BACK END REVENUE CYCLE

BACK END REVENUE CYCLE

CLAIMS PROCESS MANAGEMENT

A medical claim is a request for payment that providers submit to insurers for related items and rcm services that should be reimbursed based on the insurer’s contracts with the provider and covered patient for superior insurance verification. However, it's rarely as simple as it sounds to ensure repayment happens. But our back-end team puts their dire efforts to give definite results as it is one of the most important functions in RCM because accuracy in these areas is what ultimately predicts whether or not a claim is reimbursed the first time around. 

Workflow
  • Monitor the entire claims processing healthcare lifecycle.
  • Create smart queries and workflow queues that direct attention to the claims that require the most attention.
  • Ensure claims are worked according to user-defined priority levels.
  • Expedite claim correction through the use of error prompts and help messages.
  • Maintain work in one system via integration features for all major patient accounting systems.
  • Primary & Medicare Secondary Electronic

    • We give way to a trouble-free procedure flow on Primary and Medicare Secondary electronic claims that are submitted directly to Medicare which chains through the Client’s PMS system from the Central billing location.

  • Our flagship solution empowers users to push claims through the system with minimal manual touches and prevents recurring edits and denials through root cause reports.
  • Care-first and Commercial insurances are checked upon through a clearinghouse (Emdeon /Proxy Med) where patients' payments cycle management and clinical information exchange solutions will be kept an eye on.
  • Electronic Data Interchange (EDI) claim acknowledgment reports are fetched and inspected to trace any rejected claims within 24 hours of transmission. This will help the patients handle their healthcare payment challenges and rely on electronic remedies.
  • We don’t encourage tardiness. We support patients whose rejected claims are resolved with effective measures and reviewed for accuracy after which they’re re-submitted on the same day.
  • Queued paper claims on the client’s PMS system can be printed on a CMS 1500 form. These are scrutinized for further verification and mailed to the corresponding insurance companies.

PAYMENT POSTING & RECONCILIATION ( AUTO POSTING/MANUAL POSTING)

Payment posting in RCM allows viewing of payments and also provides a clear picture of the healthcare practice's financial structure, making it very flexible to identify the issues and fix them immediately.

Our payment posting services include:
  • Verification of payment postings according to contractual obligations.
  • Verification of incorrect claims denials.
  • Immediate action was taken to rectify inaccurate, processed insurance payments.
  • Identification and verification of trends that affect large numbers of claims to rectify payer issues.
  • Accurate and error-free payment posting.
  • Scanned Explanation Of Benefits (EOB) is made available to be downloaded from the Client's office at Trans-quest and gives the straightforward provision of distribution among the Payment Posting Team to further proceed with those batches.
  • After an insurance claim has been processed, an EOB or electronic remittance advice is generated that describes the benefits that have been paid or denied for a medical procedure or claim. Our team of experienced payment posters possesses an incredible ability to decipher payer remittance, contracts, and payer trends, which enables them to preserve the integrity of the financial data and accurately distinguish how to proceed with the claim.
  • Our exceptional Payment Team will fabricate a batch and benchmark the target values which are finally updated in the Client's PMS system.
  • Through an analytical approach, we decipher the data to identify underpayments, overpayments, and denials. Insurance payments and patient payments are applied accordingly to capture true patient balances. Our methods are accurate, efficient, and cost-effective.
  • Timely perusal on scanned EOB files and post payments are done to ensure adjustments or flag denials in the Client's PMS system are not missed out.
  • We corroborate to give the batch log printed from the Client’s PMS system to accord the batch posted and audit the transactions with the help of the posting team. Charge audits will help us know the causes for variances including Charge Entry issues, provider absences, services not billed for, and other reasons for claim denials.
  • To identify undercharges, duplicate posting, overcharging, and set the seal on optimal quality levels in transaction posting, our experienced payment team will establish a thorough re-investigation on the audits before final comprehension.

ACCOUNTS RECEIVABLE MANAGEMENT

Accounts Receivable (AR) is the money owed to Providers or medical billing companies for the medical care rendered to patients. The generated invoices are sent out to insurance companies or patients for payment.

  • Our staffs keep a tab on the AR and sees if the payments reach on time. In simple words, Accounts Receivable Management is a collection of processes such as identifying denied/unpaid claims, re-filing the corrected claims, minimizing AR days, and eliminating aged AR.
  • To determine the areas of improvement through best practices, our AR Analyst will organize all the Unpaid/Part paid claims from the Cash Posting Department and generate a survey to list the claims that need further attention. The Accounts receivable team will then receive a follow-up on the order of work to proceed further.
  • The outstanding claims are worked towards a resolution that ensures a quick collection of insurance payments. Timely follow-up on the claims will result in a reduction in the outstanding accounts receivable and ensure there are no past timely filing denials.
  • Denials received from the payers are monitored and resolved promptly. The denial analysis trends help to identify and monitor the repeated denials which will help focus on resolving the root cause of the denials. This will also help to educate the Providers, Coders, and Reimbursement Specialists.
  • We focus on fixing the problems before they arise. Hence, our Analyst team will produce a weekly insurance receivable summary and detailed reports are generated from the Client's PMS system. This holistic approach will help reveal claims that are 20 days past the billed date.
  • To achieve unmatched transparency and resolve issues in balance, our AR team will tirelessly work on them and eventually forward the reports to the client if when a need shall arise.
  • Periodical Audits and Reports:

    • One of our top qualities is conducting audits frequently to learn areas of improvement, check for problems, and assess risks. Then, the team submit reports on the audits conducted. Such reports include aging accounts receivable reports, outstanding payment reports, and more. These reports will ensure there are no future claim denials and payments reached on time.

    • Final action will be undertaken by the accounts receivable analyst after clubbing the works of the AR team, and this exactly makes the AR, an important block of the revenue cycle management.