Healthcare RCM is a financial process utilized by US-based healthcare systems to track the revenue received from their patients from appointment scheduling to the final payment of medical bills. Healthcare RCM companies track the journey of a patient that is described through a cycle of encounters from admission to adjustments of accounts receivables.
Healthcare RCM process is the strategy used by healthcare provider companies to save their time and money. Healthcare revenue cycle solutions help to streamline the medical practice’s financial side to get more money per patients with lesser efforts in a shorter time. Healthcare revenue cycle management companies leverage healthcare RCM solutions to eliminate the traditional system, enhance revenue margins and prepare for value-based payments by examining possibilities across the complete revenue cycle.
The common bottlenecks which might slow down your business growth
Huge number of billing and coding errors that increase the number of claim denials.
Failure to monitor the entire claims management process to understand and solve errors instantly.
Failure to maintain necessary HIPAA and HL7 compliance and protecting the patient's data from a breach.
Manual, paper-based medical billing process affecting the revenue collections of a care provider organization.
Slower and inaccurate claims scrubbing process increasing the number of claim denials.
Lower interoperability of multiple legacy health systems that helps the seamless transfer of data.
Optimizing your everyday collections with advanced healthcare revenue cycle solutions.
Healthcare RCM services ensure healthcare practices gain an optimal return on their investment. A full suite of healthcare revenue cycle software helps healthcare providers by streamlining healthcare RCM process. Revenue cycle healthcare needs constant monitoring to enhance reimbursement cycle and optimize patient-to-payment course.
Rather than healthcare RCM outsourcing, building your own customized healthcare revenue cycle management software proves beneficial. OSP has hands-on experience in building healthcare RCM software solutions that help in providing seamless revenue flow, enforce accurate policies, deploy time-sensitive bandwidth, facilitate compliance with regulations and reduce claim denials. Our solution for revenue cycle in healthcare can alleviate the labor-intensive manual tasks such as filing claims, working unpaid claims, exclusions, filing appeals, payment posting, secondary insurance claim filing, patient billing, etc.
As per the study by the American Medical Association (AMA), almost $15,000 per year is spent on investigating, reviewing and reworking the denied healthcare claims. Patient’s insurance eligibility issues are one of the most common reasons for claim denials. Insurance eligibility verification is the process of checking a patient’s health coverage and insurance eligibility to know the patient’s capacity to avail healthcare treatments and consultations.
Our healthcare RCM services are customized with advanced patient insurance eligibility verification module. It helps providers to track the insurance eligibility in real-time for all private health plans, Medicaid and Medicare. To streamline healthcare revenue cycle management, we can include claims scrubbing module to identify errors in CMS1500 submissions. With custom healthcare RCM, a payer rule engine in compliance with HIPAA and health plan guidelines is made possible. Our healthcare revenue cycle management services help to automatically verify procedure-specific coverage, perks, and all out-of-pocket costs.
RCM patient management software solutions are a collection of software systems that help to track the patient’s information medical diagnoses, prescriptions, interactions and encounters within healthcare organizations. We smartly integrate various patient management modules in healthcare RCM such as EHR/EMR, medical scheduling, practice management system (PMS), patient encounters and more.
OSP can build healthcare revenue cycle solutions that combine next-gen PMS systems that automate the routine processes such as patient flow management and helps healthcare providers to minimize their administrative expenses. A healthcare revenue cycle optimization can streamline all elements of a provider setting including recordkeeping, charting, medical appointment scheduling, billing, and claims processing functions. Our healthcare revenue cycle services simplify day-to-day operations with automated process management and timely patient care.
Medical billing is the system of submitting and following up on medical claims with healthcare payers to get reimbursed for treatments provided by a healthcare provider. OSP’ healthcare RCM services incorporate medical billing systems, developed with point-of-care care processing to support in-house billing process efficiently. The healthcare revenue cycle solutions can manage copays, deductibles, and coinsurance with smarter account reconciliation with patients via next-gen online payment portals.
Our medical billing services offer end-to-end healthcare revenue cycle optimization that automates follow-up requests for delayed as well as underpaid reimbursements. Our integrated healthcare revenue cycle management services can combine audit tracking software to archive every transaction in a simplified database. We eliminate revenue leakages by streamlining your entire healthcare revenue cycle workflow from eligibility verification, to check in, and co-pay collection to help you optimize revenue collection.
Medical coding is the process of translating the medical diagnosis, procedures, treatments, and equipment into ICD-10 codes to simplify the billing process. Our customized healthcare revenue cycle software can be integrated with EHR/EMR to pre-populate superbills with accurate ICD-10 and CPT codings following CMS.
The traditional manual medical coding process is labor-intensive, expensive, and prone to errors. We provide automated medical coding software solutions that are in line with ICD-10 and CPT codings. OSP’ healthcare revenue cycle management services include high-quality medical coding solutions for all medical specialties, subspecialties, and telehealth. Our tailored healthcare RCM software ensures minimum coding errors and claims denials with highly accurate and prompt medical coding services.
A revenue cycle for healthcare without advanced reporting module may have hidden problems that may grow worse with the time. Most healthcare revenue cycle management companies fail to focus on reporting that have long-term adverse effects on medical practice. OSP can build a made-to-order healthcare revenue cycle analytics that has custom reports, including financial data, management information and key performance metrics to see if your business is meeting benchmarks.
Our healthcare revenue cycle analysis solutions are capable of analyzing clinical and financial data from the data repositories, practice management systems, hospital information systems, medical billing systems and more. With in-depth healthcare revenue cycle analysis, you can find missed revenue opportunities, common coding errors, inadequate patient data capture, poor patient engagement and more. The healthcare revenue cycle analytics ensures intuitive data visualizations to understand the reports quickly.
The goal of a healthcare claim management organization in California is to replace paper-based claims processing with an advanced automated billing & claims management system. The system required to be used across a broad-spectrum including doctors, nurse practitioners, and payers to manage the dental patient.
The challenge was to bring various individuals involved in the dental claim management process from a community center, dental health providers, medical coder & biller to payer and government under the same roof.
The solution comes with-
A comprehensive web-based claim management solution was customized for FQHCs to reorganize the claim process workflow from dental health providers to government payers.
With granular-level user roles and reimbursement management, the feature-packed platform offers maximum confidential data security controlled by HIPAA regulations.
Using ICD-10 & CDT code, dentists can easily file a claim that decreases the claims denial ratio from billing reviewers and get paid on the same working day.
A US-based clearinghouse, managing millions of claims amounts every day, wanted to go paperless with an automated claim management software solution. They had a medical billing system connected to VersaForm practice management system that helps them to manage billing and claim data.
The need of the hour is to replace existing Microsoft Access based application with a web-based system hosted on the cloud server that can be accessed from anywhere, anytime.
The solution comes with-
A web-based software system that uses Versaform integration to support multi-specialty EHR for easy medical billing management for our client.
A solution that helps to manage the billing process and connects multiple provider EHR & Payer systems.
HIPAA-guided EDI solution that offers system connectivity and quick electronic data exchange to reduce claim denied ratio.
With claim audits, remittance, and secondary claim processes, the system proves to be an end-to-end software solution.
A Texas-based mental health center wanted to reinvent the medical billing process and enhance approval rates which were 10% against 100 claims submitted.
It was challenging to manage multiple insurance providers for a large clinic set up for a health specialty that needs flexibility in billing, workflow automation, accurate claim scrubbing, and fill regulatory compliance gap.
The solution comes with-
A web-based claim scrubber to check claim accuracy against hundreds of medical billing and coding requirements. A detailed report can be added to prevent future billing mistakes.
An easy way to enter procedure codes, modifiers, and bundled codes with the ability to create a streamlined list of CPT and ICD-10 codes.
Support legal forms such as HIPAA forms, HCFA-1500, Assignment of Benefits.
Ability to create appeal letter for denials, electronic remittance support for bulk check posting, automatic deposit of reimbursements, and electronic EOB.
A large physician practice in the US wanted to bring together advanced revenue management for its healthcare providers, clinicians, and patients. Our client wanted to manage claim backlogs, modernize back office operations, and enhance transparency in billing.
OSP built a revenue cycle management solution that ensures ease out billing processes while ensuring HIPAA & PCI compliance to Strong SSL certification.
The solution comes with-
Interfacing with multiple EHR systems with real-time patient pre-visit validation to increase up-front revenue collections.
Smart revenue cycle management with self-pay, deductibles, payment plan, copay or Medicaid/Medicare.
Separate dashboards for each payer with automated claim process and payment adjudication.
Claims denial module to improve payment recovery, up to date appeals, and rectify denial causes.
A US-based billing company wanted to build an automated and cloud-based claim review system to identify claim errors. The enhance accuracy of the adjudicated claims and avoid long turn-around time was the ned of the hour.
Patient authorization, Pokitdot APIs, and claim scrubbing module based on AETNA guidelines helped them to enhance the claim processing workflow.
The solution comes with-
An automated post-payment claims review model to ensure the accuracy of their claims.
Claims scrubbing tool to verify claims against specified AETNA guidelines, CDC and NCCI guidelines.
100% error-free Explanation of Review (EOR) form in PDF format to notify the errors in the submitted claim.
Reduction in time required for the entire claim reviewing process and turnaround time for error rectification.
A US-based client wanted a solution to get medical claim status for faster reimbursements and efficient analysis. The need was to replace manual paper-based claim data management system to a single and shared interface to track the rejected claims and documents automatically.
OSP offered an advanced application to manage the patient’s claim information in real time while maintaining the HIPAA compliance backed by AWS cloud hosting.
The solution comes with-
A web application to allow uploading the status of the outstanding claim, timely alerts of respective claims to the providers, upload document, add feedback or update status.
Upload ‘Claim Follow up Report’ and manage claims data in a different manner to reduce claims denials.
Reminder algorithm to alert doctors of their respective claims and required actions.
Quicker claim processing with a reduction in claim errors and reduced costs around claim status verification.
Payment posting is a critical step of the healthcare revenue cycle as it results in lesser delays in the A/R’s, ultimately improving the revenue collection and patient satisfaction. Our healthcare RCM ensures high-quality and accurate payment posting using electronic remittance reports. With advanced remittance analysis the insurance underpayments, overpayments, and denials can be analyzed. OSP' healthcare RCM ensures the capture of kick-outs and exceptions for payment reconciliation and helps to take instant actions to rectify inaccurately processed insurance payments.
OSP helps to recover underpaid insurances which are usually lost by healthcare providers when third-party payers underpay in the name of contractual adjustments. Our healthcare revenue cycle management services have the potential to identify and correct insurance underpayments, incorrect adjustments and zero payments from third-party payers. It is made possible with automated analysis of payment reports and by comparing remittances to the fee schedule and contracts. You can form a corrective course of action by discovering common claim errors leading to underpayments.
Accounts Receivable or A/R services help to ensure that the unpaid claims of provider practices are readily addressed. Being among the experienced healthcare RCM companies, OSP help providers to avoid long receivable cycles that delay reimbursements, destabilize cash flow, frustrate billing, and financial management. Our healthcare RCM process creates a systematic and stringent follow-up process that is based on the rule building system to avoid AR inflation. Timely claim submission and follow-ups ensure accurate reimbursement of claims.
We follow every government's regulatory mandate and create solutions that adhere to strict protocols.
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