This is very important to ensure that all the data/information is precisely stored and saved. This could avoid patient demographics denials. The data/information is backed up in the EMR as per required PHI policy.

Accumedr RCM makes sure to enter the patient demographics/charges with 100% accuracy with a two level audit, once the demo/charge entry process is completed. The PHI data is completely secured and hassle free.

Providers needs to be credentialed with the payers in order for their claims to processed as in network. If the providers don’t get credentialed, the claims will be processed as out of network and sometimes even get denied.

We help the providers to get credentialed with the payers. We take care of all the paper work and ensure that the provider gets credentialed with all the payers.

EDI Enrollment is a process related to the clearing house. Provider has to complete the EDI enrollment with the payers in order to submit the claims electronically and received the ERA’s and EOB’s. Besides the EDI enrollment is required to even the EFT’s from the payers.

We are EDI experts, the first thing we do is to complete the EDI enrollment process with the payers. Providers can opt any clearing houses they prefer. Some of the well know clearing houses are Trizetto and Waystar. We take care of the complete paper work.

It is always wise to check the patient’s eligibility with the insurances before the patient’s registration or at least before the submission of the claims. It is very important to know the patient’s correct Insurance to avoid COB denials or denials related to coverage.

Accumed RCM ensures to check every patient’s eligibility and benefits once the patient scheduling is done by the office.

This is the most crucial process of the RCM cycle. Using the right ICD and CPT codes are the key for better reimbursements. Some payers follow their own guidelines and others follow the CMS guidelines. Coding plays a very vital role and it is apparent that most of the denials from the insurances are related to coding.

Saying this, only professional and AAPC certified coders are recommended to do the appropriate coding. Precise coding and review would make a claim to stand in better chances of getting reimbursed.

Accumed RCM coders are professional and certified AAPC coders, who are specialized in end to end coding with ICD 10 protocols. We have coders specialized in all the specialties like cardiology, Pediatrics, Nephrology to name a few.

Additionally a thorough audit check is done on coding protocols and guidelines before the claims are disbursed to the payers. We always strive on getting 0% coding related denials.

99 % of the Claims submissions are electronic and submission of claims with in the TAT prompts easy and faster payments.

Accumed RCM adheres a TAT of 24 hours max for the submission of claims from the completion of the coding process. We believe in 100% of electronic claim submissions. This helps the clients to get the claims processed in ASAP and results in quicker payments.

The EDI enrollment set up is taken care by us for electronic claim submissions and ERA and EFT’s. This helps the complete Billing cycle to be more efficient and hassle free.

Payments can be received through different modes. Most common and easiest way to receive the payments is through ERA (Electronic Remittance Advice) received through clearing house. Once the payments are sent through EFT to client’s bank account, the ERA’s with the payment details will be sent to clearing house.

The other modes of payments are through checks sent through mail to the clients address and sometimes even virtual CC payments are made.

We post the ERA payments in EMR within a TAT of 24 hours received in the clearing house or from the client’s end. Every day the payment totals will be reconciled depending on the client’s requirement. A 100% audit will be performed on the payment posting to make sure that the payments are allocated to the right patient accounts with no errors.

Check payments will be posted in the EMR after verifying with the client. Once the payments are posted all the denied claims from the ERA/EOB will be allocated to the denial management team to work on priority.

The total payments will be reconciled with the client’s bank account every month end before the month close.

On an average 17 to 25% claims are denied by the payers. Denials are definitely preventable and submitting clean claims is the only solution to avoid denials.

Denials can be segregated in two ways, preventable and non-preventable. Most of the denial are preventable. Some of the common and frequent denials that could be prevented are related to Coding, Coverage and Additional Information. Denials vary from specialty to specialty.

We have a dedicated experienced team to work on the denied claims. We just don’t focus on working the denials, our goal is to identify the root cause of the denials and prevent them in future. Our Tat to work on denials is 48 hours from the ERA/EOB received from the payer.

Denials monitoring and working the denials with in TAT is very crucial. The delay in working on denials may cause delay in payments and claims are at higher risk for Timely filing.

Appeals, any denied claims which requires to be appealed will be appealed by our team and the appropriate follow-ups will be done on the appeals sent periodically.

This process in considered to be one of most prominent and crucial process in the RCM cycle. Once the claims are submitted, the client can expect the payments to be in their accounts anywhere between 7 to 30 days from the claim submission.

25 to 30 % of the claims end up with no responses from the payer (basically no ERA’s or EOB’s received). In this scenario AR team specialists will work with the payers to get the updated statuses on the claims with no response. Most of the times claims would have been processed and EOB’s would have been sent but unfortunately the EOB’s don’t reach the client on time.

In other scenario the claims would get pended by the payer for some additional information either from the provider’s end or the patient.

Our teams ensure that all the claims with no responses are followed up from 15th day from the submission to ensure no claim is left with no statuses.

Appeals, any denied claims which requires to be appealed will be appealed by our team and the appropriate follow-ups will be done on the appeals sent periodically.

Patient statements will be sent to the patients for the balances they owe the client. The statement period/interval can be as per the client’s requirement.

Collections:
Any bad debt accounts will be reviewed and a list of account will be sent to the client on a regular basis to determine whether the accounts can be moved to the collections process.

Patient statements will be sent to the patients for the balances they owe the client. The statement period/interval can be as per the client’s requirement.

Collections:
Any bad debt accounts will be reviewed and a list of account will be sent to the client on a regular basis to determine whether the accounts can be moved to the collections process.