Revenue Cycle Management & Claims Followup

Revenue Cycle Management

Revenue Cycle and Profit margins are the lifeline of medical services. The health and success of your services is proportionate to the efficiency of your revenue cycle. CORE OBJECTIVE offers you skilled resources that specialize in accounts receivable as well as denial management.

Extensive knowledge and experience of medical billing across multiple specialties, multiple platforms and various insurances & denials makes us a predominant driver of your timely cash flow. Our teams strive for the best results. Swift collections and improved cash flow is ensured through our AR management services.

Appointment Scheduling & Patient Registration

Eligibility & Benefits

Verification of Eligibility and Benefits is of vital importance before the services are rendered. The timely determination helps providers to get a clear view of patient’s coverage, Out of Network benefits and accurate information of other benefits such as vision, dental, etc.

Pre-Authorization

Determine the Prior Authorization requirements
Preparing & submitting requisite information to insurance
Follow-Up on submitted documents
Identifying authorization issues and notifying providers

Coding & Audits

Coding is a crucial component of RCM. It’s imperative that rendered services are coded correctly & be more specific. This includes the appropriate use of CPT, Diagnosis Codes and Modifiers. With the vast expertise that our coders bring, we are able to efficiently and accurately code the services in compliance with ICD-10 guidelines. We pride ourselves in having a separate audit team, which specializes in comprehensive review of the services coded.

Charge Entry & Entry Audits

1) Charge Entry

The main challenge faced by providers is of Charge entry and Turnaround time. We have reduced turnaround time for such practices from 72 hours to 24 hours. This includes reviewing of the superbills and submitting clean claims to insurances via clearing houses or paper submission within the stipulated time frame.

2) Entry Audits

The most common error while entering the charges is Human Error. We help in reducing such errors and increasing the efficiency. With our current clients, the charge entry errors were reduced up to 5% which helped in submission of clean claims, lesser denials and lower AR days.

Payment Posting - Automatic & Manual

1) Automatic Posting

The current technology makes it easy for all insurances as well as patients to make payments electronically. Electronic Remittances contain high volume of payment transactions. We process the batches and segregate them into denials & payments for further processing.

2) Manual Posting

Explanation of Benefits (EOB) received via mail is captured in form of scanned images. The information captured is posted to each patient account and claim.

AR Calling

AR Calling is of vital importance post claim submission. It identifies the adjudication status of the submitted claim and helps in understanding the outcome of the claim. The early notification of denial helps in correcting the claim at the initial stage and saves it from getting ‘Untimely’ for appeals or corrections.

Denial Management

This is one of the most critical vertical of RCM. A major portion of the revenue is stuck here and requires additional attention. We have a dedicated team for denial management who are experienced in identifying different types of denials and providing corrective action for them. We send out periodic reports to providers by identifying common denial types and ways to avoid it for future submission.

Patient Statements

There is a portion of revenue that is dependent on Self-Pay or patient payments, which makes patient follow up very important. We help in sending out statements on a regular basis and generally follow up with patients as per clients’ needs.

Whether your medical claims are billed electronically or paper-billed by mail, it is imperative that a consistent follow up is done with the insurance carriers to obtain claim status.

Once the bill has been received by the insurance company, you do not have to be at their mercy to get paid in a timely manner. We at CORE OBJECTIVE ensure that your claims get settled in time.

Depending on the billing method, you should expect to receive payment in as little as 15 days. If your insurance payments are averaging a turnaround time longer than 30 days from the time your bills are sent out until you receive payment, we follow up with them, diligently.

Following up on the status of your claims can definitely improve your accounts receivable days.

Reasons You Need to Follow-Up on AR

There are three reasons why you need to follow-up on your medical claims.

1. The claim was never received.

The biggest delay in payment is due to the claim not being on file. In other words, the claim was not received. This usually happens mostly with paper claims getting mysteriously lost. To avoid this, it is wise to send claims electronically when you can.

If the claim hasn’t been followed-up on quickly, it could be a month or longer before you would even know the insurance company hasn’t received the claim. For paper claims, allow 10 business days before calling to see if the claim has been received. For electronically billed claims, you should be able to call within 5 business days.

The sooner you are aware that the claim has not been received, the sooner you can get another claim out the door.

2. The claim has been denied.

Depending on the denial reason, you can have the new claim sent out way before you even get the paper denial through the mail. By calling the insurance company and finding out the denial reason instead of waiting to receive the denial in the mail, you can possibly correct the reason the claim was denied. Resubmitting the claim days up to 7 days earlier than waiting for the denial in the mail will definitely shorten the turn-around time for your payment.

The bottom line is getting a head start on your denials to get the claims process moving again.

3. The claim is pending for information from the member.

Sometimes claims can be placed in pending for a certain amount of time due to additional information needed from the member. Although the insurer has probably sent the patient a letter in the mail, it would be wise for your collectors to contact him or her as well.

One reason is that by calling the insurance, you can notify the patient before the letter ever reaches them. Also, if you can get them on the phone, you can hold a conference call with the member and insurer to make sure the information is given and received.

Revenue Cycle Management & Claims Followup