Appointment scheduling and confirmation
Most of the front desk staff invest their time on the phone talking to patients to get the confirmation if they are visiting office which becomes a distraction for the front desk to attend the patient available at office. It also restricts them from being available for the Doctor when needed. Revesolv has a team of experts who can take care of this task for your practice. Our experts are fluent in English with good grammatical knowledge and assent. We treat Client, of our client with full respect and generosity. We help practice to plan their day well in advance by speaking to your patient to see when and what time they are coming to see you. Thus, doctors can plan their day for any important meeting and have a planned relaxing day. Your front desk should focus on patients available in front of them instead of catching the uncertain patients.
Eligibility Verification and Authorization
Many times, patients are unaware of cost-sharing options with their insurances. They may not even know the difference between premium, copay, deductible, coinsurance, and out-of-the-pocket maximum – all of which work together to provide health coverage. Due to this unawareness and confusion upon billing them the accurate cost-sharing amount, they feel cheated. Having negotiated lower payment rates, they feel cheated when availing an out-of-network service takes up their bill. They are puzzled that they are denied coverage, little realizing that they may not have met the deductibles. These along with the gaps in patient information are the potential reasons for claim denials and delays. This may be linked to incorrect form-filling during their visit, or failure to update the medical dossier of the patient at the front-desk/reception, expiry of insurance cover, missing claim form, a mismatch between service provided and diagnosis, lack of pre-certification and so on. Insurance Eligibility Verification is the procedure of verifying the Active or Inactive policy status, Checking the annual deductible, Copays, Co-Insurance & Out of Pocket benefits. This information is directly linked to claim denials or payment delays of a healthcare practice, especially the account receivables (A/R). This happens when the eligibility verification is not performed correctly.
There are certain services that require pre-certification, pre-notification, or pre-authorization from the insurance company. You need to make sure whether a service requires pre-authorization during the Insurance verification process. Most healthcare plans specify the services that require pre-authorization in advance through their Medical Benefits Chart. So, what is exactly pre-authorization, why is it required, and which are the services that need that? Need of obtaining the approval or authorization from an insurance carrier to pay for a proposed treatment or service. This approval is based on medical necessity, medical appropriateness, and benefit limits.
Coding and claim creation
Revesolv assures to accurately Code and Create the charges of your encounters. Our Certified Coders and Billers make sure to get the correct details entered on the claim. That contains, checking of CPT codes and HCPCS codes, ICD10 and Modifiers, ensure documentation is accurate and up to date and entering the data into billing system, claims scrubbing for accuracy of information so the claim can be sent to the clearinghouse with no errors. We assure a 98% and cleaner claim ratio to our clients. Our billing experts are well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules.
AR FOLLOW UP
We specialize in Aging A/R recovery. Insurance accounts receivables is a common problem within all type of medical practices. This causes a reduction in cash flow and loss of revenue. We pursue every old claim by assigning our dedicated team of Aging A/R specialists. Even if you don’t want to outsource your entire billing, we can help you with your aging A/R. If your in-house billing team can’t keep up with Aging, we can help!!
Upon doing the A/R (Account Receivable) our expert finds the Denials occurred due to many reasons like, coding, billing, patient, or provider errors. We guarantee to work and address those denials within the time frame of 48 hours from the time of denial posted or received. With 10+ years of RCM experience, we follow industry-standard key performance metrics to measure success and integrate best practices, so that you get the value of our proven experience and expertise.
Many Billing Companies, consider and treat the work of Payment Posting as a Data Entry process and do not assign this work to Industry Experts rather assign it to some inexperienced staff to get rid of the work at a low cost. At Revesolv, we do not take this approach for the payment posting work. We consider this work an important part of the Revenue Cycle Management Process. Every EOB/ERA has many things and criteria to observe like, (Billed amount, allowed amount, Patient Responsibility, Provider Discount, Check number, Check issue date, Check sent Address, information of cashed or not and information if the claim was forwarded to the secondary payer or not?
Having this much information on the EOB/ERA, how can anyone consider this work, as easy as data entry or typing work? Revesolv, got the industry expert who knows how to read any kind of payer EOB/ERAs. They take much caution while putting the details in your Practice Management software which can improve the accuracy of the data in your Practice Management Software for your monthly, yearly comparison. Accurate Payment posting can guarantee the collection per your agreed fee schedule from the payers, it can avoid direct billing to patient missing billing to secondary. It will help the office to get a clear picture of patient & insurance outstanding.
Patient reminder calls
Upon getting the accurate picture of insurance and patient outstanding balance in Practice Management software, Office Front desk, and effectively collect the amount from the patient upon having the patient at the office before the visit. Yes, every practice has few indiscipline patients who don’t pay their outstanding on time. Even a small ratio of such patients impacts the Practice revenue flow in the longer run. Here in such scenarios practice loss time and monies so Revesolv is at your rescue by offering reminder calls to your patients. We follow up with your patients and request them to remit the payment at the office at earliest. Such calls happen after the non-response of patients receiving 3+ statements from us. Moving such accounts to a collection agency should be the last option for any practice.
Enrollment & Credentialing
Enrollment Process is kind of preparing a bridge between provider and payers through clearinghouse. The enrollment process includes the verification of provider information & Billing/pay to address with payers. The enrollment process includes the Electronic Data Interchange (EDI), Electronic Remittance Advice (ERA) & Electronic Fund Transfer (EFT) process as well. Proper enrollment increases the payments from payers and avoid paperwork.
Credentialing Process refers to the process of verifying the proven skills, training, and education of healthcare providers. Verification of the providers’ credentials is done by contacting the “Primary Source”, which has provided the license, training, and education. The credentialing process is used by healthcare facilities as part of their hiring process and by insurance companies to allow the provider to participate in their network. Credentialing is also the validation of a provider in a private health plan and the approval to join the network. It is very important to remember that in today’s world of health insurance and revenue cycles, improper credentialing can lead to delayed or denied reimbursement for services provided.