BLOG • Feb 19, 2025
Unlocking Revenue Potential: Why CARC Codes Are Essential for Denial Management
RCM Medical coding
🟢 Hospital Billing Services
Optimize your RCM, Reduced cost-to-collect, Access experienced RCM professionals
An extended business office experience that works seamlessly with your CBO leadership for breakthrough results
Schedule a Call$12.7M
Total Charges Submitted
85%
First-Pass Claim Acceptance Rate
18%
Self-Pay Collection Rate
Overview
Hospital Medical Billing Services
ASP-RCM Solutions helps hospitals streamline revenue cycle management, achieving measurable results based on HFMA KPI standards. Their team focuses on cost-effective, tech-driven hospital billing services, from insurance verification to accounts receivable follow-up
Key Challenges in Hospital Billing & AR Management
• Low Clean‑Claim Rate: High AR and denials disrupt cash flow, risking hospital operations. • Payer Delays: Slow reimbursements weaken revenue stability. • Complex Coding: Errors in CPT/ICD‑10 and DRG grouping lead to claim rejections. • Fragmented Systems: Poor integration hampers timely billing and collections.
How We Simplify Hospital Billing
• RCM Tracking & Trend Analysis: We identify patterns in denials and AR to pinpoint root causes, implementing real‑time fixes. • Dedicated Hospital RCM Staff: Skilled coders and billing specialists ensure accuracy, compliance, and an elevated first‑pass claim acceptance rate. • Proven Governance & Collaboration: Our structured approach fosters transparency between your hospital leadership and our extended business office services
RCM Solutions for Hospital Billing
• Patient Insurance Verification • Patient Demographic Entry • CPT/ICD‑10 Coding • Charge Entry • Claim Submission • Payment Posting • Account Receivable Follow‑Up • Denial Management • Reporting & Analytics
Our Organized Process for Simplified Hospital Billing Services
• Insurance Verification • Medical Coding • Charge Entry • Payment Posting • Rejection Management • AR Follow-Up • Credit Balances
Benefits of a Streamlined RCM Approach
• Lower Collection Costs • 98% First‑Pass Acceptance • Boost Net Collections • Value‑Based Care Support • High-Impact Cash Flow • Quality Medical Billing • HFMA KPI Tracking
Operations
Technical Operations: Ensuring Efficiency & Compliance
Our hospital billing operations leverage modern EHR integrations, HL7 interfaces, and robust data‑driven analytics to minimize denials, shrink AR, and improve overall revenue cycle outcomes—while staying firmly within HIPAA and data security guidelines
Advanced Medical Coding & Charge Entry
We employ certified CPT/ICD‑10 coders to accurately convert clinical documentation into billable charges. Using advanced coding validation tools and DRG logic, we reduce the risk of rejections, leading to faster reimbursements
Robust Denial Management & AR Follow‑Up
Our denial prevention teams continuously analyze payer trends, identify coding or documentation gaps, and deploy immediate solutions. Automated trackers alert staff to pending AR accounts, enabling swift appeals and underpayment recoupment
Transparent Reporting & HFMA KPI Tracking
Customizable dashboards measure performance across key HFMA KPI metrics such as clean claim rate, days in AR, and net collection rate. This real‑time visibility keeps your leadership fully informed of ongoing improvements
Secure Data Handling & HIPAA Compliance
We follow strict data encryption, ** SOC 2** best practices, and periodic security audits to protect sensitive PHI. By adhering to HIPAA standards, we ensure safe transmissions of EDI files and claim attachments
Interoperability & EHR Integrations
We seamlessly interface with various EHRs and practice management systems via HL7 or API connections, unifying front‑end patient data with back‑end billing workflows for a frictionless RCM experience
Ongoing Support & Continuous Improvement
Our partnership model positions us as an extended business office for your hospital. Lean methodologies, ongoing staff training, and process optimization keep your billing cycle efficient and adaptable to ever‑changing payer requirements
Testimonials
Client Success Stories
FAQ
Frequently asked questions
Once we have securely received your patient and encounter data, we code, review, and submit claims to payers. We manage appeals and denials, track payments, and provide regular updates. Our process is designed to be efficient and transparent.
Our certified coders and billing specialists review every claim carefully. We use quality‑control checks, regular coding audits, and payer‑specific validation to reduce coding errors and the risk of denials.
Our denial‑management team reviews each denied claim to identify root causes. We correct issues, resubmit claims promptly, and, when needed, pursue appeals with payers to maximize reimbursement.
We offer flexible pricing tailored to client needs — including fixed fees, per‑claim pricing, or percentage‑of‑collections models depending on volume and services required. Contact us for a custom quote.
Yes. We specialize in seamless transitions from in‑house systems or other vendors. To ensure secure data migration, our team works closely with you and provides training as needed.
Resources
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