Our healthcare admin assistant will take care of your Revenue Cycle Management process end-to-end.
Revenue Cycle Management Process end-to-end:
- Patient Scheduling Your healthcare admins assistant will answer phones and schedule patients’ appointments. He/She will also collect any applicable copays/deductibles.
- Benefit and Eligibility Verification At the time of scheduling, the patient's insurance information is captured so your healthcare admin assistant may verify benefits and determine insurance coverage. In this way, if necessary, a financial planning engagement can be arranged in advance of medical services rendered and appropriate patient contributions can be collected at the time of service or scheduling.
- Pre-authorization During the Benefit and Eligibility verification, the patient’s insurance carrier may inform the provider that they need to submit a pre-authorization to provide and be reimbursed for services to the patient. Your healthcare admins assistant will proceed to obtain authorization for your services.
- Medical Coding Your healthcare admin assistant will code your visits based on information in HER.
- Charge Capture / Claims Generation & Submission Your healthcare admin assistant will translate your services rendered into the appropriate CPT and ICD10 codes that are tied together with the patient demographic and insurance information as well as your rendering provider and facility information to create a claim that is submitted to an insurance company for payment.
- Cash Posting/Payment Posting Your healthcare admin assistant will record communication of insurance decisions against the claim on a line-by-line basis. Should there be a patient share of cost after the payment is posted these amounts will be transferred to the patient so that patient statements can be sent out to collect this amount.
- Secondary Billing If a patient has multiple insurances, then once the primary insurance has adjudicated the claim the balance is transferred to the secondary insurance for payment. Your healthcare admin assistant will bill second insurance with the primary EOB to complete the proess.
- Insurance Follow-up If the claim adjudication results in a denial, it is posted on the claim, your healthcare admin assistant will review the reasons for non-payment and take the necessary steps to appeal and get the claim re-processed as appropriate. Should this be due to non-covered services then your healthcare admin assistant will transfer the balance to the patient and request payment from patient.
- Denial Management Your healthcare admin assistant will work on denial management to make sure appeal for reimbursements with insurance companies are done timely.
- Accounts Receivable Your healthcare admin assistant will work on your Accounts Receivables (AR) to collect outstanding amount that is pending for services you have rendered Your healthcare admin assistant will do both a) Insurance follow-up, which is to collect payment from the insurance company and b) Patient follow-up, which is collection of any outstanding payment that is the patient's financial responsibility (copays, coinsurance, or other out-of-pocket medical costs).