate listings to ensure fast & proper payment.
On-site’s support ensures that all services delivered get coded and documented accurately with all key points and modifiers correctly elected for improved billing cycle efficiency & cash-flow:
- Our processes allow for a smooth and transparent transition from documentation to coding and on to billing when using the clients EMR system.
- We review the medical documentation daily to make sure all claims get billed timely; all documentation signed off for fast & proper payment.
- Our goal is to have a 48-72-hour, fast turnaround on all coding and claims transmission.
- Setting up the practice for outgoing & incoming electronic transactions allows us to address all rejection or denials promptly.
- After the insurance carriers have finalized their process, and a balance remains for the patient, monthly statements get processed for timely collection.
- If there is a need for a collection’s agency, a separate agreement will be coordinated to process all patient balances transferred to the agency.
Monthly reports are provided to show practice activity by the provider; payments received as well as patient/insurance aging reports.
With over 55 years of combined experience and a long and lasting business relationship with our clients, we are confident that are an excellent match for your medical billing needs.