Recruiting Certified Medical Coders  

Revenue cycle management is the financial process healthcare facilities use to manage the administrative and clinical functions associated with patient appointment, billing, claims processing, and revenue generation.

The revenue cycle management process begins when the patient makes the appointment and enters the healthcare system and concludes with processing of the payment for the healthcare services rendered by the provider.

HOM’s dynamic RCM ecosystem reduces your turnaround time, fastrack payments, and keeps your cashflow smooth and healthy. We help you reduce the gap between providing a service and receiving payment with our RCM services. We create a robust RCM workflow that facilitates seamless financial transactions, ensuring the optimal functioning of our healthcare establishments.

Our Tech

Our technology enables seamless operations and improves procedural efficiency reducing processing time by up to 50% and resulting in higher satisfaction.

A robust system to collect, track and maintain data through the latest technology and infrastructure.

All verification and legitimization processes comply with NCQA, URAC, and JCAHO standards.

Highest productivity and quality standards with competitive pricing.

Secure storage of all documents on the client’s server, less chance of a breach.

More acquainted with payor requirements for the credentialing.

Process

The revenue cycle starts with pre visit services which is the first block of RCM and it includes the following steps in order:

  1. Scheduling and Demographic Entry: This step is the first entry of the patient into the system by scheduling appointment and collecting patient’s information.
  2. Eligibility Verification: The next step is validating the patient’s insurance information, coverage and benefits.
  3. Prior Authorization: The pre visit block concludes with obtaining prior approval from the payor to ensure the payment is received for the prescribed procedure, medication or service.

Starting with pre-visit services, the revenue cycle moves into claim prep which is the second block of RCM. Claim prep includes the following steps in order:

  1. Medical Coding: Medical Coding involves identification of medical diagnosis and procedures and documenting them in a patient’s medical record as universally accepted codes.
  2. Billing and Charge Posting: involves recording information about the services provided into a medical claim.
  3. Claim Management: determines the amount of reimbursement the provider will receive after the insurance company clear the dues.
  4. Utilization Management: is the evaluation of the medical necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities.

Essential Value Adds services contribute to the overall success of the primary blocks which include:

  1. CDI/Chart Prep: ensures the events of the patient encounter are captured accurately and the electronic health records properly reflect the services provided.
  2. Credentialing: validates that a physician meets standards of delivering clinical care wherein the insurance verifies physician’s education, affiliations, licenses, certifications, training, and ensures absence of malpractice and any adverse clinical occurrences.
  3. Referral Management: is a process of suending a patient to another practitioner (ex. specialist) for consultation or a health care service that the referring source believes is necessary but is not prepared or qualified to provide.
  4. Quality (HEDIS): HEDIS is a set of standardized performance measures developed by the NCQA to objectively measure, report, and compare quality across health plans.

The primary blocks of RCM conclude with the Receive Payment block which includes the following steps:

  1. Payment Posting: is reconciling the payments received from the insurance payer to each individual claim. Once payments are posted, any secondary claims can be created and submitted.
  2. Denial / AR Management: is tracking and managing unpaid claims ensuring that no time is lost on pursuing every reimbursement possibility.

Our Edge

01

Providing end-to-end RCM services

02

Industry-leading coding accuracy

03

State-of-the-art in-house tech

04

Certified and experienced workflow

Up to

70-80%

reduction in operational costs

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