We accurately enter the patient demographic data from hospital face sheets and other sources to comply with regulations and protect health information. Our data entry team implements multiple quality checks to ensure that the correct patient’s name, date of birth, and insurance ID are accurately entered. If the client systems can support it, automation through interfacing is also an option.
Our team of coders has extensive experience in various specialties, such as Cardiology, Radiology, Gastroenterology, Emergency, Audiology, and Ambulance. They are skilled in abstracting from both paper and electronic records and perform coding validation, assigning ICD, CPT, and HCC codes. All coders are trained and certified, and they identify issues with physician documentation that can lead to improving reimbursement and staying compliant with AMA and ASA guidelines.
When a client is not able to do electronic charge entry, our staff take the responsibility for doing manual entries. It is important to maintain accuracy in charge entry, with a minimum of 98% to ensure that the correct CPT service codes are entered for the correct patient. Incorrect entries can cause numerous compliance issues that may lead to problems with the carrier. Choosing the wrong patient or entering an incorrect diagnosis or procedure can result in incorrect health history. To ensure minimum errors, all our data entry processes undergo multi-level audits. Our staff have extensive experience in all areas of the billing cycle and are more than just data processors.
Accurate payment posting is crucial to ensure proper management of accounts receivable, minimize credit liabilities, and correctly bill patients and secondary carriers. Our staff members undergo thorough training in Accounts Receivable principles before they are assigned to Payment Posting. Our payment posters are well-versed in the various types of reimbursement, such as Government programs, Managed Care, Fee for service, In-network, and out-of-network. Regardless of their experience, each agent undergoes RCS training to learn how to calculate allowable, deductibles & patient responsibility. They also receive extensive training on posting line-item denials and understand write-offs and adjustments. To ensure that we provide personalized services, each client receives a profile questionnaire that is used to design the decision tree for the payment poster. Our process includes Electronic Remit, manual insurance payments, and patient payment posting. We balance EFTs to the electronic remits plus other daily transactions and ensure rejections are worked and daily books are reconciled.
Submitting clean claims is essential for practices to receive timely and maximum reimbursements while minimizing follow-up costs. At RevCentric, we ensure that claims are thoroughly checked and corrected for any errors before transmission. Our team stays up-to-date with payer billing rules and changes in CPT codes to ensure accurate and efficient claim submissions.
Insurance payers often change their payment rules, which can result in denials of claims. These denials can significantly delay or denial of payments. At RevCentric, we have trained agents who can manage various types of denials, underpayments, and no-payments. We understand that timelines are crucial in the follow-up process, and we manage the aging of accounts receivable accordingly. We categorize AR by Denial types and Insurance types, and our coders review the denials for medical necessity and file written appeals if needed. Our agents are well-trained in handling phone calls with payers and can resubmit claims where possible. We are an action-driven team focused on recovering revenues with efficiency. Our goal is to achieve a one-touch AR process for payment.
We specialize in clean-up projects and ongoing management of Credit Balances. Our team of Credit Balance specialists are well-versed in the accounting principles of debits and credits. Credit Balances can occur due to various reasons such as accounting/posting errors, miscalculations in coinsurance amounts, or duplicate payments made by the same or other insurers. Our specialists possess the expertise to accurately identify a credit liability from an adjustment, posting correction, or COB and follow the necessary procedures to resolve the credit.
The revenue cycle of the healthcare industry commences with the registration of patients. This initial interaction with the patient is of utmost importance in the billing process. Gathering accurate and complete personal and financial information, as well as ensuring the verification process is error-free, is crucial for accurate billing and reimbursement. To minimize errors, our staff are trained in using automated and online eligibility portals. They also record patient responsibility, deductibles, eligibility periods, and exclusions in the Patient Financial systems. We perform pre-visit validation by cross-checking the appointment schedule and/or post-visit verification to ensure that the service is billed to the correct carrier or responsible party. Our staff is knowledgeable about clinical diagnoses and procedures that require pre-certification.
Our document management department specializes in abstracting, indexing, and filing documents electronically. We provide the following services:
Our team of experts is highly skilled in providing services for Medicare Advantage (MA) / Medicare Advantage Prescription Drug (MAPD) plans.
WIDUNI C-SaaS is designed with the healthcare sector’s unique challenges in mind, particularly in managing revenue cycles. Our partnership delivers solutions that simplify financial operations while enabling physicians to focus more on patient care. Key areas of integration include:
Our partnership extends beyond RCM. WIDUNI C-SaaS will also serve as a powerful enabler in other critical healthcare areas, including:
By leveraging the strengths of WIDUNI C-SaaS, we’re helping healthcare organizations reduce operational costs and enhance overall performance, ultimately benefiting physicians by creating more efficient, streamlined workflows. As WIDUNI’s ambassador in the healthcare industry and beyond, [RCM Company Name] is dedicated to supporting businesses in all sectors as they transition to the digital future.