Handling complete practice revenue management, from claim creation to claim submission, A/R follow-up, denials management, payment posting, clearinghouse rejections, enrollment & credentialing, financial analysis, Audits, HIPAA compliance, and any relevant task.
RCM Manager Complete Practice Management System
- Patient Registration & Verification
- Coding & Documentation
- Claim Submission
- Claim Adjudication
- Payment
- Explanation of Benefits
- Patient Responsibility
- Appeals & Resubmission
- Record-Keeping and Compliance
AR Follow-up Services
- Review Aging Reports
- Contact Insurance Payers
- Resubmit Claims
- Follow Up with Patients
- Appeals
- Utilize Clearinghouses
- Escalate as Needed
- Regularly Recheck AR
Analyze Trends
Provider-Payer Communication
Verification of Benefits (VOB)
- Effective date of the insurance policy.
- The type of coverage (e.g., PPO, HMO, Medicare, Medicaid).
- Services covered (e.g., hospitalization, surgeries, outpatient care).
- Pre-authorization requirements
- Deductibles and out-of-pocket maximums
- Copayments or coinsurance
- Coverage limits or exclusions
- Referrals or pre-certifications
Reporting and Analytics
- Aging Reports
- Claim Status Reports
- Denial Reports
- Payment Reports
- A/R (Accounts Receivable) Reports
- Productivity Reports
- Referral Reports
- Provider Performance Reports:
- Compliance Reports
- Payer Analysis Reports
- Patient Financial Reports
- Monthly Payment Reports
Year-End Financial Reports