Comprehensive End-to-End Revenue Cycle Management Services Medical Coding, Billing, Payment Reconciliation and Accounts Receivable services
Charge Entry & Claim Audit
According to recent research into denial rates reported in February 2021, out of $3 trillion in total claims submitted by healthcare organizations, $262 billion were denied, translating to nearly $5 million in denials, on average, per provider. (HFMA)
Reduce Denials with our Pre-Bill Process -Our Revenue Cycle
ASP-RCM provides comprehensive Revenue Cycle Services, which Categorize into three Segments, Pre-Bill Process, Payment Reconciliation Process & Post Bill Process Our Pre-Bill Process includes these functions to ensure that we accelerate maximum collections by our Claim Review expert Team.
The top reason for claim denials according to the analysis was registration and eligibility issues with 23.9 percent of claims being denied by payers for this challenge. Researchers (Change Healthcare study) also found the common reasons for claim denials, including:
- Missing or invalid claim data with 14.6 percent of claims
- Authorization and pre-certification issues with 12.4 percent of claims
- Medical documentation requested with 10.8 percent of claims
- Service not covered with 10.1 percent of claims
Majority of claim denials are due to administrative errors
Charge entry and Claim Submission is a pivotal steps in the medical billing cycle. Our Billers Verify all the CMS claims form fields includes Patient and Guarantor’s name, Member ID, gender, Date of Birth, address, phone number, guarantor details, insurance details, Diagnosis Codes, CPT’s, HCPCS, Modifiers, Provider Information etc. before submitting the claims
ASP-RCM Charge Entry Review, Clearing house rejections review
Our approach on reviewing charges and clearing house rejections
We take an analytical approach to:
- We enter Charges in to the client’s EMR or practice management system based on account specific payer rules and clinic rules.
- Our billers also hold or pend any claims that required additional documents or clarification from clinics
- Our Team verify for any prior authorization number for the service performed by Clinics. We also ensure that we include the prior authorization number on the insurance claim.
- We will ensure that we are submitting claims either the day of the appointment or within one business day, this will ensure that our clients maintain a constant cash flow and revenue
- Our billers review the daily roaster from our clients billing system to Identify any no-shows, discrepancies on appointment etc.
- We also update our clients on the daily reporting on revenue billed, rejections worked and claims transmitted to payers
Reach out to us to learn on how your clinic leverage ASP-RCM billing services to get Optimum results