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Recent Reforms such as the MIPS and MACRA have created a focus on quality of care and value based models. Transcending the models of revenue based system to prepare the system in order to meet the demands of these ever evolving regulatory reforms is very essential.
Medical Billing at Rely On US is handled by experienced and skilled billers who stay on top of eligibility verification, entering charges, medical coding, claim transmission, payment posting, accounts receivables and denial management.
At Rely On Us, we embrace flexibility and work towards a customer friendly methodologies. We also ensure operational excellence towards reducing the costs, increasing the pace of revenue generation and the efficiency.
Eligibility verification is said to be first and foremost process in the revenue cycle management. Prior to the patient’s visit with the provider, it is very essential to have a clear understanding on the coverage. We communicate the practice well in advance regarding the eligibility related issues proactively. This ensures a hassle free communication with the patient and enables customer delight. We also check the requirement for any referral, any co-payment to be collected and if the patient’s insurance covers the service sought from the provider.
For every patient, the charges from the coded documents are entered into patient’s account. Entered charges are audited by the Quality Control team to make sure a “CLEAN CLAIM” is submitted. Entering the charges on time ensures prompt reimbursement. We also work with our customers to optimize the revenue days.
Our web platform on AWS ensures secure data interchange opportunities between Rely On Us and the practitioners. We ensure the review of coding before entering the charges or simultaneously entering the charges as per the customer requirements. Doing so, confirms increased accuracy of first pass rate of the claims.
We process the claims electronically and also through paper submissions. We also stay on top of rejections after the claims are scrubbed from the clearing houses and through our internal auditing processes. We generate reports and rectify the incorrect claims for further processing on a daily basis.
Timely entry of payments improves the patient communication and customer satisfaction. We at Rely On Us generate patient balance reports. Underpayments and Overpayments are captured accurately and followed promptly with the insurance.
All insurance claims which are unpaid are pursued by our team that have crossed a month bucket to bring down accounts receivable days of the claim. We at Rely on Us analyse the patient population which causes the backlogs and address them strategically. Our innovative strategies bring down the AR days below 50 on an average.
At Rely On Us, we believe denial management should commence prior to the treatment. We address the receivables on a priority basis with our unique strategies and re-file or appeal the claims. Our denial analysts fix the issues and send the claim for reprocessing. Wherever, the claims require more information from the provider, the gaps are filled, and in case of claim denial where the patient is responsible, the claim is billed to patient.
Our team does a regular follow up with those patients who have pending balance due once the insurance claim is processed. According to the business requirement, a patient statement is generated on a monthly basis. We stay ahead with proactive communication with regards to patient balances which needs to be moved to collections.
We provide monthly customized reports, which include Key Performance Indicators report, insurance aging reports, which provide details of the practice financial status and length of claim payment cycle.
Credentialing is one of the crucial processes in revenue cycle management. We have experts who can support on the necessary paperwork and follow-up for applications with regards to the enrollment of the provider with the payers. All payer contracts are followed through contract load date and copies of executed contract is provided.