Revenue Cycle Management Solution

Inefficiencies in the Revenue Cycle can result from complexities due to changing rules and regulations, but more often than not, from weak or ineffective business processes. Data-Core Healthcare's Revenue Cycle Management solution (AXIA-RCM) supports traditional and accountable care reimbursement models, working towards value based care. Your institution can thrive during this industry shift and drive greater profitability, efficiency, and enhanced quality of care.

Our data-driven software tools and experienced service teams can help achieve industry best practices across the revenue cycle. The Actionable Intelligence feature of AXIA improves processes, lets you manage proactively, uncovers hidden revenue opportunities, and improves profitability.

Revenue Cycle Management Solutions

Eligibility Verification

  • AXIA provides multiple channels to perform this critical activity. Our Patient Engagement Solution (AXIA-PE) has the option of verifying eligibility right after a patient registers. This can be followed with your organization’s established EDI process.
  • We can augment this process by providing resources to extract eligibility information from Payer websites or by calling when any of the previous modes have failed.

Medical Coding

  • Health Information Management (HIM) departments are challenged daily with retention of skilled and knowledgeable coders. The resulting staff shortages create coding backlogs and quality issues. These factors, in turn, have a direct impact on the organization’s bottom line due to higher claim denial rates and lower reimbursements.
  • Data-Core’s coding organization is built on a global team of experienced coders, tightly coupled with software tools that enhance their efficiencies.

Quality Audits

  • Healthcare organizations must adopt a standardized method to:
    • Measure coding quality performance
    • Define coding variance
    • Classify and report variances
  • Data-Core’s specialized team of coding quality professionals perform reviews of coded patient charts to ensure that they conform to established standards for any given level of acuity.

Claims Management

  • An efficient RevCycle model must include a process to recover overdue payments smoothly, and on time.
  • Our specialized services include:
    • Small Balance Claims – Many health systems and physician practices have a large number of small balance accounts which they cannot pursue cost effectively. Data-Core Healthcare has the systems and processes to reduce your workload.
    • Aged Claims - Aged accounts are claims which your staff and process haven’t been successful in resolving. As the weeks and months grow, they become harder to collect and often get passed over. Data-Core Healthcare knows how to resolve these accounts more efficiently, leaving your staff to work on current claims to improve your KPI’s.
    • System Conversions – Legacy system conversion is always complex and stressful. Data-Core Healthcare can manage your legacy A/R while your staff learns the new system.

Denial Management

  • Losing track of denied claims is like losing cash from your back pocket. Therefore, creating a strong workflow for denied claims establishes a successful denial strategy.
  • Our experienced denial processors not only handle the root cause analysis and take corrective action, but also create detailed reports to help providers prevent future denials.

Lockbox Processing

  • Our robust Lockbox process is geared towards timely handling of mailed remittances daily. Payments are deposited to the designated bank via Image Cash Letter.
  • Embedded within our Lockbox process is the ability to handle patient and payer correspondences. The documents are reviewed and routed to appropriate departments for necessary action.

Payment Posting

  • Accuracy in payment posting, one of the final steps in the reimbursement processes, is a critical function in revenue cycle management which directly affects the overall profitability. Payments can be automatically posted with ERAs while other insurance checks from EOBs and patient payments must be posted manually.
  • Payments from all sources are consolidated and analyzed prior to posting correctly into the respective patient accounts and reconciled with total reimbursements.

Patient Services

  • The patient services department of any healthcare organization is the link that allows the company to stay in touch with their patients. Whether it is through a telephone call or mail, the objective of this department is to ensure that the patient is satisfied with the services rendered; while guaranteeing the usage of the appropriate billing practices.
  • Our dedicated associates attend to patient questions and concerns while also dealing with all correspondence pertaining to the patient’s visit.