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Medical Biller & Coder, RCM Services & Dental Coding | RM Health Care

OUR SERVICES

CODING

ANALYTICS

CHARGES

PAYMENTS

MCCA

AR

RCM

How do we do it?

  AAPC and AHIMA certified coders

  Very experienced Billing and Coding staff

  Quality Control and Quality Assurance Processes

  Six Sigma delivery models

  Persistent AR Follow-up team

  Experienced Management team with advanced analytics

  In-house workflow solution to support your team at RM Health

  HIPAA compliant Work Space

  ISO 9001 certified process flows

  Every penny on the claim is tracked by a process

What Could we do?

  Clean Claim submission Rate: 95-98% [MGMA Standards]

  Denial Management: All denials will be addressed within 48 hours of receipt

  Reduced Payment cycle for Less AR Days

  Account Receivables: 90 days < 15%

  Our Teams deliver at least 98% quality on all services

Our Services

Coding

  Professional and Facility Coding.

  All our coders are Life Science graduates​.

  97% - 98% accuracy rate confirmed by Client side audit teams.

  Our internal quality assurance procedures maintain strict coding standards.

  Our Team of available coding specialists ensure that compliance is not compromised by an effort to maintain productivity.

Some of the Specialties we handle

Anesthesia, Radiology, Emergency, Urgent Care, E&M, Podiatry, Pathology, Neurology, Nephrology, Urology, Surgery, Cardiology, Radiation Oncology, Orthopedic, Ophthalmology

Medical Coding Process Flow

Retrieve medical records or access the client's EHR or PMS through a secured Connection or cloud.
Pre-coding to check and validate the correctness of the information.
Review the records and assign the appropriate procedure (CPT) and diagnosis codes (ICD).
Complete audit of the coded documents by our QA team.
Batch completion report sent to the client.
Review feedback from the client on any nuances.

Analytics

   Detailed Practice Health analysis provided month on month.

   RPV Analysis by Payor.

   Route cause analysis on the payment trend.

   Service performance trend.

   Payor performance trend.

   DSO, 120+, cash from 90+.

   Charges, payments, adjustments 3 months rolling.

   Credentialing progress.

   Movement in AR buckets.

   Year on Year, Month on Month Comparison.

   GCR, NCR.



Charges

   Creation of New Patient account

   Updating Demographics based on need.

   Selection and Updating of Insurance /Self Pay.

   Entry into billing system from coded documents.

   Eligibility verification of insurance/IPA.

   97% - 98% accuracy rate confirmed by Client side audit teams.

   Experienced Charge Entry team lead by a six sigma certified account manager.


Payments

   Review Payments from payors to ascertain the adherence to the contract

   Investigate allowable against contract.

   Report the payment cycle delays.

   MIPS and MACRA reporting of penalties and incentives.

   providing inputs to providers for better contract negotiations.

   97% - 98% accuracy rate confirmed by Client side audit teams.

   Experienced analyst team lead by a six sigma certified account managers.


Managed Care Compliance Audit

   Review Payments from payors to ascertain the adherence to the contract.

   Investigate allowable against contract.

   Report the payment cycle delays.

   MIPS and MACRA reporting of penalties and incentives.

   providing inputs to providers for better contract negotiations.

   Submit documentation for reviewed Claims necessary for payment to responsible party, including claims, itemized statements, pre-certification documents, and referrals.

   97% - 98% accuracy rate confirmed by Client side audit teams.

   Experienced analyst team lead by a six sigma certified account managers.



Accounts Receivable

   Correspondence logging (from mail/EOBs) into practice management system from insurance companies.

   Investigate pending Claims by contacting the insurance carrier, physician, and medical records personnel as required.

   Follow up contact of responsible parties on third party Claims to secure payment, which payment shall be made directly to Customer by responsible parties. Methods of follow up contact including telephone contact, tracer letters (not to be mailed from India), submission of Claims, and faxed status request to third party payers.

   Submission of electronic claims through a clearinghouse contracted with by Client.

   A/R follow-up for denied claims until resolution, including claims “statusing” – for 90 or 120 days and then move to collections.

   Submit documentation for reviewed Claims necessary for payment to responsible party, including claims, itemized statements, pre-certification documents, and referrals.

   97% - 98% accuracy rate confirmed by Client side audit teams.

   Experienced Follow up team lead by a six sigma certified account manager.



Revenue Cycle Management

   Professional and Facility Coding.

   Payment posting, revenue reconciliation, and refund processing.

   Pre-appointment verification enabling practices collect the out of pocket upfront.

   Focused review of Payor/clearing house rejections.

   Patient Follow-up and Statement processing.

   Focused analytics to quickly identify trends and increase cash flow.

   On-Demand advanced reporting.

   Practice Health Analytics.

   Managed care compliance audits to review payments against contracts.