Revenue Cycle Management
Our RCM Services Include:
Charge Creation & Coding (ICDs, CPTs, Modifiers, etc.)
Accurate coding is the base of an efficient RCM system. Our expert coders at Integrity Support, ensure precise CPT, ICD, and modifier codes are applied to accurately reflect the services rendered during a patient’s visit. The goal is to minimize errors, prevent claim denials, maximize reimbursement, and ensure correct reimbursement while complying with coding guidelines.
Insurance Follow-ups
This is a tedious and a time-consuming operation but an Integral part of the RCM cycle. Our team ensures follow-ups of claims with insurances to track their status. This meticulous follow-up helps to keep the rejections or denials in check and ensures speedy reimbursements. We maintain open communication with insurance companies to check the status of claims. In case of denial or refusal, we ensure to rectify the errors by providing the required explanations and documentation along with a timely resubmission if required.
Claim Filing / Claim Submission
After coding, the next crucial step of our RCM services includes claim filing or submission. This process involves sending the verified accurate coded information to the correct insurance companies for reimbursement using an electronic claim submission process for faster processing. HCFA 1500 forms are submitted incase an insurance doesn’t entertain electronic claims. Our team ensures to submit all relevant documents including medical reports.
Payment Posting
Our team maintains accurate records by reconciling and recording all the payments received from patients and insurance companies. It helps in identifying any discrepancies and maintaining accurate financial records. This step involves verifying the payment received matches the expected payment, allocating payments to the respective patient accounts, reconciling payments with outstanding balances for accuracy, and documenting all Payment Postings for future auditing and reference.
Denial Management
Claim denials can have a significant impact on the revenue cycle of Healthcare Practices. Integrity Support ensures to apply an effective denial management approach. Our process of denial management involves the identification of denial reasons, preparing new appeals with proper documentation, implementing changes to coding and billing processes if needed, training staff to avoid controlling and managing future denials, and continuously monitoring denial rates to take corrective actions swiftly and promptly.
Daily/Weekly/Monthly/Yearly Reporting
Regular reporting is critical to maintain a healthy financial performance and identify loopholes or areas for improvement in Revenue Cycle Management. Integrity Support provides reporting on a daily, weekly, monthly and yearly basis, depending on the unique needs of the Healthcare Practice. Our reporting process includes the collection of relevant data on key performance indicators (KPIs), analysis of the data to identify areas of improvement or issues, and development of efficient action plans based on the results and findings. Regular monitoring of KPIs to optimize Revenue Cycle Processes and track progress toward goals. Sharing of reports with relevant stakeholders to ensure collaboration and transparency.
Obtaining Prior Authorizations
Our team conducts prior authorizations for certain medical treatments, services, or medications to avoid claim denials and enhance the reimbursement ratio. We ensure to diligently observe the requirements of insurances for covered services, submit the required documentation for prior authorizations, monitor the status, keep track, and maintain records of all the requests made, for reference. Authorizations are obtained before procedures and services rendered to avoid discrepancies.
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