The first step in the revenue cycle is patient registration and eligibility verification. It is necessary to check the insurance benefits of a patient prior to generating a claim. This is done through an online verification process or by a telephone call to the insurance provider. This process, when done properly and in a timely manner, significantly reduces the chance of denial of payments and subsequent rework of claims.
Health information management departments are challenged daily with the retention of skilled and knowledgeable coders. This, in turn, has a direct impact on the organization’s bottom line. To address this issue, most of the providers outsource medical coding and billing. Data-Core Healthcare has built a global team of experienced coders and developed software tools that enhance their coding effectiveness.
Medical Coding being a critical aspect of the Revenue Cycle, regular audits are necessary to measure coding quality performance and classify and report coding variances against standard practices. Data-Core Healthcare’s specialized team of coding quality professionals perform reviews of coded patient charts to ensure that they adhere to established standards for any given level of acuity.
Data-Core Healthcare’s Lockbox process is aimed at timely and accurate handling of mailed remittances on a daily basis. Processing efficiency is improved using Robotic Process Automation (RPA) components. Payments are deposited to the designated bank anywhere in the U.S. via Image Cash Letter. Embedded within our Lockbox process is the ability to handle patient and payer correspondences. These documents are reviewed and routed to appropriate departments of the providers for necessary action.
Data-Core Healthcare’s team of medical billing specialists evaluate the A/R aging report and contacts the payer to determine why certain claims have not yet been resolved. The team prioritizes the claims based on value and age and takes the appropriate actions to move the claims along in the process.
Electronic payments are posted through Electronic Remittance Advice (ERA) and verified by our Posting Specialists. Check payments are posted manually from the Explanation of Benefits (EOBs). Payments from all sources are consolidated and analyzed prior to posting into the respective patient accounts and reconciled with total reimbursements.
Our dedicated associates attend to all correspondence pertaining to a patient’s visit. The team reviews the correspondence and takes the necessary actions to ensure patient satisfaction with the episode of care.
With Data-Core Healthcare, denial management starts even before the claim is submitted. Our Denial Management Solution predicts possible denials, allowing the Denial Specialist to make the necessary corrections prior to submissions. However, if a claim is ultimately denied, our specialists not only work in correcting and reversing the denial process, they use this data for our AI/ML-based Engine to ‘learn’ from the mistake.
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