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Having understood the physician pain, Rely On Us as a Revenue Cycle Management (RCM) company primarily focuses on improving the physician cash flow, reduce rejections and follow up with insurance / patients for prompt payments.
Our proven RCM strategies enhances revenue optimization and elevates the practice operational performance; more importantly help physician groups to address their day to day medical billing challenges and other revenue cycle management requirements.
As soon as we are on board, we quickly identify global issues and other process gaps to improve the Physicians cash flow / first pass rate & reduce rejections
Predominantly Rely On Us uses KPI metrics as a managing and checking point to improve the Net Collection Ratio of the Physician practice.
Best RCM techniques are deployed to address delinquent accounts to completion especially the old or aged AR.
Periodical reviews and management of bad debt accounts results in collection of payments.
Physician groups are always under tremendous stress to improve the quality of patient care and to reduce the healthcare cost.
Charges are entered and submitted within a TAT of 48 hours from the DOS
Clearing house rejections are worked to resolution within a TAT of 24 hours
Prior to the claim submission, Eligibility verification will be performed to avoid eligibility denials
Aggressive follow up on aged AR claims.
For each specialty, MGMA standards are used for guidance and followed upon
Three levels of quality checks are implemented to ensure that set quality target percentage is achieved
Refresher training sessions to all the staff on Insurance information’s and updates.
Weekly, Monthly & Quarterly dashboards on the agreed KPI’s are published
Reconciliation Dashboard - Services Performed Vs Charges Entered Vs Charges Submitted to the insurance Vs Charges Accepted by the insurance
Submission of a clean claim to the payer is always the priority
Rely On Us works on AR by Age Trail Balance (ATB) by Insurance wise, thereby assisting physicians in obtaining faster payments, and lesser AR days
Primary goal of Rely On Us is to ensure that Insurance AR days is always lesser than 40 days.
Please refer the below AR work Flow
AR is analyzed based on the ATB reports and appropriate work-files are created based on Rejection codes, Dollar threshold, Payer wise, Service Date Wise, No Activity vs Rejection, Provider, Location etc., and allotted to the team members.
AR Work files will be worked to completion.
Status of the claim will be assigned to each account in the work file post working. In addition to the status, an action code will be assigned indicating the action taken on the claim
At the end of every week, detailed report will be run to identify the trends and gaps along with the status of the physician account
In short, AR Team works the account to completion in the following 3 ways namely: -
Appealing or resubmission of claims for payments
Flipping the balance to the patient level based on the AR scenario
Adjusting the claims
Historical rejection data is compiled and used during refresher training program
Collection methodologies do vary by client depending on their policies and procedures
All accounts receive a series of phone calls and letters in addition to their statement series (Typically, each patient will receive two phone attempts and three letter attempts)
Delinquent accounts are identified and moved to collections.
Prioritization of accounts into various work queues
The account queues are sorted by balances, so special emphasis is always accorded to the higher patient balance accounts.
Our systematic approach ensures that all avenues of reimbursement from government eligibility program such as Medicaid, Charity Care and/or Financial Hardship are assessed and explored.
Lesser A/R Days
Faster insurance payments
Increase in First Pass Ratio
Increase in NCR
Underpayment Follow Up
Skip Tracing on high $ patient accounts
Reduced eligibility rejections
Denial Management & Aged AR follow up
Appeals and resubmission of claims wherever it is appropriate
Business Intelligence Reporting
We help you achieve your financial goals
* Lack of proper follow up
* Regular changes in Managed care contracts.
* Ever changing re-imbursement pattern
* Low revenue
* High bad debt
* Increase in AR aging
* Improved workflow process and increased productivity using In House AR Work Flow Tool
* Identify global trends
* Appeal claims
* Reduce aged AR
* Encourage electronic billing and resolve timely filing
* Target Payor specific denials
Assist to ensure an overall Denial Rate (% of Gross Revenue) <= 7%
Underpayments additional collection rate >= 75%
Appealed denials overturned rate 40-60%
Percentage of Insurance A/R above 120 days at 12-18%
Assist to ensure Insurance A/R Days maintained at 35-45
Insurance Net Collection rate retained at 94-97%
KPI: “Key Performance Indicators” helps us to review the performance of the process through various measures/metrics
Measures: Charges, Payments, Contractual Adjustments, Write Offs.
Metrics: AR Days, GCR, NCR, Self-Pay AR (%)