While the complexity in generating revenue is increasing, hospitals are also facing a lot of pressure to reduce costs. Hospital revenue cycle outsourcing is an area many health systems and hospitals have increased consideration for. Your core expertise lies in providing quality patient care. So, why not control costs by managing your expensive administrative functions? Additionally, your hospital revenue cycle management services partner will implement efficient billing processes, which will improve your reimbursement and assist you in maintaining a healthy cash flow.
Tracking critical KPIs can provide insight into the state of your revenue cycle. And that is exactly what we do! The health and success of your services relies considerably on the efficiency of your revenue cycle. Outsourcing hospital billing services to us can help streamline your process. Swift collections and improved cash flow are ensured through our hospital revenue cycle management services. By integrating people, processes and technology, we can help you improve your system efficiencies, meet organizational needs and reduce operational cost.
To receive reimbursements for services provided, hospitals need to verify each patient’s eligibility and benefits before the patient visits. This helps determine information not only about insurance coverage, but also patient’s responsibility. Incorrect insurance information can result in delayed payments, rejected claims and delays in care provision. To improve your clean claim submissions, our team verifies coverage on all primary and secondary payers, follows-up with patients for any missing or incorrect information and initiates prior authorization requests and obtains treatment approvals, whenever required.
Accurately capturing patient details in the demographic entry process is important as it forms the basis for the patient’s medical record. To facilitate quick claims processing, our team captures and validates patient details, payment information, insurance coverage and any additional medical information such as allergies, special requirements, etc.
Coding is a crucial component of the hospital billing process. Appropriate use of CPT, HCPCS, ICD codes and modifiers are critical for accurate reimbursement for all services rendered. Our certified coders are experienced across various specialties and care settings and are regularly educated on updated coding guidelines, to ensure high coding accuracy and mitigate compliance risk. That’s not all! With a separate team of quality auditors, we have built audits into the process to ensure there is a comprehensive review of the services coded.
The charge entry process decides the reimbursement amount hospitals will receive from payers. The patient account value is assigned using the coded chart and appropriate fee schedule. Accuracy is key while processing charge entry transactions. Thus, we ensure effective collaboration between the coding and charge entry teams to make sure appropriate reimbursement is obtained. Our charge entry team captures patient demographic information, date and place of service, billing provider details, referring provider, admission date, prior authorization number, CPT/procedure codes, diagnosis codes, modifiers and number of units with exceptional accuracy. Charges are entered into the hospital’s system and reviewed for accuracy before claims are submitted to a clearinghouse. We also perform charge entry audits to identify missed charges, over-billing or coding errors, which would result in lost revenue.
Our payment posting team does not just process payments, but analyzes reimbursement and denial trends to understand the effectiveness of your hospital’s revenue cycle. Our payment posting services include patient payment posting, electronic remittance advisory (ERA) posting, manual payment posting and denial posting.
Accounts receivable management is an important part of the revenue cycle. Issues with A/R will directly impact hospital’s margins, debt and organizational financial health. Our team will analyze your financials, identify errors and implement efficient processes to collect payments and clear backlogs of unresolved A/R within a quick turnaround time. In short, you can trust us to convert your receivables to revenue!
Dealing with claim denials can be a cumbersome task. Access our expertise to streamline workflows for improved and efficient collections. Our team can help health systems and hospitals identify and correct root causes of denials, resolve underpayments, appeal denied claims and improve your financial performance.
A credit balance is a liability in your accounts receivable ledger. Failure to address credit balance accounts can lead to compliance risks and penalties. With our credit balance resolution services, you will reduce financial liability, maintain the integrity of your revenue cycle and remain in regulatory compliance. Our team will analyze your credit balances, identify overpayments, correct errors and generate patient/insurance refund letters in a timely manner.
Billing can be overwhelming. Implementing a streamlined and compliant billing process is a daunting task. With our years of experience coupled with our understanding of the nuances of the healthcare regulatory environment, we devise strategies and processes to adapt to your hospital’s goals and maximize reimbursements.
Managing hospital billing in-house can be expensive. With our hospital billing services, you can save costs associated with this process such as salaries and benefits for staff, technology, hardware and training.
Not only does outsourcing to us help you save costs, we also help accelerate your revenue through timely claims submission and increased reimbursement. There’s no doubt that your hospital will improve its profitability.
Handling your billing in-house requires a lot of time and effort. Time and effort that could be directed towards your core expertise – patient care. Let us focus on your financial health, while you get to focus on your patients’ health.