Working in the healthcare industry can be very challenging. With a growing population, not only do we have to deal with the shortage of providers, turnover of staff, constantly changing regulations, technology and payer demands, but we also need to provide access to care with fewer resource.
With the implementation of EHR, one may think that billing process has become automated, very efficient and minimal human intervention is required in billing activities. But in reality, the situation is not that simple. The time that the staff used to manually post charges is now needed to review and reconcile transactions in the system. The challenges faced by a billing department vary according to practice, as there are different group of people who are responsible for the efficiency of billing process. Providers, front desk staff, billing staff and software (EPM & EHR, clearing house) are key factors in establishing an efficient billing process.
What is Revenue Cycle Management?
Revenue Cycle Management (RCM) is the process which includes the generation of an accurate claim, submission of a claim, payment on a claim, and posting of a claim hence collecting revenue of services being rendered. It entails the use of technology to track the claims being processed through each stage of its life cycle so the healthcare provider doing the billing can follow the process and address any issues, allowing for a continuous stream of revenue generation.
While most may know what the RCM is, your sites/clinics may need to assess and focus on improving efficiency in some or all of these areas. A lot can go wrong during the revenue cycle and MMHCS is here to provide you with extraordinary expertise through our understanding the programs and services you provide and align the revenue you should be collecting.
RCM Services Scope
Revenue Cycle services involve focusing on maximizing maintenance and growth. To do that one must start at the source of financial gain in the medical office; claims. The patient calls for an appointment, staff checks eligibility and schedules the patient, patient registers at the office and verifies personal information, staff collects any payments required, clinician/provider sees the patient, visit is completed and documentation is finished, information is reviewed and processed, clean claim sent to insurance company (payor), payor processes claim and sends back either a payment or denial, staff then posts payments or does denial management to reprocess the claim and get paid. This is universal for Community Health Centers and Private Providers alike!
There are several steps in the revenue cycle and a lot of opportunities for things to go wrong. Keep things right; have us provide our Billing services and we will make your practice as efficient as possible and maximize your financial return! See services included in the scope of RCM below.
Billing: This step includes encounter review and charge acceptance involving eligibility verification and accuracy of all charges before submitting to the payer. Also during this process, we ensure that all encounters are accepted and billed to the applicable payor. This includes reviewing documentation and records, reconciling all encounters daily, weekly, and monthly using high level analysis, as well as working on all edits and errors both internally and with the client.
Coding: MMHCS’s coding for services is done by utilizing our highly trained certified coders. During this service, we would optimize the client’s revenue while reducing compliance risk, increase cash flow by reducing lag days, and improve claims submission.
payors to adjudicate the claim that might have been denied initially due to many different reasons. A detailed reason code analysis is completed by provider and location to minimize the denials during initial claim submission. We will also be educating the staff on specific coverage of programs and series including CHDP, Family Pact, Medi-Cal, Presumptive Eligibility, Cancer Detection Program, etc. Please note that the client has the flexibility to provide us their current and or old Accounts Receivable as per their need requirements.
Our eligibility services include capturing eligibility to reduce claim errors and capturing missed opportunities, all directly relating to increasing and timely cash flow. We can provide eligibility in many different case scenarios:
- Eligibility prior to scheduled appointments.
- Verifying eligibility on demand before claims are submitted to the payor.
- Retro eligibility on claims that were never captured due to patient being self-pay/uninsured during date of
This process includes posting all electronic and manual Remittance Advices (RA). Each RA is reconciled with the check that has been received by accounting either electronically or manually. This process requires very tedious and detailed work due to required adjustments depending on how the contracts might be set up in clients practice management system. This process also includes making all required adjustments based on the contracts when posting receipts.