Revenue Cycle Management
Increase Profitability, save up to 35% cost
Pro1Health RCM services are designed to streamline and optimize financial workflow of healthcare providers, ensuring maximum revenue efficiency and financial health. It encompasses all the administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.
Patient Scheduling and Registration
Patient scheduling and registration is a highly time-consuming and manual process. Our experienced team can manage the entire scheduling process, reduce no-shows, and improve patient engagement to ensure best possible outcomes for providers and patients.
We identify the level of care required for patient and reduce the waiting time, prioritize, and schedule the request to the correct department. To achieve better efficiency in the engagement processes we coordinate through multiple channels.
Our Services include
Schedule appointments using Patient Portal
Collect patient demographics, and medical conditions to
verify eligibility and obtain prior authorization
Coordinate using Patient Portal to schedule and confirm
patient appointments
Communicate with physicians and patients via email, phone,
and messaging system
Benefits of Patient Scheduling and Registration include
Improving patient engagement and satisfaction
Optimize physician calendar to minimize wait times
Reduce patient no-shows
Reduce denials with improved eligibility verification and
prior authorization
Automated reminders and follow ups
Track
patient payment history and outstanding payments
Benefits of eligibility verification services
Reduce
patient information-related denials
Improve
speed of care to patients
Reduce
days in A/R
Improved patient satisfaction
Improve
on collection and profitability
Improve
Quality of Service
Eligibility and Benefits Verification Services
Most of Claim denials is contributed by the absence of proper checks of patient eligibility for the services that is billed to the insurer. Pro1Health, provides insights on patient’s eligibility to the provider before the encounter. This information helps healthcare providers reduce their account receivable cycle and increase revenue and suggest course of treatment that is aligned with the scope of coverage
Our team has rich experience in handling patient eligibility verification and will provide quick turnaround.
Our eligibility and benefits verification service includes
Receive
the schedule of patients
Team
performs verification of primary and secondary coverage
details including benefits information.
Team
will verify patient demographic and policy information
including benefits, plan inclusions and exclusions.
Verify
patients’ coverage, co-pays, co-insurance, deductibles, and
claims mailing addresses on all primary and secondary payers
The
results are updated on the practice management system – member
ID, group ID, coverage dates, co-pay information.
Benefits of eligibility verification services
Reduce
patient information-related denials
Improve
speed of care to patients
Reduce
days in A/R
Improved patient satisfaction
Improve
on collection and profitability
Improve
Quality of Service
Patient Registration Process
Patient Registration has more impact on the revenue cycle as its causes delayed payments and claim denials. An established process for collecting patient demographic information helps against mistakes being made later. Accurate information will increase the rate of clean claim submissions while reducing payment delays and denials.
Components of Patient Registration Process
Collecting Demographic Information and Verification
Legal
Name, address, phone numbers and gender
Health insurance policy details
Social Security Number
Medicaid or Medicare Cards
Name,
address, phone number of the individual responsible for
payment
Special needs and care requirements
Benefits of Patient Registration Services
Reduced denial claims
Improved clean claim submission
Increased productivity due to quick turnaround time
Detailed Status updates and weekly reporting
Benefits of Medical Coding Services
Improved Quality, Productivity and Accuracy
Reduce
Turnaround Times
Decrease in DNFB
Improve
Provider Documentation
Support
Team to address issues
Medical Coding
Coding is an essential component in the revenue cycle management that helps in quality processes and productivity gains. Our team of AAPC certified coders ensure accurate application of procedure and diagnosis codes to the patient’s medical records. Our team adheres to the guidelines and match the right Current Procedural Terminology (CPT- 4) with the ICD 10 CM codes, to prevent coding denials and ensure no revenue loss to providers.
Pro1Health coding and auditing services makes your revenue cycle improve productivity and quality.
Ensure
ICD-10 compliance
Improve
Quality of Care
Monitor
Quality in coding process
Reduce
Turnaround Times
Our team has good insight of various medical procedures and understanding of different components within a procedure. The team ensures that there is no component that is not billed and work with the providers to understand the procedures and reduce the case of DNFB (Discharges not fully billed). We have a pool of skilled medical coding team who have required skill set and expertise to deliver best quality services.
Benefits of Medical Coding Services
Improved Quality, Productivity and Accuracy
Reduce
Turnaround Times
Decrease in DNFB
Improve
Provider Documentation
Support
Team to address issues
Claims Submission and Rejection Management
The claims submission process involves parsing of claims information from the revenue cycle system to the clearinghouse and addressing any rejections. This process enables in the identification of claims that are not correct and enables the medical billers to address the claims.
Batch
run from the RCM system to the clearinghouse system
Updates as appropriate to the exceptions
Parsing to the Payer Systems and corrections as
appropriate
Benefits
Our team will address the issues with the claims proactively and eliminate denials.
Avoid
Claim denials and get quicker reimbursement
Improve productivity and accuracy
Documentation of all business rules
Benefits of Medical Coding Services
Improved Quality, Productivity and Accuracy
Reduce
Turnaround Times
Decrease in DNFB
Improve
Provider Documentation
Support
Team to address issues
Accounts Receivable (A/R) Management
Every healthcare provider wishes to improve their cash flow, and this can be done with our effective A/R Management service. It is important that the follow-up is not only diligent but based on a strong governance process. Our A/R Management service to clients will accelerate and improve their financial management through proper analysis, follow-up with clients, for appropriate action to be taken.
Our team shall perform a thorough analysis of the Accounts Receivable with timeline, set a strategy and create a process for negotiation with the insurance companies to clean up the old and unresolved accounts.
A/R Management includes
Create Workflow – On analysis of the A/R, ageing buckets and workflows are
created for our team to follow-up.
Effective Follow-up – Our team has complete understanding as to the follow-up
process and ensure it is effectively done.
Multichannel Reach Out - Many payers today provide information via their website and
IVR services. We work with our clients to improve adoption of
websites by registering with payers. This reduces the effort
involved in making calls, and only those claims that require
follow-up are called upon.
Reduce DSO - Our diligent follow-up reduces Days Sales Outstanding. We
can obtain the status of the claim, identify denied claims and
file appeals.
Benefits of Medical Coding Services
Improved Quality, Productivity and Accuracy
Reduce
Turnaround Times
Decrease in DNFB
Improve
Provider Documentation
Support
Team to address issues
Denial Management
Denial Management is one of the most important pieces of a health Revenue Cycle. When insurance companies are denying an average of 10% of claims submitted, to ensure a health cash flow, healthcare organizations need to focus mainly on root cause and denial prevention.
Pro1Health uses a systematic, hands-on approach to ensure each claim receives the attention it needs to be resolved quickly, while also adhering to a strict systematic approach and defined best practices. This ensures maximum results and improves collections.
Resubmission:
Each denied claim is analyzed, issues with the claim are
resolved, claim is resubmitted, and follow-up done
regularly. We refile claim with correct ICD/CPT Codes,
provide supporting clinical documentation, understand
covered and non-covered services, and correct patient or
insurance information.
Denial Prevention:
Our service focuses on denial prevention by aggregating
denial reasons, perform analytics and address it with the
revenue cycle team, and/or the healthcare provider.
Correspondence and Appeals:
We validate the payer website for appeal formats, prepare
appeal letters and attach any clinical documentation to
reprocess the denied claims.
Benefits
Team
dedicated to focus on resolving claims
Perform analytics to reduce and prevent denials
A/R
management dashboards provide clear view of state of revenue
cycle
Develop policies and procedures for write-offs and
adjustments
Benefits
Arrest
revenue leakage by avoiding out of network denials
Improve
speed to care by ensuring that the specialist physicians you
call upon are credentialed ahead of the patient visits
Get
more patient referrals by becoming part of the health plan’s
network and improve your revenue.
Provider Enrollment and Credentialing Services
Provider credentialing, the process of getting a physician or a provider affiliated with payers, is a critical step in the revenue cycle. The process enables patients to utilize their insurance cards to pay for medical services consumed and enables the provider to get reimbursed for the medical services provided.
Pro1Health will help to get you credentialed faster as our team understands the process involved including the forms that is required by each payer, and their policies and procedures.
Provider Credentialing Process Involves
Completing the required documents and identifying the
exceptions
Validate practitioner / facility information
Collect
missing documents and update with payer’s database
Capture, label, and link images to specific provider /
facility in payer’s database
Update
provider information as per policies and procedures
Provider Enrollment Process Involves
Verify
Provider information on file before submission of claims
Validate and update provider billing address
Enroll
for electronic transactions
Monitor
the entire process to understand gaps
Benefits
Arrest
revenue leakage by avoiding out of network denials
Improve
speed to care by ensuring that the specialist physicians you
call upon are credentialed ahead of the patient visits
Get
more patient referrals by becoming part of the health plan’s
network and improve your revenue.