Revenue Cycle Management

Our Certified Coders and Billers would ensure Optimizing your collections...

HEIGHTENING END-TO-END REVENUE CYCLE Management SOLUTIONS

Comprehensive End-to-End Revenue Cycle Management Services Medical Coding, Billing, Payment Reconciliation and Accounts Receivable services

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RCM SERVICES

  • Disruptive alterations brought on by increasing medical expenses and increased patient cost sharing need a progression in conventional patient billing and collection practices.
  • ASP-RCM Revenue Cycle services tailored to address an extensive array of issues and challenges confronted by hospitals and physicians while accelerating cash.
  • We are experts in multi-specialty medical billing services starting from Cardiology, Pathology, Radiology I/R, Orthopedics, Ophthalmology, Internal Medicine, Psychiatry, Podiatry, Gynecology, Family Practice, Mental Health, Emergency Room, Behavioral Health.
  • We adapt robust automated technology solutions to provide Qualitative results. Ensuring optimum results with ASP-RCM with our Lean Six Sigma best practices.
  • We focus on reducing your AR days, reducing your administrative expenses by re-engineering your practice process with our divide and rule approach.

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    PLEASE PROVIDE THE FOLLOWING INFORMATION ABOUT YOUR BUSINESS NEEDS. WE WILL REACH YOU AT THE EARLIEST.

    Practice Management leaders report their biggest challenges with appointments are no-shows and appointment availability

    Scheduling Patients challenges are a clinic-wide concern, affecting every administrative staff member, especially with long waiting list, verification of benefits with accurate out of pocket information and any prior authorization mandates. The most important factor for efficient scheduling patients begins with analyzing the needs of the patient intake process, ASP-RCM process on patient intake & appointment scheduling services
    • Scheduling patient appointments using the Practice EMR management system helps in a seamless pre-registration process
    • Ensuring that the capturing patient’s demographics for Verification of Benefits and any mandate authorization requirements
    • Review Clinic’s EMR and update the schedule based on the Provider availability
    • Establish seamless governance with Providers and patients through the broadcast messaging system
    • Appraising patients on any changes on their schedule and receiving confirmation
    • Sending automated reminders on their schedules to the Physicians and patient
    Key components that ASP-RCM leverage for an efficient scheduling listed below
    • Leveraging the use of appointment scheduling process and tool
    • Execute and implement an appointment reminder system to reduce the no shows
    • Establish a patient waiting list to fill no-shows or cancellations by sending mass text messages to patients
    • Use broadcast messages for any unavoidable circumstances, to saves your staff time on calls to update your patient on potential delays and possible rescheduling.
    • Analyze data to spot anomalies, trends, and prospects to identify gaps that might impact blocks and workflow issues in your scheduling process
    • Leverage a referral appointments tool, which automatically sends a message to the referred patients about their schedule, which saves your staff time instead of phone call

    Eligibility Verification & Prior Authorization (on the image 34% of Physicians report that Prior Authorization has led to a serious adverse event for patient in their care)

    Insurance Eligibility verification is a vital process performed by healthcare providers to verify insurance coverage. This process primarily identifies whether the patient service will be covered before treatment. Inconsistency in this information will lead to revenue and collection loss to practice. Failure in this process can lead to high denials in turn delayed reimbursements.

     

    • Prior Authorization is the process of obtaining Payer approval before the provider performing the service and it’s a mandatory part of the revenue cycle for a healthcare practice.
    • Payer based staffing to navigate payer dynamics. Our dedicated staffs are responsible in payer-based nuances, learning their specific payer needs. Our staff also establish relationships with their counterparts at the payer, to expedite auth request.
    • Our technology-based solutions help us to improve our efficiency on Eligibility verification and Prior auth request by Prepopulating the patient information in forms for each payer. We leverage automated tools using payer online forms for the prior authorization need to optimize the results
    • Our leaders understand payer medical policy guidelines for treatment decisions and establish the medical necessity for Payer justification for prior authorizations.
    • Our workflow management tool tracks and monitor these Eligibility request and prior authorization request, ensuring the rigorous follow up with payers performed consistently.
    • Our data mining tool will help clinics to outline the requirement of treatments and medications for frequent diagnoses require a prior authorization by payer and the accepted alternatives. This guide enables saving physicians time by regulating them toward medical necessity services that the insurance company will accept.

    The global medical coding market is expected to grow from $14.33 billion in 2021 to $15.85 billion in 2022 at a compound annual growth rate (CAGR) of 10.61%. The medical coding market is expected to reach $23.73 billion in 2026 at a CAGR of 10.62%.(Global Market Report)

    Medical coding is an important process of Revenue Cycle, where a Medical Coder reviews all the clinical documentation, physicians’ medical transcripts, and EMR records so that appropriate ICD 10 and CPT, HCPCS codes can be selected for billing a claim. The payments or reimbursement that a Healthcare system receives directly depends upon choosing the accurate codes for the services rendered to the patients.. Are you experiencing under payment or over payment issues due to upcoding or down coding of your clinical documentation in your practice. We understand that Medical coding is a convoluted and challenging task with the industry drift and dynamic changes of medical codes every year are revised and updated. Leverage ASP-RCM coding and Auditing services to Optimize your revenue cycle compliance and accurate reimbursement. Our medical coder has a best practice to follow a golden rule to never code a bill if there is no medical documentation to justify or support it. ASP-RCM Medical Coding services includes,
    • Compliance on ICD-10-PM, CPT, HCPCS coding, and ICD-10-PCS coding
    • Chart Audits and Code Reviews
    • HCC coding
    • Improve clinical documentation at a Health System level
    • Consistent and reliable reporting of clinical data
    • Payer specific coding requirements
    ASP-RCM Certified Coders perform medical coding for specialties includes,
    Cardiology
    Pathology
    Radiology I/R
    Orthopedics
    Ophthalmology
    Internal Medicine
    Psychiatry
    Podiatry
    Gynecology
    Family Practice
    Mental Health
    Emergency Room
    Key tasks performed by our Certified medical coder are
    • Capturing patient information from clinical documents and records, ensuring the age and gender accurate with documentation
    • Verifying the documentation from Providers, Healthcare Systems, and other healthcare professionals as per the coding guidelines
    • Adapting payer policy guidelines on medical documentation ensuring that the claim not being denied
    • Choosing the appropriate ICD 10 and any crosswalk assistant for ICD9 and assigning codes CPT and HCPCS coding accurately
    • Educating the external medical practice and administrative staff on the coding requirements to avoid future inaccurate documentation

    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

    Remittance Processing & Payment Reconciliation

    Remittance or Payment posting is a vital step of the revenue cycle management for healthcare organization. This process involves posting payments, deposits and reconciling posting activities with deposits received in lockbox or bank. The payment posting process affects downwards Revenue Cycle and can have a major impact on patient satisfaction, efficiency, and overall financial performance. ASP-RCM Payment Reconciliation process Our approach on payment posting can make your organization billing process more efficient and acclerate cash:
    • Our Team accesss EOB and ERA from different sources including payer portal, lockbox and billing systems and do complete reconciliation on daily deposits - This will ensure the data from both EOB’s and ERA’s match bank payments.
    • Handling denials - Our payment posting updated and review denied claims to the appropriate cross functional team including coding and denial management team for rework and re-submission to payers in a timely manner.
    • Patient responsibility - Our Team identify and transfer balances to the patient's responsibility or any out of pocket that required patient payments helps to ensure faster patient billing.
    • Write-offs and adjustments - We also process write-offs and adjustment in respective patient accounts and report any unusual under payment or overpayment or contractual adjustments while processing payment.
    • Dashboard Reporting- Our provide dashboards on revenue recognition, forecast collections based on the historical trends and provide inputs on trends in denials

    Accounts Receivable - Get Paid Faster with ASP-RCM AR management

    AR Process is the most important step to determine the financial health of your Health organization, AR days provides as a important indicator of overall AR performance. This measure the average number of days it takes to collect the payments due for services rendered. Monitoring these monthly will help to accelerate the cash flow of your Organization Our best-in-industry AR team works dligently to get your Organization 30-60, 60-90, and over 90-day aged and unpaid claims submitted, paid, appealed and resubmitted as needed. ASP-RCM Key to Accelerated and Efficient Accounts Receivable Management: Automation Our Robust AR management reengineered with solid process backed by automated tools. Our Automated interfaces and tools improves the end-to-end AR process and ensures hands-off, accurate completion of repetitive tasks and avoid redundancy
    AR Workflow Strategy - Benefits
    • Our workflow tool help to reduce Days in AR Outstanding significantly
    • Optimally reduce past-due A/R
    • Accelerate 90%+ no-touch cash posting for checks and electronic payments by stratgizing the unpaid claims in specific workflow queues
    • It will help to reduce bad-debt write-off for your Organization by providing insights on aged and uncollecable AR
    • Build Efficiency in Overall AR process by improving productivity of user
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