Revenue Cycle Management: The Process

The main steps in the revenue cycle management (RCM) process include verifying patient eligibility, reviewing draft encounters from the EHR, submitting encounters to the clearinghouse and payor, processing receipts via payment posting, and managing any claim issues.

Streamlined Eligibility Verification

Our software improves the patient eligibility verification process by parsing eligibility reports and automatically verifying critical details such as patient name and date of birth. This reduces errors and increases the accuracy and efficiency of the verification process, ensuring a smoother patient experience.

Coder - Submitting the Encounter/Claims

In the next step of the RCM process, our system ensures that encounters are correctly structured and validated, achieving a high First Pass Rate (FPR) for clean claims. Automated functions place encounters on hold if issues are detected, ensuring only well-prepared claims are submitted.

Encounter and Claim Analysis

We analyze the content of each claim within an encounter against thousands of rules based on procedure codes, modifiers, place of service, diagnosis codes, and insurance plans. Our rules engine enables automatic submission of encounters with high confidence, streamlining the process and improving efficiency.

Collection Analyst

Our Collection Analysts handle claims that did not pay as expected. Our system includes features such as automated triage and preliminary checks to correct basic errors before the Collection Analyst reviews complex issues.

This ensures claims are handled efficiently, with a focus on continuous improvement and learning from each denial to minimize future issues.