Revenue Cycle Management

Accurate registration data results in reduced denials, fewer rejected claims, less returned statements, and a reduction of other delays that impede the collections process and slow your revenue cycle. We Receive Schedules of patients via EDI, email or fax or check them every day in the appointment scheduling software.

Verify patients’ insurance coverage with primary and secondary payers by making calls to the payers and checking through their authorized online insurance portals. We also contact patients for additional information, if required, update the medical billing system with eligibility and verification details such as member ID, group ID, coverage period, co-pay.

In ELATE-RCM this service is provided by the US Healthcare standard certified/qualified CPC (Certified Professional Coders). They capture the services following the NCCI and CCI Edits and convert them into the specially designed 5 digits codes following all the compliances. Correct coding can lead to the improvement of physician’s revenue and at the same time reduce the compliance risk. As per the Client’s expectation, ELATE-RCM CODERS are certified and experienced with updated knowledge of ever changing Healthcare Industry compliance protocol.

ELATE-RCM has built a strong working relationships with our clients to consistently meet their needs as Ledger balance of Credit and Payment, backlogs are prioritized and processed as per client’s need. We handle the Incorrect adjustments, erroneous credits to ensure outstanding credit balances are accurately resolved in an expeditious manner. Our analysts are diligent and well trained to handle this task efficiently. Our operational model is highly client-centric.

We take the following steps:

  • Analyze accounts along with EOBs.
  • Work all assigned accounts – big and small-balances
  • Resolve all accounts – inspect for patient liability or other adjustment issues.
  • Determine if Double Payments were made – if so, refund as required:

Check for Duplicate Payments made for the same account

ELATE-RCM has the objective is to improve your cash flow by reducing days in A/R and improving profitability by increasing your collections ratio. Our skilled staff is trained to identify patient accounts that require follow-up and take the necessary action to collect unpaid/underpaid claims.

Services include:

  • Receivables Analysis
  • Self-pay Follow-up
  • Payer/Insurance Follow-up
  • Denials management
  • Credit Balance Resolution

Denial management is an essential part of the medical billing process. At ELATE-RCM we are constantly working to minimize the time and efforts associated with denied claims Our Denial Management team is Constantly trying to improve processes by investing quite an amount of thoughtful time utilizing new technology, automation and is achieving the goal.

We employ electronic edits to flag potential problems before the submission of the claims to the insurance and resolve those issues. The result of these practices helps ELATE in having more than 95 % of claims submissions paid by insurance on the first pass. This allows ELATE to reduce the range of A/R days.

Our custom Electronic Remittance Advice Denial Management Module allows us to see trends, resolve provider/ payor issues quickly and track individual claims until adjudication.

DOWNCODING ANALYSIS AND REPORT GENERATION

Accurate registration data results in reduced denials, fewer rejected claims, less returned statements, and a reduction of other delays that impede the collections process and slow your revenue cycle. We Receive Schedules of patients via EDI, email or fax or check them every day in the appointment scheduling software.

Numerous Organizational IT systems will be affected by the change to ICD-10-CM/PCS. Industry is conducting an inventory of information systems and applications throughout the organization which is a helpful first step in identifying which systems may need to change to accommodate the new code sets. Systems requiring changes may include:

  • Electronic health record systems.
  • Decision support systems
  • Billing systems (e.g., inpatient, outpatient,
    physician or other provider, home care, long-term care)
  • Treatment authorization systems (preapprovals, preauthorization)
  • Managed care referral systems 
  • Clinical systems
  • Encoding software
  • Computer-assisted coding applications
  • Medical record abstracting systems
  • Registration and scheduling systems
  • Aggregate data reporting
  • Utilization management
  • Quality management systems
  • Case-mix systems
  • Accounting systems
  • Case management systems
  • Incident reporting systems
  • Disease management systems
  • Operating room scheduling systems
  • Provider profiling systems
  • Provider credentialing systems
  • Clinical protocol and pathway systems
  • Ancillary department clinical and billing systems (e.g., pathology, radiology, anesthesiology)
  • Test ordering and reporting systems
  • Clinical systems
  • Clinical reminder systems
  • Performance measurement systems
  • Medical necessity software
  • Encounter form outpatient/physician billing documents and systems

 

ELATE-RCM is Working with physicians for the purpose of clinical documentation improvement as ICD-10-CM needs more specificity in documentation, this is a vital piece of work towards successful implementation if ICD10. Understanding the clinical documentation concepts and being able to convey the same to physicians is much more beneficial than memorization of codes. The experts are taking initiatives to educate the coders, auditors and others responsible for working with physicians. Key learning areas include:

The benefits and use for good documentation .

  • How ICD-10-CM intersects with clinical documentation
  • How to apply clinical documentation concepts
  • Hands-on reinforcement exercise

Thank you for your interest in ELATE RCM Services. To send any query, please share your query right away.