Rcm olution
Eligibility verification
Medicare Risk Adjustment Coding (HCC Coding) is a process that evaluates and adjusts payments to healthcare providers based on the health status and risk profile of their patients. It is a critical component for ensuring accurate reimbursement under Medicare Advantage plans. Here’s an overview of the different aspects of risk adjustment coding:
Benefits for Providers
- Accurate expense estimates
- Time efficiency
- Reduced errors and higher claim rates
Benefits for Providers
- Reduced stress with early bill estimates
- Informed choice of providers and services
Novelite RCM offers global, cost-effective RCM services with top-notch workflow, secure communication, and 100% HIPAA compliance. Save time and reduce claim denials by scheduling an appointment with us today.
Patient scheduling
Patient scheduling plays a critical role in Revenue Cycle Management (RCM) by serving as the first step in the billing and revenue process. Effective scheduling ensures that appointments are managed efficiently, reducing no-shows and optimising provider availability. By verifying insurance eligibility and obtaining prior authorizations during scheduling, potential issues are identified early, helping to prevent delays in care and payment.
Proper patient scheduling improves patient satisfaction and streamlines the overall revenue cycle by minimising errors, enhancing resource utilisation, and ensuring that patient data is accurate and complete from the start. This proactive approach sets the stage for smooth billing processes, quicker reimbursements, and improved financial performance for healthcare providers.
Authorizations
Authorizations are a vital component of Revenue Cycle Management (RCM) in healthcare, ensuring that services are approved by insurance providers before they are delivered. This process involves verifying whether a procedure, test, or treatment requires prior authorization and obtaining the necessary approvals to secure coverage. Proper management of authorizations helps prevent claim denials and reduces the risk of financial loss due to unpaid services.
Efficient authorization processes streamline the patient journey, enhance cash flow, and ensure compliance with payer requirements. By integrating authorizations into the RCM workflow, healthcare providers can minimise delays in care, improve patient satisfaction, and optimise their revenue cycle, ultimately contributing to a more robust financial performance.
Charge and Demographics entry
Charge and demographics entry is a critical step in Revenue Cycle Management (RCM) that involves capturing and entering patient information and service charges accurately into the billing system. Demographics entry includes collecting essential patient details such as name, date of birth, address, insurance information, and contact details, ensuring all data is complete and accurate.
Charge entry involves recording the services provided, including procedures, tests, and treatments, along with the corresponding codes and charges. Accurate charge and demographics entry is essential for clean claims submission, reducing the risk of claim rejections and denials. Properly managed entry processes enhance billing accuracy, speed up reimbursement, and support overall financial health for healthcare providers by ensuring that all charges are captured and billed correctly from the outset
Claims Submission
.At Novelite RCM, we are committed to leveraging electronic claim transmissions exclusively, acknowledging the inherent limitations and risks of traditional paper submissions. By opting for electronic claims, we enhance efficiency and accuracy in the billing process, reducing the potential for errors and delays that can occur with manual handling.
Our process is distinguished by a comprehensive and meticulous follow-up approach. From the moment a claim is submitted, we ensure it is thoroughly tracked through every stage until payer acknowledgment is received. This careful monitoring guarantees that no claim is lost or overlooked, and that each is processed in a timely manner.We also place a strong emphasis on daily monitoring of clearing-house rejections. By scrutinising these rejections promptly, we identify and address any issues that may arise, allowing for swift re-transmission of claims. This proactive approach helps to maintain a seamless and efficient claims process, ensuring that any potential disruptions are quickly resolved and that reimbursement is maximised.
Overall, our rigorous attention to electronic claim transmission, detailed tracking, and proactive issue resolution enables us to deliver a reliable and effective claims management service, ultimately supporting your financial performance and operational efficiency.
Payment Posting
Payment posting is a key function in Revenue Cycle Management (RCM) that involves recording payments received from insurance companies and patients into the healthcare provider’s billing system. This process provides a clear and accurate picture of the revenue cycle, allowing for quick identification of payment discrepancies, denials, or underpayments.
By accurately posting payments, healthcare providers can streamline cash flow, improve financial reporting, and expedite the follow-up process on outstanding balances. Effective payment posting also helps in identifying trends in payment delays or denials, enabling providers to address issues promptly. This step is crucial for maintaining accurate financial records, optimising revenue collection, and ensuring the financial stability of the healthcare practice.
AR follow up
AR Follow-Up is essential for managing unpaid or denied claims, ensuring timely reimbursement, and maintaining cash flow in the healthcare sector.
Why It Matters
Maximises Revenue
Ensures all claims are pursued and payments are collected.
Reduces Days in AR
Speeds up the claims process for quicker payments.
Improves Financial Health
Addresses denials and billing issues to maintain stability.
AR follow up Services
Patient Managemen
Resolves billing questions and facilitates payments.Reporting: Provides detailed AR status reports and performance analysis.
Partner with Novelite RCM to streamline your AR process, enhance cash flow, and improve financial health. Contact us today to learn more.
Claim Tracking
Systematic follow-up and resolution of outstanding claims.
Denial Handling
Investigates and corrects denials or rejections.
Denial management
Denial Management deals with claim denials, where a service is refused due to errors, which can be corrected unlike claim rejections. With denials increasing by 23% over the past four years and the high cost of rework, effective denial management is crucial. Ibex Medical Billing achieves a 94% success rate in this area.
Our Denial Management Strategies
Identify
Determine the root cause of denials, either through Claim Adjustment Reason Codes (CARC) or manual investigation by our skilled team.
Manage
- Add denied claims to our task list using automated tools.
- Sort and prioritise work using specialised software.
- Develop and execute action plans for each denial.
- Maintain a checklist of errors to prevent recurrence.
Monitor
Track the denial management process meticulously, documenting details to ensure accurate submissions and prevent future denials.
Prevent
Use monitored data to implement strategies that prevent future denials, assigning tasks to different teams to ensure efficient workflow and minimise revenue loss.
Patient payments and statements
At Novelite RCM, managing patient payments and statements is integral to our comprehensive Revenue Cycle Management services. We prioritise accurate and timely processing of patient payments to ensure a smooth financial experience for both providers and patients.
Our system facilitates efficient collection of patient payments through various methods, including online portals, mobile payments, and traditional methods. We ensure that all payments are accurately recorded and applied to the correct accounts, minimising errors and discrepancies. By streamlining payment processing, we help improve cash flow and reduce the administrative burden on your practice.
We generate clear, detailed statements for patients that outline their financial responsibilities, including balances, insurance adjustments, and payment due dates. Our statements are designed to be easily understandable, helping patients comprehend their charges and reduce the likelihood of payment delays. We also offer automated reminders and follow-ups to encourage timely payments and address any billing inquiries promptly.